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HomeMy WebLinkAbout2019-191-E AMS - HM Kern Corporation Passmore Center contract amendment DocuSign Envelope ID:EEC95C86-425F-4B19-8B7B-D793E7A74AE5 ORANGECOUNTY CHANGE ORDER REQUEST NORTH CAROLINA Date:9/24/2018 Project: Passmore Center Expansion Change Order No. 1 Department:AMS Department Address: 131 W.Margaret Lane, Hillsborough,NC 27278 Project: Passmore Center Expansion Contractor: H.M.Kern Contractor Address:160 Thatcher Road,Greensboro,NC 27419 Effective date of original contract: 1/23/2018 This change order❑ increases❑decreases the contract time by days. Check here if no impact to contract time Z. Will this change order impact the date of substantial completion?❑ Yes❑ No. If yes,the amended date of substantial completion is: October 15,2018 Full Description of Change:This change order is to increase the original contract value to include items that were changes to the scope of work,or adds per the tentants.See the attached project description of changes for full details. Reason for Change: See the attached project description of changes for full details. Original contract sum: $494,820.00 Contract sum prior to this change order: $494,820.00 Amount of this change order: $15,138.00 Total sum of the contract including this change order: $509,958.00 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. Aoogoved and executed this 24th day of September,.2018. ON-N lvEhv. 3/20/2019 E�aw'+t}}0'w'Ht, 3/26/2019 3/20/2019 Contractor Owner Architect(when retained) By:project Manager gy:county Manager By: Associate Revised 10/17 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 ORANGE COUNTY NORTH CAROLINA Asset Management Services Date: September 24, 2018 Project: Passmore Center Expansion This contract amendment is to increase the contract amount by$15,138.00 Background: In January, 2018 H.M. Kern was awarded a contract for the expansion to the Passmore Center. The expansion is to add an additional 1050 square foot living room space, with a new entry vestibule with sliding doors. During the initial stages of awarding the base contract there was a list of items taken out of the contract for Value Engineering (VE) to reduce the overall budget. These VE items were: 1. Credit for roofing membrane change. 2. Credit for using a different awning supplier/manufacturer versus the one called out on the plans. 3. Credit to reduce the underground storm piping. 4. Credit for owner supplying the temporary power for the construction. 5. Credit to change the interior and exterior lighting. 6. Credit to reduce the number of windows installed (2). 7. Credit to remove the foundation drains. 8. Credit for using MC Cable versus conduit where allowed by code. The total credits accepted with the VE items was: ($29,880.00) Change Order Description: This change order is for multiple changes to this project. These changes include the following: 1. Remove all carpet from the scope of work, and replace the carpet with LVT flooring. 2. Provide and install (2)windows and (2) blinds that were originally removed from the scope per customer request. 3. Provide and install French drain system to handle the storm water for the new addition. This French drain system shall replace the foundation drains, and the underground storm water piping that was removed as a part of the VE process. 4. Provide and install (1) exterior hose bib on west wall at door. Demo existing hose bib and install '/4" ice maker box in same location, and install (1) GFCI electrical outlet above coffee bar on existing circuit. 5. Remove the existing building signage letters and replace due to new addition cover the existing letters. 6. Upgrade the surface on the coffee bar to be a solid surface. 7. Modify existing desk drawers to ensure hanging file folders can be filed within the drawers. P.O. Box 8181 * 131 West Margaret Lane,3rd Floor* Hillsborough, North Carolina 27278 Telephone:919 245-2625 Fax:919-644-3001 E-mail:AMService@orangecountync.gov DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 Passmore Expansion Change Request Descriptions&Details Change Order Line Item Cost: This change order is for multiple changes to this project. These cost for these changes are as follows: 1. $157.00 2. $5,179.00 3. $6,663.00 4. $826.00 5. $1,135.00 6. $482.00 7. $696.00 Explanation for Change by Line Item: 1. The customer requested to change the carpet to LVT flooring. This would allow for ease of maintaining the floor, and keeping the floors cleaner and for longer periods of time. 2. As a part of the value engineering process, we removed two windows and blinds from the scope of work. The customer's decided as the walls were being installed that they wanted to install these two windows so that their clients could enjoy the scenery and also the staff could see the patio and anyone who would be on the patio. The Friends of the Passmore Center issued a check to Orange County in the amount of$4,200.00 to cover the cost for installing the two windows. The additional $979.00 is to purchase and install blinds for the windows. 3. As a part of the value engineering process, the underground storm drain system was removed from the scope of work. This included taking up the pavement across the parking lot over to the pond, then installing storm drainage, then replacing the pavement. The revised solution for the storm drainage included roof leaders to a French drain system. This design provides the required storm drainage needed to meet code requirements. 4. As a part of the original design it was requested by the customer to relocate the existing hose bib to the exterior of the expanded portion of the building. This hose bib is needed for the gardens, cleaning the patio, etc... The drawings did not include any relocation or reuse of the existing hose bib. The customer requested that we continue with installing a water source at the coffee bar for a coffee machine, and the exterior hose bib as originally requested. 5. The building letters "Jerry M. Passmore" was located directly within the area the expansion roof and walls were installed. This change is to relocate those letters and to center them within the remaining open portion of the northwest end of the building in order to reuse the existing letters. 6. The customer requested to create the coffee bar with a solid surface to match the new receptionist desk. The original design was for the coffee bar to be a laminate top. The customer wants the coffee bar to be the same color and materials used at the receptionist desk. 7. This item is to change the bottom file drawers on the receptionist station to allow hanging file folders to fit. Currently the drawers are two small to allow for a hanging file folder. The customer has requested for this modification to be made due to their file storage needs. DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 Passmore Expansion Change Request Descriptions&Details This contract amendment is to increase the contract amount by $15,138.00 Professional Services: $52,973 Construction Services: $494,820 Total Project Costs: $547,793 (Before Change Amendment) Change Amendment Cost: $15,138 Total Project Cost: $562,931 (Including Change Amendment) Remaining Project Funds: $0.00 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. KERN CORPORATION 160 THATCHER ROAD PO BOX 19424 GREENSBORO, NC 27419 (336) 668-3213 FAX: (336) 668-2142 PROPOSED CHANGE ORDER PCO-2 TO: CRA Associates 222 CLOISTER COURT CHAPEL HILL, NC 27514 ATTENTION: Mr. Ken Smith REFERENCE: Jerry Passmore Center SUBJECT: LVT Flooring IN ACCORDANCE WITH OUR CONTRACT, WE PROPOSE A CHANGE ORDER IN THE AMOUNT OF ONE HUNDRED, AND FIFTY SEVEN DOLLARS. $157.00 FOR THE FOLLOWING CONDITION: This PCO would delete all carpet from floor finishes. LVT would be installed in place of carpet. PRICE GOOD FOR FOURTEEN (14) DAYS. TOTAL COST: $157.00 Total Impact Days NIA PLEASE CALL WITH ANY QUESTIONS. ORIGINATED BY: ACKNOWLEDGED BY: H.M. Kern Corporation CRA Associates SIGNED: L4SIGNED: BY: Justin Gr `des BY: Ken Smith DATE: March�2, 2018 DATE: DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-02 3/22/2018 Job#879 Jerry Passmore Center Flooring 668-3213(p 668-2142(f) Phase Description (fit unit unit Amount _ Labor: _ 20110 COORDINATION 21 HRS 35.00 70 0.00 0 0 0.001 D 0 0.00 -0 0 0.00 0 0 - J0.00 D 0 0.00 0 0 0.00� 0 0 0.001 0 Total Labor 70 Materials: 0 0.00; 0 01 0..00 0 0� 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00; 0 0 0.00. 0 0' 0.00 0 Total Materials 0 Equipment: -- ----- 0 .. 0.00 0 0 0.00 0 0 0.00 0 0 , 0.00 0 0 0.00 0 0` 0.00. 0 0 0.00� a Total Equipment 0 Subcontractors: 40951 Brock Con. Ser. (LVT) 1 LS 4534.92 4,535 40980 Brock Con. Ser. (CARPET) 1 LS 4493.89 -4,494 0 D.DO 0 0 0.001 0 0 0.0.0 0 Total Subcontractors 41 Total Labor, Materials & Equipment 70 Sales Tax(Materials & Equipment) 6.75% 0 291fi0 Labor Burden - 40% 28 Subtotal _ _ 98 89800'OH & Profit(Labor Materials_ & Equipment) 10% 10 Total Subcontractors -41 89800 OH & Profit (Subcontractors) 10% 4 Subtotal ---- - 153 62050;Performance & Pay ent Bond 2% 4 Total Proposed Change OrderL $157 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 Brock PH(919)570-1300 Request for Change Order contract FAX(9I9)570-1305 P.Q.BOX 33415 Attention: JASON KEPLEY services RALEIGH,NC 27636 Customer PO: s6714 P Strength • service spry c,tna atliyr Dale: 3/8/2018 Project#: 30357 Request#: I CO#: 0 63431 Manager: DAMON A BROCK Ship To JM PASSMORE FITUP .bill To HM KERN CORPORATION 103 MEADOWLANDS DRIVE IGREENSBORO,NC HILLSBOROUGH,NC Contacts JUSTIN GRAVES Contacts IASON KEPLEY Phone:(336)601-8672- Phone: Phone: Cell: Cell: Cell: Pager: Pager: Pager: Fax: Fax: Fax: Description of Change Order Request: DELETE CARPET,ADD RESILIENT Additional Information: DELETE CARPET,ADD RESILIENT DELETE ANUFACTU.RER: __ 7yLE; COLOR NAME: COLOR NUMBER: UOM: QUANTITY.• UNIT PRICE: TOTAL PRICE. 1 C-1 CARPET SUPPLIED AND INSTALLED- BROCK CONTRACT SERVICES MATERIAL AND LABOR TBD Sy (130.00) (34.568) (4,493.89) Total DELETE ($ 4,493.89) ADD­ MANUFACTURER;_ _ 7_YLE: _ COLOR_NAME: COLOR NUMBER: UOM: QUANTITY. UNIT PRICE: TOTr�C PRICE. 1 LW-1 LUXURY VINYL TILE SUPPLIED AND INSTALLED- ARMSTRONG 1PARRALLEL b"X 36" I2 MIL VINYL PLANK TBD SF 1,170.00 .1. 3.876 1 4,534.92 Total ADD S 4,534.92 Total This Option - Tax Included : S 41.03 SALESMAN$SIGNATURE CUSTOMER'S A UTHORIZATION 311212018 Job No:30357 !'age 1 of I DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. KERN CORPORATION 160 THATCHER ROAD PO BOX 19424 GREENSBORO, NC 27419 (336) 668-3213 FAX: (336) 668-2142 PROPOSED CHANGE ORDER PCO-3 TO: CRA Associates 222 CLOISTER COURT CHAPEL HILL, NC 27514 ATTENTION: Mr. Ken Smith REFERENCE: Jerry Passmore Center SUBJECT: VF Window add back. IN ACCORDANCE WITH OUR CONTRACT, WE PROPOSE A CHANGE ORDER IN THE AMOUNT OF FIVE THOUSAND, ONE HUNDRED, AND SEVENTY NINE DOLLARS. $5,179.00 FOR THE FOLLOWING CONDITION: Provide and install (2)windows, and (2) blinds removed from scope during VE. PRICE GOOD FOR FOURTEEN (14) DAYS. TOTAL COST: $5,179.00 Total Impact Days N/A PLEASE CALL WITH ANY QUESTIONS. ORIGINATED BY: ACKNOWLEDGED BY: H.M. Kern Corpor tion CRA Associates SIGNED: SIGNED: BY: Justin Grav s BY: Ken Smith DATE: May 5, 18 DATE: DocuSign Envelope ID:EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-03 5/2/2018 Job#879 Jerry Passmore Center Window add back. 668-3213(p 668-2142(o Phase Description [�yt unit unit Amount Labor: 20110 COORDINATION 2 HRS 35.00 70 0 0.00 0 0 0.00 0 0 0.00 0 0. U0 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 Total Labor 70 Materials: 0 0.00 0 0 0.00 0 0 0.00 0 0. 0.00 0 0 0.00 0 0 0-00 0 0 0.00 0 0. 0.00 0 0. 0.00 0 Total Materials 0 Equipment: 0 0.00 0 0 0,00. 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 Total Equipment 0 Subcontractors: 40880 The Glass Shop 1 LS 4200.00 4,200 41250 The Blindman 1 LS 300.00 300 0 0.00 0 0 0.00 0 0. 0.00 0 Total Subcontractors 4,500 Total Labor, Materials & Equipment 70 Sales Tax (Materials& Equipment) 6,75% 0 29160 Labor Burden 40% 28 Subtotal 98 89800 ❑H & Profit(Labor, Materials & Equipment) 10% 10 Total Subcontractors 4,500 89800 OH & Profit (Subcontractors) 10% 450 Subtotal 5,058 62050 Performance& Payment Bond 2% 121 Total Proposed Change Order $5,179 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. KERN CORPORATION 160 THATCHER ROAD PO BOX 19424 GREENSBORO, NC 27419 (336) 668-3213 FAX: (336) 668-2142 PROPOSED CHANGE ORDER PCO-04 TO: CRA Associates 222 CLOISTER COURT CHAPEL HILL, NC 27514 ATTENTION: Mr. Ken Smith REFERENCE: Jerry Passmore Center SUBJECT: FRENCH DRAIN IN ACCORDANCE WITH OUR CONTRACT, WE PROPOSE A CHANGE ORDER IN THE AMOUNT OF SIX THOUSAND, SIX HUNDRED,AND SIXTY THREE DOLLARS. $6,663.00 FOR THE FOLLOWING CONDITION: Provide materials, and install per drawing submitted by H M Kern. Canopy piping included. PRICE GOOD FOR FOURTEEN (14) DAYS. TOTAL COST: $6,663.00 PLEASE CALL WITH ANY QUESTIONS. Total Impact Days NIA ORIGINATED BY: ACKNOWLEDGED BY: H.M. Kern Corp ration CRA Associates SIGNED: SIGNED: BY: Justin Gra0es BY: Ken Smith DATE: June 018 DATE: DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-04 4/23/2018 Job # 879 Jerry Passrnore Center French ©rain 668-3213(p) 668-2142(f) Phase Description unit unit Amount Labor: 20110,000RDINATION 3� HRS `35.00 105 20181 CLEAN UP 3- HRS 25.00 75 20250,EXCAVATOR OPERATOR 8 HRS 35.00 280 20250 LOADER OPERATOR 8 HRS 35.00 280 20250 DITCH MAN 12 HR5 25.00 300 20250 PIPE INSTALL 6 HRS 25.00 150 20250 LABOR FOR CANOPY PIPING 6 HRS 25.00 150 0 -- 0.00 0 _.-_ � 0� o.oD D Total Labor 1,340 Materials: 0 EA 0.00 0 30180�LANDSCAPE FABRIC 1 LS 236.00 236 30250 18CY 57 Stone 2 EA 450.00 900 0.00 0 DIESE 30154 L FUEL �� .------_-. 24 i_ GAL 2.99 72 31500!PVC PIPING 1 LS 275.00 275 31550 CORRIGATED PIPING & CATCH BASINS 1. LS 240.00 2.40 0 0.00 0 0.00 0 Total Materials - - 1 723 _ Equipment: 10153 EXCAVATOR 1.25 DAY 440.0D 550 10153 LOADER 2 DAY 115.00 1,230 0, 0.00--­0 0 _ 0.00 0- 0. 0.00 0 0 0.00 0 0 0.00 0 Total Equipment 1 780 Subcontractors: 40250 18CY HAUL OFF _ 2 EA 150.00 add 0.00 0 0: 0.00 0 0 0.00 0 0 0.00 0 Total Subcontractors _ 300 Total Labor, Materials& Equipment 4,843 �__ _ Sales Tax(Materials & Equipment) -6.75% 236 29160'La bor Burden 40% 536 Subtota[ 5,615 89800 OH & Profit(Labor, Materials & Equipment) 10%; 562 Total Subcontractors _ 300 89800 OH & Profit (Subcontractors) 109. 30 _ . Subtotal _ 6 507 62050 Performance & Payment Bond 2% 156 Total Proposed Change Order $6,663 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H, M. KERN CORPORATION 160 THATCHER ROAD PO BOX 19424 GREENSBORO, NC 27419 (336) 668-3213 FAX: (336) 668-2142 PROPOSED CHANGE ORDER PCO-06 TO: CRA Associates 222 CLOISTER COURT CHAPEL HILL, NC 27514 ATTENTION: Mr. Ken Smith REFERENCE: Jerry Passmore Center SUBJECT: Additional Hose Bib/Outlet IN ACCORDANCE WITH OUR CONTRACT, WE PROPOSE A CHANGE ORDER IN THE AMOUNT OF EIGHT HUNDRED, AND TWENTY SIX DOLLARS. $826.00 FOR THE FOLLOWING CONDITION: Provide and install (1)exterior hose bib an west wall at door. Demo existing hose bib, and install %" ice maker box in same location. Add (1)outlet above coffee bar on existing circuit. PRICE GOOD FOR FOURTEEN (14) DAYS. TOTAL COST: $826.00 Total Impact Days NIA PLEASE CALL WITH ANY QUESTIONS. ORIGINATED BY: ACKNOWLEDGED BY: H.M. Kern Carp ation CRA Associates SIGNED: SIGNED: BY: Justin Gry., es BY: Ken Smith DATE: May 2J1, 2018 DATE: DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-06 5/21/2018 ,Job#879 Jerry Passmore Center Wall Hydrant 668-3213(p 668-2142(f) Phase Description gy# unit unit I Amount Labor: 20110 COORDINATION 2 HRS 35.00 70 0. 0.00 0 0 0.00. 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 Total Labor 70 Materials: 0 0.00 0 0 0.00 0 0 0.00. 0 0. 0.00 0 0. 0.00 0 0 0.00 0 0 0.00 0 0- 0.00 0 0 0.00 0 Total Materials 0 Equipment: 0 0.00 0 0 0.00 0 0 0.00 0 0. 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 Total Equipment 0 Subcontractors: 41500 JC PIEDMONT PLUMBING (ADD HOSE BIB) 1 LS 484.93 485 41500 JC PIEDMONT PLUMBING (CREDIT DEMO) 1 LS -100.00 -100 41500 JC PIEDMONT PLUMBING (ICE MAKER BOX) 1 LS 100.00 100 41600 C S James Ele 1 LS 150.00 150 0. 0.00 0 Total Subcontractors 635 Total Labor, Materials & Equipment 70 Sales Tax (Materials& Equipment) 6.75% 0 29160 Labor Burden 40% 28 Subtotal 98 89800 OH & Profit (Labor, Materials & Equipment) 10% 10 Total Subcontractors 635 89800 OH & Profit (Subcontractors) 10% 64 Subtotal 807 62050 Performance& Payment Bond 2% 19 Total Proposed Change Order $826 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 Justin Graves From: Trish McMillan <jcpiedplbg@gmail,com> Sent: Monday, May 21, 2018 2:31 PM To: Justin Graves Subject: Hillsborough Senior Center Change order Request to replace& relocate existing wall hydrant. Material....................................$214.93 Labor.. 3 hrs. @ 80.00 per hr....$240.00 TOTAL CO REQUEST.-...........$454.93 i DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-07 7/3/2018 Job#879 Jerry Passmore Center Remove&replace exterior signage 668-3213(p 668-2142(f) Phase Description f3yt unit Rniq Amount Labor-. 20110 COORDINATION 2 HRS 35.00 70 0 U0 0 0 0.00 0 0 0.00 0 0. 0.00 0 0. 0.00 0 0 0.00 0 0 0,00 0 Q. 0.00 0 Total Labor 70 Materials: 0 0,00. 0 0 0.00 0 0 0.00 0 0 0.00 0 0. 0.00 0 0. 0.00 0 0 0.00 0 Q 0.00. 0 0 0.00 0 Total Materials 0 Eauipment: 0 0.00- 0 0 0.00 0 0. 0-00 0 0. 0.00 0 0 0.00 0 0. 0.00 0 0 0,00 0 Total Equipment 0 Subcontractors: 60200 ADA SIGNS (EXTERIOR) 1 LS 909.49 909 0. 0,00 0 0 0.0Q 0 Q U0 0 0- 0.00. 0 Total Subcontractors 909 Total Labor, Materials & Equipment 70 Sales Tax (Materials& Equipment) 6.75% 0 29160 Labor Burden 40% 28 Subtotal 98 89800 OH & Profit(Labor, Materials& Equipment) 10% 10 Total Subcontractors 909 89800 OH & Profit(Subcontractors) 10% 91 Subtotal 1,108 62050 Performance& Payment Bond 2% 27 Total Proposed Change Order $1,135 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 � PROPOSAL 3185098NC (4.1) ie r AOA Signs,Inc. B ■ 214 E.CHERRY STREET (0- r>s YApKi'fVV1LCE,NC 27055 Project Manager:Joy Kay John Herring Email:JoyK@AOASrgns.com €sfinator- Ratigo.NC Mice:336-679-3344 (336)679.3344 ext.1076 Fax: 600-2824830 John@AOASom.com Cate: 612812018 WORK TO BE PERFORMED AT.* Jerry M. Passmore Center Addition & Renovation Hillsborough, NC Architect: CRA Associates We hereby propose to fumiah the materials and/or perform the labor necessary for the completion of Job Description: REMOVAL&REINSTALLATION OF EXISTING LETTERS QUANTITY UNIT COST TOTAL REMOVAL&REINSTALLATION OF EXISTING LETTERS 1 Installation Template AOA Signs,Inc.is a State Certified WBE Aim NOTES: -InstalitaWn Pricing Includes Removal and Reinstallation of Dimensional Characters Up to 15'Above Grade Material Total, $101.85 Installation Includes One(1)Mobilization Unless Otherwise Stated In this Proposal. Installation 5800.00 All material is guaranteed to be as specified.and the above work to be performed in Orange Co.Tax(7.m accordance with the dramngs and specifications submitted for above wok and completed in a Total Estimate i909.49 substantial workmanlike manner. Note-This proposal may be wdhdrawn Respectfully Submitted John Herring by us dnot accepted wiMin 60 days. any rz.ae n en+ao-wr o.r..caus W 59-. @d wy�nnrf n o dr.a wo bcom -fta carp.ow.rid a6om rn..snmaz. ax.p..m.m.cmunye u wa++rnk.s..coevnrr.a m.ys a.ywd ow rmpo m.cvnom. s nspon.id.to rr prm n.�u.mp.d.npner.rmawnps m m~& rs propan,of AOA 9011s wed cuear+04� F,.ndrad J...y M P—. o.o Ca..t­ DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-08 7/17/2018 .lob#879 Jerry Passmore Center Upgrade to Solid Surface on Coffee Bar 668-3213(p 668-2142(fi) Phase Description Q_�(t unit ypi �t.j Amount Labor: 20110 COORDINATION —� 2, _ T�- HRS 35.OQ 70 0 0.00 p 0 0.00 0 0 0.0Q' 0 01 0.00 0 0 - 0.00 0 01 0.001 0 0 0.00 0 _ 0 0.00 0 Tota l Labor 70 (Materials: 0 OA 0 01 0.00: 0 0 0.00�. 0 0 0.00! 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 0 0.001 0 Total Materials — 0 E ui meat: . 0 0.00 _0 TF 0 0.00 0 0 0.00 0 .� _0 0.00 0 0 0.001 0 0 a.010 0 ... Q o.00 .-0- Total Equipment — 0 Subcontractors: _40670 Carolina Heritage Cab 1 LS 330.00 330 o - —0.00. a 0 0.0M 0 0 0.00 0 - 0 0.00' 0 Total Subcontractors 330 Total Labor, Materials & Equipment 70 _ Sales Tax (Materials & Equipment) 6.75 0 29160 Labor Burden 40%! 28 Subtotal i 98 89800 OH & Profit (Labor Materials& Equipment) 10% 10 Total Subcontractors E-- 330 89800 OH & Profit(Subcontractors) 10% 33 Subtotal _ 471 620501 Performance & Payment Bond 2%I 11 Total Proposed Change Order $482 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 OCAR O LI NA 209 Elkin Hwy. H ERI'TA E North Wilkesboro, NC 28659 CABINETRY Office: (336) 818-1078 Fax: (336) 818-1079 Date: 6/27/2018 Project: Jerry M. Passmore Center Construction: Box: NIA Countertops: SS Version #: 1 Special Requirements: Change Order SCOPE OF WORK Carolina Heritage Cabinetry supplied work: Add (1) SS Top for coffee station, install. Pricing includes typical hardware, millwork and countertops listed above, delivery, installation and work described above totaling $330.03. This includes local and state taxes. Joe Hartzog Carolina Heritage Cabinetry ihI artzogftchcabinetry.com Office: (336) 927-0748 Kevin R. Howell Signature: Carolina Heritage Cabinetry khoweli(c_chcabinetry.com Print: Office: (336) 818-1078 "' DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 H. M. Kern Corporation PCO-09 9/12/2018 Job#879 Jerry Passmore Center Modify desk drawers for hanging files 668-3213(p 668-2142(f) Phase Description (sty unit unit S Amount Labor: 20110'COOROINATION 2 HRS 35.00 70 0 0.00 0 a 0.00 0 -01 1 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 _ o, 0.00 0 0 0.001 0 Total Labor 70 Materials: 0 0.00 0 0 0.00 0 0 0.00 0 01 0.00 0 01 0.00 0 0! 0.00 0 0 0.00 0 0 0.00 0 0 0.00 0 Total Materials 0 Equipment: 0 0.00 0 0 0.00 0 0 000 0 0 0.00 0 01 0.00 0 a 0.00 0 0 0.001 0 Total Equipment 0 Subcontractors: 40670 Carolina Heritage Cab 1 LS 520.00 520 0 0.00 0 0 0,00 0 0 0.00 0 0 0.00 0 Total Subcontractors 520 Total Labor, Materials & Equipment 70 'Sales Tax(Materials & Equipment) 6.75% 0 29160 Labor Burden 40% 2$ . Subtotal 98 89800 OH & Profit(Labor, Materials & Equipment) 10%, 10 Total Subcontractors 520 L62050 9800 OH & Profit(Subcontractors) 10% 52 Subtotal 680 'Performance & Payment Bond 2% - Total Proposed Change Order $696 Page 1 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 C_ARO L_I NA 209 Elkin Hwy. H_E R I T_AG_ E North Wilkesboro, NC 28659 CABINETRY Office: (336) 818-1078 Fax: (336) 818-1079 Date: 9/12/2018 Project: Jerry M. Passmore Center Construction: Box: NIA Countertops: NIA Version #: 1 Special Requirements: SCOPE OF WORK Carolina Heritage Cabinetry supplied work: Changing 2 drawers to file drawers, including delivery Pricing includes typical hardware, millwork and countertops listed above, delivery, installation and work described above totaling $520. This includes local and state taxes. Matthew Shumate Carolina Heritage Cabinetry ms hum ate 9chcabinetry.com Office: (336) 818-1078 Kevin R. Howell Signature: Carolina Heritage Cabinetry khowell(EDchcabinetry.com Print: Office: (336) 818-1078 DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7g/25/2018 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT NAME: SIA Group, Inc. PHONE FAX 827 Gum Branch Road WC No Ext:910-455-7576 A/C No):910-455-7481 Jacksonville NC 28540 ADDRESS: certs@siagroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company Of America 12572 INSURED HMKERNC-01 INSURER B: Builders Mutual Insurance Company 10844 H.M. Kern Corporation P.O. Box 19424 INSURER C: Liberty Mutual Insurance Company 23043 Greensboro NC 27419-9424 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:626333689 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 LIMITS LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY S225942201 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY� PECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY S225942201 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT $ Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR S225942201 7/1/2018 7/1/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION WCP105344801 7/1/2018 7/1/2019 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Leased/rented equipment IM6980116 7/1/2018 7/1/2019 Limit 500,000 Builders Risk Any one Project 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Jerry M Passmore Center Addition&Renovation. Certificate holder is additional insured for general liability and automobile liability. Waiver of subrogation in favor of the additional insured applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Orange County PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD