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HomeMy WebLinkAbout2021-207-E-AMS-ASJ Wilson Construction-Board of Elections-Provide and install 3 well points DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 NORTH CAROLINA CONTRACT AMENDMENT ORANGE COUNTY THIS CONTRACT AMENDMENT ("Amendment") is made and entered into this 16th day of April, 2021 by and between ORANGE COUNTY (hereinafter referred to as "County") and ASJ Wilson Construction, LLC. (hereinafter referred to as"Provider"). WITNESSETH: THAT WHEREAS, the County and Provider entered into a contract dated January 18, 2021, (hereinafter the "Original Agreement"), for the provision of services for Stormwater Improvements and Waterproofing Services at the Orange County Board of Elections; and WHEREAS, the County and Provider desire to amend the Original Agreement while keeping in effect all terms and conditions of the Original Agreement not inconsistent with the terms and conditions set forth below. NOW THEREFORE, for and in consideration of the mutual covenants and agreements made herein, the parties agree to amend the Original Agreement as follows: 1. In order to ensure the completion of the Services identified in the term of the Original Agreement is amended to reflect an end date by which all Services shall be completed of June 30, 2021. 2. Exhibit A to the Original Agreement is amended by adding the following tasks and services to the Services to be provided by the Contractor: Provide all labor, materials and equipment to install three (3)well points per proposal dated April 15,2021. 3. Article 5 Payment & Taxes, Section"a" is amended to reflect a maximum payable not-to-exceed amount of One Hundred Thirty-Three Thousand, Seven Hundred Seventy-two Dollars($133,772.00) 4. Except for the changes made herein,the Original Agreement shall remain in full force and effect to the extent it is not inconsistent with this Amendment. In the event there is a conflict between the terms of the Original Agreement and the terms of this Amendment,this Amendment shall control. IN TESTIMONY WHEREOF, this Amendment has been executed by the parties hereto, as of the date first above written. ORANGE COUNTY PROVIDER �0 s'9n.tl bY: D. s'9 d by: �aWAc f�MKI 4/28/2021 4/21/2021 oanasaassEan_. �s�acozumma_. Bonnie Hammersley Joe Wilson,Manager County Manager ASJ Wilson Construction,LLC. Revised 07/20 DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 ORANGE COUNTY-DEPARTMENT USE ONLY Party/Vendor Name: ASJ Wilson Construction LLC. Party/Vendor Contact Person: Michael R. Phillips (asilmichael(a^gmail.com) Contact Phone: 336.272.7122 Party/Vendor Address: 415 Pisgah Church Road, PMB 128 City: Greensboro State: NC Zip: 27455 Department:AMS Amount: Increase contract from$130,935 to$133,272 by adding$2,837.00 to existing contract Purpose: Board of Elections—Provide and install (3)Well points Budget Code(s): 61370035-880000-10008 Vendor# 66963 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal ❑ Amendment ® Effective Date 4/16/2021 Approved by Board Yes❑No® Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: D S11 gby: Department Director's Signature[�^a Date: 4/21/2021 Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: NA Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: D Sig g by: Office of the Risk Management Office aGsa(ann�$e Date:4/21/2021 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: P( D g.by: Office of the Chief Financial Officer �"" Date:4/27/2021 Legal Services This agreement is approved as to legal form and sufficiency: D Sig—by: Office of the County Attorney LOS Z R M, Date:4/28/2021 acscscoD�ce_. Clerk to the Board Received for record retention: All DocuSign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for DocuSign contracts: Office of the Clerk to the Board Date: Revised 07/20 DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 .iiaANN AIIWl Wilson Construction, LLC . 415 Pisgah Church Road PMB 128 Greensboro, NC 27455 Bus: (336) 272-7722 MBE, DBE, HUB, VOSB April 15, 2021 RE: Orange County Board of Election Site Improvements—Change Order#1 To Whom It May Concern: ASJ Wilson Construction LLC is requesting a change order to provide a quote for labor, material and equipment to install 3ea well points to include the following: Excavation of 3ea 3x3 well points Install 6in stone Install 3ea pumps with discharge hoses Total -$2837.00 If you should have any questions regarding the above quote, please do not hesitate to contact me at (336) 272-7722. Very truly yours, Joe Wilson Manager DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 01/06/2021 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 Jen Shon NAME: Pelnik Insurance PHONE (g19)459-8000 FAX (866)714-3576 A/C No Ext: A/C,No): 100 Ridgeview Drive E-MAIL Jen.Shon@pelnik.com ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# Cary NC 27511 INSURERA: West Bend Mutual Ins Co 15350 INSURED INSURER B: ASJ Wilson Construction LLC INSURER C: 415 Pisgah Church Rd INSURER D: PMB 128 INSURER E: Greensboro NC 27455 INSURER F: COVERAGES CERTIFICATE NUMBER: CL211620837 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PRIM SES Ea :NcE ence $ 300,000 MED EXP(Any one person) $ 5,000 A A826708 01/06/2021 01/06/2022 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A826708 01/06/2021 01/06/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 UMBRELLALIAB 4,000,000 OCCUR EACH OCCURRENCE $ A EXCESS LAB CLAIMS-MADE A826708 01/06/2021 01/06/2022 AGGREGATE $ 4,000,000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION X STATUTE EREIR H AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ A OFFICER/MEMBEREXCLUDED? NIA Y A823975 01/06/2021 01/06/2022 (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) A Waiver of Subrogation applies in favor of the Certificate Holder with respects to Workers'Compensation&Employer's Liability policy when required by written contract,executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. 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 DocuSign Envelope ID:2BBAA47C-8833-44D1-93B9-43EOEOA7B240 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04 84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule "Organizations for which the Named Insured has agreed to by written contract executed prior to the loss to furnish waiver' This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/6/2021 Policy No.A823975 Endorsement No. Insured ASJ Wilson Construction, LLC Premium$ Insurance Company West Bend Mutual Insurance Countersigned by WC 00 03 13 (04 84) Page 1 of 1 Copyright 1983, National Council on Compensation Insurance, Inc.