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HomeMy WebLinkAbout2019-555-E AMS - Sasser Soltys Phase II change order 1 DocuSign Envelope ID:4A03D7DC-9143-4585-A738-51 E13A50C13F ORANGE COUNTY CHANGE ORDER REQUE NORTH CAROLINA Date: 8/13/2019 Project: Soltys Phase II Change Order No. 1 Department: AMS Departn 300 West Tryone Street, Hillsborough, NC, 27278 Project: Soltys Phase II Contractor: Sasser Contras Box 10 Whitsett, NC Effective date of original contract: 6/30/2019 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 sub< completion is: Full Description of Change: Drain sprinkler system,to remove the sprinkler line that was found inside the wall cavity durir Reason for Change: Current condition does not meet code requirements Original contract sum: $ 80,500 Contract sum prior to this change order: $80,500 Amount of this change order: $ 1,875 Total sum of the contract including this change order: $ 82,375 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. OocuSigned by: �ocu5igned by: I cecuted this 13th day of August, L Gu�VU S�.SSU�' STw t, Qrwk 9DC3E3752C684EF. 2DD9CD6B81844C5. Contractor Owner Architect (when retainei B�Cevi n Sasser By: Steve Arndt By. ocuSigned by: 1�6' Ra*�t rsL" 379946755E477.. Revised 12/18 DocuSign Envelope ID:4A03D7DC-9143-4585-A738-51 E13A50C13F rMVE rn r SAAPO Box 10 Whitsett,NC 27377 MT Ph:336-449-1144 - Change Request To: OC-Solty's Adult DC Number: 1 Date: 8/12/19 Job: 19-0201-103 OC-Soltys Adult DC-Phase 2 Phone: Description: Repairs to Sprinkler System Line We are pleased to offer the price to make the following changes: Drain sprinkler system,to remove the sprinkler line that was found inside the wall cavity during demo. Not to exceed cost of$1,875.00 The total amount to provide this work is.................................................................................................. $1,875.00 If you have any questions,please contact me at. Submitted by: Kevin Sasser Approved by: Date: All Change Orders shall be signed by both The Customer and The Contractor, and shall be incorporated in, and become part of the contract.Any and all Change Orders shall be paid in full upon approval of said Change Order and prior to commencement of any associated work. Page 1 of 1 DocuSign Envelope ID:4A03D7DC-9143-4585-A738-51E13A50C13F SASSCOM-01 DBAKER '4�aRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/07/2019 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 FAX PO Box 939 (A/C,No,Ext):(336)228-0541 (A/C,No):(866)590-4281 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 Companies 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 IN SD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR S 2253759 02/01/2019 02/01/2020 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 F7 JECOT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO S 2253759 02/01/2019 02/01/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED Parr c -Z)AMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE S 2253759 02/01/2019 02/01/2020 AGGREGATE $ 10,000,000 DED RETENTION$ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER WCV6139124 02/01/2019 02/01/2020 1,000,000 OFFICERO/MEMBER EXCLUDED?ECUTIVE ❑ N/A E.L.EACH ACCIDENT $ (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) RE: Orange County Emergency Services Building 510 Meadowlands Drive Hillsborough,NC 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. 200 South Cameron St 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