HomeMy WebLinkAbout2021-385-AMS-Custom Stone NC, Inc-Extra Digging and Gravel at Veterans MemorialChapel Hill due to bad soilRevised 07/20
ORANGE COUNTY
CHANGE ORDER REQUEST
NORTH CAROLINA
_____________________________________________________________________________________________________________
_ Date: 06/30/2021 Project: Veterans Memorial- Chapel Hill Change Order No. 02 Department: AMS
Department Address: 300 West Tryon St Project: Veterans Memorial Contractor: Custom Stone NC, Inc
Contractor Address: 1001 Ellis Road, Durham NC 27703 Effective date of original contract: 10/06/2020
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 substantial
completion is:
______________________________________________________________________________________________________________
_
Full Description of Change: Extra digging and Gravel Installation. Labor and machine time to excavate to find suitable soil to build on
top of, add 12" gravel bed to fill void to pour concrete on top of
Reason for Change: Veterans Memorial Change Order Due to Bad Soils
_____________________________________________________________________________________________________________
__ Original contract sum: $ 98338.00
Contract sum prior to this change order: $ 100124.00
Amount of this change order: $ 3150.00
Total sum of the contract including this change order: $ 103274.00
_______________________________________________________________________________________________________________
This change order is executed to amend the contract time or contract sum. It shall not be construed to impact the original contract,
project, services, or work in any other manner. All other terms of the Original Contract remain in effect.
Approved and executed this 30th day of June, 2021.
_______________________________ _____________________________ _____________________________
Contractor Owner Architect (when retained)
By:____________________________ By:___________________________ By:___________________________
DocuSign Envelope ID: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB
7/2/2021 7/8/2021
Revised 07/20
DocuSign Envelope ID: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB
ORANGE COUNTY—DEPARTMENT USE ONLY
_____________________________________________________________________________________________________
Party/Vendor Name: Custom Stone NC, Inc Party/Vendor Contact Person: Daniel Benner Contact Phone: 919-682-8868 Party/Vendor Address:
1001 Ellis Drive City Durham State: NC Zip: 27703 Department: AMS Amount: $3150 Purpose: Extra Digging and Gravel at Veterans Memorial
Chapel Hill due to bad soil Budget Code(s): 61370035-880000-10060 Vendor # 57997 Vendor is a BOCC consultant? Yes No Contract Type:
(Check one) New Renewal Amendment Effective Date 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:
Department Director’s Signature ________________________________________ Date: ________
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:
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
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: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB
7/2/2021
7/4/2021
7/6/2021
7/7/2021
INVOICE
Date
5/25/2021
Invoice #
8048
Bill To
Orange County Public Works
131 E Margaret Ln,
Hillsborough, NC
Custom Stone NC Inc.
1001 Ellis Road
Durham, NC 27703
Terms
Net 30
Job Name
Orange County Vetera...
Total
Balance Due
Deposits/Credits
Description Quantity Price Amount
Veterans Memorial Change Order Due to Bad Soils
Extra Digging and Gravel Installation
Labor and machine time to do the following scope of work:
-over excavate to find suitable soil to build on top of
-add 12" gravel bed to fill void to pour concrete on top of
1 3,150.00 3,150.00
Finance charges of 1.5% per month on all past due accounts.
$3,150.00
$3,150.00
$0.00
DocuSign Envelope ID: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB
DocuSign Envelope ID: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB