Sample_Change_Order.pdf

PDF 73 KB Posted

Attached to
Countywide Mast Arms - Group 3 (PID 004183A)
Solicitation number
23-1147-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 for documenting modifications to an existing contract. The template provides a standardized format for recording changes to the total agreement amount, including potential additions or deletions, with designated spaces for fiscal number, change order number, and account number.

The change order includes critical legal provisions that stipulate when a contractor executes this document, they waive claims for additional time or compensation related to activities prior to execution. The document also confirms that any payment authorized represents full compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and associated work time. The template requires signatures from multiple parties, including an Investigator, Director of Purchasing, County Attorney, County Commissioners, Clerk, and the contracting company, ensuring comprehensive administrative review and approval of any 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

File details come from the government source that posted it. Updated .