Sample_Change_Order.pdf
PDF 73 KB Posted
- Attached to
- FY 2024 Pavement Preservation Package 1
- Solicitation number
- 23-0831-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is a Sample Change Order template from the Pinellas County Purchasing Department in Clearwater, Florida, designed to facilitate modifications to existing contracts. The template provides a standardized format for documenting changes to agreement terms, including additions, deletions, and adjustments to the total contract value. When executed, the change order serves as a comprehensive record of agreed-upon modifications, with spaces for fiscal number, change order number, account number, and detailed financial adjustments.
The change order includes critical legal provisions that waive contractor claims for additional time or compensation for activities prior to the change order's execution. It explicitly states that the authorized payment represents full compensation for labor, materials, incidental expenses, overhead, profit, impact costs, and associated time. 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 multi-level approval and documentation 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
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