HomeMy WebLinkAbout2019-843-E AMS - Sasser Link remediation change order 1 DocuSign Envelope ID:OAB94D7E-1704-4418-9071-090B81C37189
ORANGE COUNTY
CHANGE ORDER REQUEST
NORTH CAROLINA
Date: 11/12/19 Project:Link Remediation Change Order No.001 Department:AMS Department
Address:131 W.Margaret Lane Project: Link Remediation Air Scrubbers and Monitoring(PO1901881) Contractor: Sasser
Companies,Inc Contractor Address:PO Box 10 Whitsett,NC 27377 Effective date of original contract: March 15,2019
This change order❑ increases❑decreases the contract time by days. Check here if no impact to contract time N.
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:This change is to increase the current contract amount by an additional $50,400.This includes additional
rental to provide air scrubbers above the ceiling to contain the air quality within the building.This covers the rental and maintenance of
said air scrubbers.Rental shall be billed at$35.00 per day for each 500 CFM AFD and$50.00 per day for each 1400 CFM AFD.HEPA
filters are to be changed as recommended by Industrial Hygentist to maintain satisfactory air test results.This includes additional
containment as needed and recommended by Industrial Hygentist,adding additional AFD's as required after further testing,and
additional electrical requirements for AFDs.
Reason for Change: This change is required due to the number of bids required,and the change within the building status throughout
the duration of the design,and bidding process.
Original contract sum: $25,000
Contract sum prior to this change order: $25,000
Amount of this change order: $50,400
Total sum of the contract including this change order: $75,400
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 othermanner.
id executed this 15/h cllmo4f Noverr`
�� n. SnSs�r �JbuLu� {{euN.we+S 11/14/2019
Contractor Owner r Architect(when retained)
By.Kevin Sassed' By: County Manager By:
Revised 12/18
DocuSign Envelope ID:OAB94D7E-1704-4418-9071-09OB81C37189
SASSCOM-01 DEIAKER
,d►C�►e�- CERTIFICATE OF LIABILITY INSURANCE DATE{MMI°DIYYYYJ
02107/2019
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 1S WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rig hts to the certificate holder in lieu of such endorsements).
PRODUCER License#1000009384 Co NA TncT
Hub International Carolinas PHONE EAx
PO Box 939 Arc,No,Ft):(336)228-0541 wc,No:(868)590-4281
Burlington,NC 27216 E--MAIL
INSURERS AFFORDING COVERAGE NAICR
_ INSURER A:Selective Insurance Company of America 12572
INSURED INSURER B:Accident Fund General Insurance Company .12304
Sasser Companies Inc INSURER C:
P 0 Box 10 INSURERD:
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 CONTRACTOR 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 SUER POLICY NUMBER POLICY EFF POLICY EXPLTR L1AIrT5
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE l "I OCCUR S 2253759 0210112019 02/01/2020 DAMAGE TO RENTED $00,000
MED EXP(Any one arson s 15,000
PERSONAL&ADV INJURY 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE a 3,000,000
POLICY PE OT LOG PRODUCTS-COMPIOP AGG 3,000,000
OTHER:
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
x ANY AUTO S 2253759 02/01/2019 02/01/2020 BODILY INJURY Per arson
OWNED SCHEDULED
AUTOS ONLY AUTOS E BODILY INJURY Per accident
AUTOS ONLY Al]TOS ONLY Pea'.'; nt AMAGE S
S
A )C UMRRELLA UAB x OCCUR EACH OCCURRENCE 10,000,000
EXCESS UAB CLAIMS-MADE S 2253759 02(01/2019 02/01/2020 AGGREGATE 10,000,000
QED RETENTION$
13 WORKERS COMPENSATION PER 07H
AND EMPLOYERS'LIABILITY YIN WCV6139124 02101/2019 02 O11202Q 1,000,000 �
ANY PRO PRIETORIPARTNERIEXECuI IVE ❑ NIA E.L EACH ACCIDENT $
QFFIGERIM MBER EXCLUDED? 1'000,000
andatory�n NFi] E-L DISEASE-EA EMPLOYE $
Ifyes,describe under 11000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE"-POLICY LIMIT $
I
DESCRIPTION OF OPERATIONS I LOCATIONS r 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
9 y ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 8181
Hillsborough,NC 27278
AUTHORIZED REPRESENTATIVE
ACORD 25(2018103) 01988.2015 ACORD CORPORATION. All rights reserved.
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