Sample_Change_Order.pdf
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- Attached to
- Bridge Structures-Fixed Concrete, Maintenance and Minor Repair_Structures_Pedestrian Bridges_Box Culverts
- Solicitation number
- 24-0211-ITB-C
- Issued by
- Pinellas County, 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. The template provides a standardized format for recording changes to contract terms, including financial adjustments such as additions or deletions to the total agreement amount. The change order includes spaces for fiscal number, change order number, account number, and sections to detail the financial modifications.
The document serves as a procedural instrument that allows for contractual amendments while explicitly stating that the contractor's execution of the change order constitutes a waiver of additional time or compensation claims related to the changes. The change order requires multiple authorized signatures, including representatives from the contractor, Pinellas County Board of County Commissioners, the County Attorney's office, and the Clerk's office, ensuring formal governance and accountability in contract modifications.
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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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