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Home My WebLink About2019-281-E AMS - Riley Surveying Northern Campus Hwy 70 addl mapping survey DocuSign Envelope ID:El 9BECF9-5262-4897-B2D4-1 DA341 E7561 B ORANGECOUNTY CHANGE ORDER REQUEST NORTH CAROLINA Date:05/20/2019 Project: Northern Campus-Detention Center Change Order No.004 Department: AMS Department Address:Orange County,PO Box 8181 Hillsborough,NC 27278 Project: 10071 Contractor: Riley Surveying,P.A. Contractor Address:3326 Durham Chapel Hill Blvd,Ste B-100,Durham,NC 27707 Effective date of original contract: 05/21/2018 This change order® increases❑decreases the contract time by N/A 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: Full Description of Change:proposed Utiilty and Access easement Reason for Change: This Fourth Addendum to Agreement dated 21 May,2018 is to provide preparation of an Exhibit and description for the proposed Utility and Access easement through the adjacent NC Dept.of Transportation property.The survey/mapping shall conform in all respects with 21 NCAC 56. Original contract sum: $28,700 Contract sum prior to this change order: $38,900 Amount of this change order: $750 Total sum of the contract including this change order: $39,650 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. Approved and executed this 20th day of May,2019. Riley Surveying, P.A. orange County NC Contractor Owner Architect(when retained) �Do-Signed by- Doousigned by- B[ PU KbR By:l L.Lt. V6V*Adti, By: R1D32R7Ffl7r'..i4,1f L 71 FF37,'1AC.n1S4F= Revised 10/17 DocuSign Envelope ID: El9BECF9-5262-4897-B2D4-1 DA341 E7561 B Riley Surveying, P.A. 3326 Durham Chapel Hill Blvd. Suite B-100 Durham, North Carolina 27707 THIRD ADDENDUM TO AGREEMENT FORTH PROVISION OF LIMITED PROFESSIONAL SERVICES DATE: May 15, 2019 CLI ENT: County of Orange 131 West Margaret Lane, Suite300 Hillsborough, NC 27278 Attention: Alan Dorman, Interim Di r. Asset Management Services PROJECT NAM E/LOCATION: Highway 70 Tracts Development Surveys Hillsborough, NC SCOPE AND EXTENT OF SERVICES: This Fourth Addendum to Agreement dated 21 May, 2018 is to provide preparation of an Exhibit and description for the proposed Utility and Access easement through the adjacent NC Dept. of Transportation property. Fourth Addendum Fixed Fee: $750.00 Special Provisions 1) The survey/mappi ng shad I conform i n al I respects with 21 NCAC 56. 2) As per original Agreement. The Terms and Conditions in the Original Contract dated 21 May, 2018 area part of thisAgreement. ThisAgreement entered into asof the day and year first written above. CLI ENT SURVEYOR A AM Authorized Signature Phillip W. Riley, PLS President Phone—(919)667-0742 Fax—(919)402-0234 NC Firm LicenseC-1281 DocuSign Envelope ID: El9BECF9-5262-4897-B2D4-1 DA341 E7561 B ACCN?{J CERTIFICATE OF LIABILITY INSURANCE 14;aq'ry'yyl THIS CERTIFICATE IS ISSUED AS A MATTER OF WORMATION ONLY ANO CONFERS NO PJGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATlVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORI51*J�7 BY THE POLICES BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE Aw CONTRACT BETWEEN THE ISSUING INSURER(S), AtTfHORl7E-0 REPRESENTAT;Vp-OR PRODUQER,AND THE CER-IFICATZ HOLDER- IMPORTANT: If ttva certificate holder is an ADDITIOMAE,INSURftl,the P6II1Wies}must be endorsed. I'f FAUBROGATION IS WAIVED, subject to the #errs and condlllarrs of the Policy, certal.n Policies may require an andorsement A statement On this cartirficate does riot confer rights to the Lartificain holder Irr lieu of such endorsenlengt,)- PRooucea Greg LopLeman, CPCULanr+nlan tate Farm In$urance PHONE E,RI�979- 33-7T11 1NC Nor:919=9r33.77t3 J=�+51L 1134 NC Hwy 541N o1 ss:Gre g.LWwan-W3LQSt2ti�tatm.o�m_ A) arrboro. NC 27510 weJC M IwsuRER a:S4 ie Fame Fire and Pasuahy Co npqnv #3 IH3�IRF,p RILEY SURVUING PA WSUMER B:SWa Farm M*M1 Auwrnoeile Ir►surarrta co!Tmenv T8 STE 100E INSUAERC! 3326 DURHAM CHAPEL HJLL 8LVD 1M9Ld4[atD- DURHAM NC 27707- 695 IN�LMiERE: MISUREk F• - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT FHE POLICE.$ OF INSURANCE LISTED SELOWV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE[]- NCTWIrHSTANDING ANY RFOLIIREMENT, TEW OR CC1401TION OF ANY CONTRACT OR OTHER DOCUMENT WrrF1 Rk$PECT To V01ICH THIS CE MFICATE MAY BE; ISSUED OR MAY PERTAi . THE INSURANCE AFFC4MF,) BY THE POLICII±S DESCRQEO HEFM14 1$ SUBJECT TO ALI, THE TEfWS, EXQL,l$IONS AND CONDITIONS OF SUCH POLICIES,LIMITS SL CWN MAY HAVE BEEN REDUC;FQ Sy PAID CLAIMS, LV TYPEDFINSURAIpE aoL346Fk TfGTEFF PpLlcr p P64�CY NUA16E72 Si11f3 GENERAL LIA13NMY Y ❑� 9$-CCY,7_OU5$ =IN2*19 0=0=20 EACHODrMxRENCE $ 9.Od0.OP4 C0G4dF.RCI+,L GENERAL LIAI$IUTY !',�ekWES tEs ooagrm $ W0,000 CLAIMS-NE,4aE OCCURA+EaIXP(,aycnePevecn�i 5 5,000 PERSONA{t.ADV INJURY _ $ 1.0f 0.000 �- CLENERALAGGRF,CATE L 2,00 .Wo G€ML AGGREr AT=LN{IT APPLI_Ffi PER: FROUMM L COMPIOP AGG i 2,000-000 } I PDuiCY Y F;'ELI 4 C B nu MLE UAMLmr I U71 9T d�f33D 33 1 OJ3012ff7 B 1 W34J2419 I LE ulna $ AHYAtJTO BOULY3M,ILIRY(Ref puro $ 500,000 ,+LTC)15 4 SCMEDALMMJLEd �FAM,(INARY{peromedwd) �.IJTOti ALIfO° S SOIJ,OD4 HIRED AUTC6 }( NON-WMF.p — AUTOS �� S 100,000 S f{ UMBREL LA OCCUR 42-0- CI�pP.E}1CC S 1.000,044 EXCE5 93•Gi4t-1S19-1 0819W0118 .. ClAlr.,$-HRQE ATE S 1.000-000 oFr+ CNI74,N5 10,OOQ - rR A I WORKERSCOMPENSATJON - o+J1D EMPLUTERIX L"MffY TONAWY PROPRMTORPMR1NCWIEXECtITIVEN,4CG14ENr $oFflCErnnEMBEREXCLUOEW M1A 93•CV-R463-3 02020020111 02170i2d {Man�6ory In NMt E.L.Dh3 E-E4 EMPLOYEE S 1,009,4dd a YBe,deseritg prQg, E.L.DISEASE-r'(L,kICY LIMIT-F- 1,00¢,q(r0 I bEWRWTIOw OF OPGRAT,quS a LOCATIONS ewr;HICLJES{Avmeh ACORD 101.Ad=i al R*.na.ha Schedula.it R54fB SpLam is mgUkVq CERTIFICATE HOLDER CANCELLATION Orange County SHOULD o T Il ADOV'E DESCRIBED POUMES BE CANCELLED BEFORE Tt� 8XP1 N DATIE THEREOF, N#ti7CE VWLL BE DELIVERED IN PO Box 8181 ACCORD CE THE POLICY PROVISIONS- Hillsborough, NC 27278 AMMORUEv TA e 1988-2010 ACORD CORK AT N= All rights reserved. ACORD 26 J2010;05) The ACORD name and logo are reg-mmired marks of ACORD f001466 132849.6 1 t-1 01a DocuSign Envelope ID: El9BECF9-5262-4897-B2D4-1 DA341 E7561 B A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 10/01//2018 Y) 018 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 Trish Clark NAME: Trustpoint Insurance aCONN. Ext: (540)389-0261 ac,No): (888)872-5496 16 East Church Ave E-MAIL tclark@trustpointins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Roanoke VA 24010 INSURERA: AXIS Insurance Company INSURED INSURER B: Riley Surveying,P.A. INSURER C: 3326 Durham Chapel Hill Blvd INSURER D: INSURER E: Ste B-100 Dur NC 27707 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE To CLAIMS-MADE OCCUR PREMISES Ea occurrence)l $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) r $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Claim $1,000,000 A Professional Liability LHR882546206 08/10/2018 08/10/2020 Aggregate $2,000,000 Deductible $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) certificate provided as evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Asset Management Services ACCORDANCE WITH THE POLICY PROVISIONS. 131 West Market Lane 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