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HomeMy WebLinkAbout2019-326-E AMS - Sasser Flooring change order DocuSign Envelope ID:701EAF9E-D724-42ED-A571-523FBF449F2C ORANGE COUNTY CHANGE ORDER REQUE NORTH CAROLINA Date: 6/6/19 Project: Sheriff's Office Carpet Installation Change Order No. 1 Department: AN Department Address: 106 E. Margaret Lane, Hillsborough NC Project: Orange County Sheriff's Department- Inst� carpet for two small rooms, including cove base over weekends. Contractor: Sasser Flooring and Design Address:481 Compass Dr, Mebane NC 27302 Effective date of original contract: 5/20/2019 This change order® increases ❑ decreases the contract time by 25 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 sub completion is: July 31, 2019 Full Description of Change:This change order is to increase the scope of work to install additional carpet, cove base and materials for two additional offices per the Sheriff's request. This change order is for the amount of$2,341.14 to be added to the existing PO# 1902222-00. Reason for Change: This change is to improve the overall flooring at the Sheriff's office per the Sheriff's request. Original contract sum: $ 32,814.96 Contract sum prior to this change order: $ 32,814.96 Amount of this change order: $ 2,341.14 Total sum of the contract including this change order: $ 35,156.10 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. Aaoroved and executed this 6th day of June, 2019. ­M ik.S xsst+ 6/6/2019auv t.�{euu.wtvS 6/10/2019 Contractor Ownerr' Architect (when retainer By: President By: County Manager By: Revised 10/17 DocuSign Envelope ID:701EAF9E-D724-42ED-A571-523FBF449F2C "W PROPOSAL � � # 021490CS 481 Compass Dr Mebane, NC 27302 Phone: 919-964-1801 Fax: 336-449-1151 TO: DATE: 6/5/2019 PROJECT: Extra Rooms&Weekend Work Orange County Sheriff's Office 106 East Margaret Lane Hillsborough, NC 27278 QTY UNIT COLOR DESCRIPTION AMOUNT 48.000 SY Artist II Carpet Tile Color Architect $1,200.00 48.000 SY Install Carpet Tiles $240.00 432.000 SF Tear Up Carpet $172.80 1.000 EACH Carpet Adhesive $115.00 1.000 EACH Move Furniture $75.00 1.000 EACH Weekend Labor(2 different weekends) $300.00 Freight $75.00 Tax $163.34 Total $2,341.14 NOTES: Important Notes: All Invoices more than 30 days old are charged a late fee of 1.5%per month or 18%per year of the unpaid amount with a minimum monthly charge of$5.00 or such late fee allowed under applicable law, regulation or contract. If your check is returned to us for insufficient funds, it will be resubmitted electronically and your account will be debited for the amount plus any fees. ACCEPTED BY: By: By: Sasser Flooring SIGNATURE DATE SIGNATURE DATE DocuSign Envelope ID:701EAF9E-D724-42ED-A571-523FBF449F2C SASSCOM-01 DBAKER ,4co►zo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 4/29/2019 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 License#1000009384 CONTACT NAME: Hub International Carolinas PHONE 336 228-0541 FAX 866 590-4281 PO Box 939 (A/C,No,Ext):( ) (A/C,No):( ) Burlington, NC 27216 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B:Accident Fund General Insurance Company 12304 Sasser Flooring&Design,Inc INSURER C: P O Box 10 INSURER D: Whitsett,NC 27377 INSURER E 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F-X]OCCUR S 2253759 2/1/2019 2/1/2020 DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY jE LOC PRODUCTS-COMP/OP AGG $ 3,000,600 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO S 2253759 2/1/2019 2/1/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PeOPERTntDAMAGE $ AUTOS ONLY AUTOS ONLY r A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE S 2253759 2/1/2019 2/1/2020 AGGREGATE $ 10,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN WCV6139124 2/1I2019 2/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is an additional insured under the General Liability for work performed by the named insured for such additional insured,if required by contract signed by an authorized representative of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD