Sample_Change_Order.pdf
PDF 73 KB Posted
- Solicitation number
- 24-0470-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is a sample change order template from the Pinellas County Purchasing Department in Clearwater, Florida, designed to formally document modifications to an existing contract or agreement. The template provides a standardized format for recording changes to the total agreement amount, including potential additions or deletions, with spaces to specify fiscal number, change order number, and account number.
The change order template includes important legal provisions, notably that the contractor's execution of the change order constitutes a waiver of any additional time or compensation claims for activities prior to the change order's execution. The document requires signatures from multiple parties, including an investigator, Director of Purchasing, County Attorney, Board of County Commissioners Chairman, County Clerk, and the contractor, ensuring a comprehensive and official record of the contract modification. While this is a generic template, it appears related to an ARPA-funded project involving EV charging infrastructure installation for diesel/electric bucket trucks at 22211 US Highway 19 in Clearwater, Florida.
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Text version
APPENDIX 2 – SAMPLE CHANGE ORDER
APPENDIX 2 – SAMPLE CHANGE ORDER
SAMPLE CHANGE ORDER
PINELLAS COUNTY PURCHASING DEPARTMENT
CLEARWATER, FLORIDA
FISCAL NO. CHANGE ORDER NO.
ACCOUNT NO.
TO Total Agreement $
FOR Addition $
IN CONNECTION WITH New Total $
Deletion $
New Total Agreement $
Execution by the contractor of this Change Order shall be considered a waiver of all claims or request for additional time or compensation for any activities prior to time of execution related to items included in the Change Order. The contractor also acknowledges that payment authorized by this Change Order represents full and complete compensation for labor, materials, incidental expenses, overhead profit, impact cost, and time associated with this Work. Claim procedures are outlined in the Contract documents.
Investigator
Director of Purchasing APPROVED AS TO FORM: Accepted this day of
OFFICE OF COUNTY ATTORNEY 20
By PINELLAS COUNTY Attorney BOARD OF COUNTY COMMISSIONERS
By Chairman
Attest: KEN BURKE, CLERK By
Deputy Clerk
Use Authorized Signatures Only Company
By Title
Witness
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