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Home My WebLink About2018-803-E AMS - Phoenix Fire Smoke Detection System Eno Fire Change RequestRevised 10/17 ORANGE COUNTY CHANGE ORDER REQUE NORTH CAROLINA ___________________________________________________________________________________________________ Date: 12/5/2018 Project: ES - Sprinkler System at ENO Fire Dept and EMS Station 1 Change Department: Emergency Services Department Address: 510 Meadowlands Drive, Hillsborough NC 27278 Pr Contractor: Phoenix Fire Protection, Inc. Contractor Address: 2857 Lee Ave., Sanford NC 27332 Effective original contract: September 12, 2017 This change order increases decreases the contract time by 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 subs completion is: ___________________________________________________________________________________________________ Full Description of Change: This change request is to add interconnected smoke detection system to the sleeping quarters the previously approved and installed sprinkler system at the Eno Fire Department as required by the Orange County Fire Building Inspections Department Reason for Change: This change is to add the smoke detection system that was not included as a portion of the base scop was change was requested by the inspections department after the base contract was awarded. ___________________________________________________________________________________________________ Original contract sum: $ 39,055.00 Contract sum prior to this change order: $ 39,055.00 Amount of this change order: $ 3,633.00 Total sum of the contract including this change order: $ 42,688.00 ___________________________________________________________________________________________________ This change order is executed to amend the contract time and/or contract sum. It shall not be construed to impact the o project, services, or work in any other manner. Approved and executed this 5th day of December, 2018. _______________________________ _____________________________ ____________________ Contractor Owner Architect (when retained By:____________________________ By:___________________________ By:__________________ DocuSign Envelope ID: 4069CA99-5827-45B2-BE9F-9A0110C81475 DocuSign Envelope ID:4069CA99-5827-45B2-BE9F-9A011OC81475 A" CERTIFICATE OF LIABILITY' INSURANCE DATE05101/018 0510,/2018 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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED Provisions or be endorsed. It 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 PRODUCER CONTACT NAME• LLLENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O.BOX 32$ PHONE,No Exl:888-233-4949 A C No:507-446-4664 OVVATONNA,MN 55060 A DRESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS)AFFORDING COVERAGE NAIL# INSURER A:FEDERATED MUTUAL.INSURANCE COMPANY 13935 INSURED 157-075-3 INSURER B: PHOENIX FIRE PROTECTION INC INSURER C., 2863 LEE AVE SANFORD,NC 27332-6205 INSURER D: INSURER E: INSURER R COVERAGES CERTIFICATE NUMBER:80 REVISION NUMBER.0 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 DL SUBR POLICY NUMBER POLICY Err POLICY FXF LIMITS LTR INSR WVO MJDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 ED CLAIMS-MADE �OCCUR Pl ISES Ea oc urr nce $10Q,000 MED EXP(Any one person) EXCLUDED A N N 6057280 04/22/2018 04122/2019 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO LOC JECT PRODUCTS-COMPJOP AGO $2,000,000 X OTHER: AUTOMOBILE LIABILITY 'COMBINED SINGLE LIMIT $1,000,000 Eaac'e I X ANY AUTO BODILY INJURY(Perperson) OWNED AUTOS ONLY SCHEDULED A AUTOS N N 6057280 04l221201$ 04l2212413 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY p e r X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAR CLAIMS-MADE N N 61057281 04/22/2018 04/22/2019 AGGREGATE $5,000,000 DED RETENTION WORKERS COMPENSATION X PER STATUTE I OER AND EMPLOYERS'LIABILITY Y f N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 A OFFICERJMEMBER EXCLUDED? NIA N 6057284 04/22/2018 04/22/2019 E.L DISEASE-EA EMPLOYE E $1,000,000 (Mandatory In NH) If yes,describe under E.L DISEASE•POLICY LIMIT DESCRIPTION OF OPERATIONS below $1,000,000 DESCRIPTION OF OPERATIONS J LOCATIONS J VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is requiredl POLICY COVERAGE AS OF 04/29/2.018 MAY 20118 CERTIFICATE HOLDER CANCELLATION 151-075-3 800 ORANGE COUNTY ASSET MANGEMENT SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 131 W MARGARET LN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILLSBOROUGH, NC 27278-2547 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 1908-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD