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HomeMy WebLinkAbout2017-024-E AMS - ASD-Asphalt Services On Demand - CO to 2016-576-E for repaving parking lot at Skills Developmen lope ID: F4E9815A-D9D2-4217-83BE-B882B3C57138 ORANGE COUNTY CHANGE ORDER REQUEST NORTH CAROLINA Date: January 12, 2017 Project: Skills Development Parking (61370035-880000-30029) Change Order No. 1 Department: AMS Department Address: 131 W. Maragret Lane, Hillsborough Project: Skills Development Parking Lot (61370035-880000-30029) Contractor: Asphalt Services on Demand (64082) Contractor Address: 959 Short Journey Road, Smithfield NC 27577 Effective date of original contract: November 03, 2016 This change order® increases ❑ decreases the contract time by 15 days. Check here if no impact to contract time '''. Will this change order impact the date of substantial completion? ® Yes ❑ No. If yes, the amended date of substantial completion is: February 10, 2017 Full Description of Change: Undercut 6" of the existing soil, remove soil from site, deliver to landfill, backfill area with fabric and ABC stone. Reason for Change: The existing soil is saturated with water and is no long compactable Original contract sum: $ 100,702.50 Contract sum prior to this change order: $ 100,702.50 Amount of this change order: $ 5,580.00 Total sum of the contract including this change order: $ 106,282.50 This change order is executed to amend the contract time and/or contract sum. It shall not be construed to impact the original contract, project, services, or work in any other manner. Apprpmed and executed this 16th day of January zQ ,7„y (iNtAAALII, E5ok,kAt.Ramomurstt �o kb-Rammerstui s9 ednv us A59,17a4s/ Contractor Owner Architect(when retained) By: Project Manager By: county Manager By: Principal Revised 6/16 DocuSign Envelope ID: F4E9815A-D9D2-4217-83BE-B882B3C57138 Change Order Request REVISED ., �� Skills Development Center P L SERVACES c Undercut 6"Haul off/Backfill w/Fabric&ABC 959 Short Journey Rd Smithfiel,NC 27757 919-524-1979 OWNER-GC/CONTACT PROJECT/DESCRIPTION OWNER: Asset Management, Orange County Skills Development Center AU: Michael L. Hammersley, PE CRA 222 Cloister Court Chapel Hill, NC 27514 PO# Date CO# Page Plan Date P.O. 1700984-00 11/11/16 1 1700984-00 DATE DESCRIPTION OF WORK PERFORMED QTY. Unit RATE AMOUNT Undercut 6"Haul off/Backfill w/Fabric&ABC 185.00 TN $ 60.00 $ 11,100.00 We appreciate your business. Total $ 11,100.00 DocuSign Envelope ID: F4E9815A-D9D2-4217-83BE-B882B3C57138 ---- -� ASPHA-1 OP ID: DO '4"4C ---- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/4....---- 10/12/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER NAMEACT Danielle Ohlendorf Pittman Insurance Group, LLC PHONE FAX 5838 Faringdon Place (NC,No,Ext):919-878-8028 (NC,No): 919-876-4567 Raleigh,NC 27609 ADDRESS: danielle@pittmaninsurancegroupllc.com Hasten McDermott INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NW Mutual Fire Insurance Co. 23779 INSURED Asphalt Services on Demand INSURER B:Accident Fund Insurance Co of 10166 959 Short Journey Road Smithfield,NC 27577-8266 INSURER C Selective Insurance Co.of Ame 12572 INSURER D:Mt. Hawley 37974 INSURER E:NW Mutual Insurance Company 23787 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ACP3017155310 06/21/2016 06/21/2017 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ � CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X MT LOC $ JEC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 (Ea accident) $ , , C X ANY AUTO S2218622 04/13/2016 04/13/2017 BODILY INJURY(Per person) $ X ALL NED X SCHEDULED BODILY INJURY(Per accident) $ AUTOOS W AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS JPER ACCIDENT) $ X UMBRELLA LIAB )( OCCUR EACH OCCURRENCE $ 4,000,000 D EXCESS LIAB CLAIMS-MADE EMX0321560 04/14/2016 04/14/2017 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE WCV 611323100 06/21/2016 06/21/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Inland Marine ACP3017155310 06/21/2016 06/21/2017 Limit 970,522 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD