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HomeMy WebLinkAbout2023-116-E-AMS-Siemens Industry-Motor Pool modules to monitor generatorRevised 06/21 ORANGE COUNTY CHANGE ORDER REQUEST NORTH CAROLINA ______________________________________________________________________________________________________________ Date: 02/17/2023 Project: OCPT Admin Fire Alarm System Change Order No. 02 Department: AMS Department Address: 306 Revere Road Project: OCPT Admin Bldg Fire Alarm System Contractor: Siemens Industry, Inc. Contractor Address: 215 Southport Drive, Ste 900 Effective date of original contract: 5/16/2022 This change order increases decreases the contract time by 20 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: April 3, 2023 _______________________________________________________________________________________________________________ Full Description of Change: Add modules to monitor control points on the generator Reason for Change: This is required in order to complete the final programming and inspections. _______________________________________________________________________________________________________________ Original contract sum: $ 41,206.00 Contract sum prior to this change order: $ 46,435.00 Amount of this change order: $ 7,839.77 Total sum of the contract including this change order: $ 54,274.77 _______________________________________________________________________________________________________________ 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 8th day of March, 2023. _______________________________ _____________________________ _____________________________ Contractor Owner Architect (when retained) By:____________________________ By:___________________________ By:___________________________ DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 3/13/2023 Branch General Manager 3/14/2023 County Manager Revised 06/21 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 Revised 06/21 ORANGE COUNTY—DEPARTMENT USE ONLY _____________________________________________________________________________________________________ Party/Vendor Name: Siemens Industry, Inc. Party/Vendor Contact Person: Terry Parody (terry.parody@siemens.com) Contact Phone: 919.469.5095 Party/Vendor Address: 215 Southport Drive, Ste 900 City Morrisville State: NC Zip: 27560 Department: AMS Amount: $7,839.77 Purpose: Motor Pool Modules to monitor generator Budget Code(s): 61370035-880000-30001 Vendor # 53325 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 03/8/2023 Approved by Board Yes No Agenda Date: --- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No This agreement is approved as to technical form and content and I as Department Director affirmatively state wor k 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: N/A 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:_________ DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 3/13/2023 3/14/2023 3/14/2023 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 09/27/2022 MARSH USA, INC. 445 SOUTH STREETMORRISTOWN, NJ 07960-6454 CN102147003-RAM--22/23 228 Rentas NOC60 . HDI Global Insurance Company Travelers Property Casualty Co. of America The Travelers Indemnity Company 25658 25674 41343 SIEMENS INDUSTRY, INC. 1000 DEERFIELD PARKWAYBUFFALO GROVE, IL 60089-4513 NYC-009196547-30 2 X X X GLD1110114 10/01/2022 10/01/2023 1,000,000 100,000 1,000,000 1,000,000 B X X X X TC2J-CAP-7440L34A-TIL-22 10/01/2022 10/01/2023 N/A N/A N/A 2,000,000 B C B N '''''''''''$500K LIMIT / $500K SIR''''''''''' TWXJUB-7440L338-TIL-22 (OH) UB-8P79233A-22-51-R (AZ,MA,WI) UB-8P83929A-22-51-K (AOS) 10/01/2022 10/01/2022 10/01/2022 10/01/2023 10/01/2023 10/01/2023 1,000,000 1,000,000 1,000,000 RE: JOB NO. N/A SEE ATTACHED INCL 10,000,000 X A COUNTY OF ORANGE of Marsh USA Inc. ASSET MANAGEMENT SERVICES 600 NC HIGHWAY 86 N HILLSBOROUGH, NC 27278 DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: MARSH USA, INC. 2 2 SIEMENS INDUSTRY, INC.1000 DEERFIELD PARKWAYBUFFALO GROVE,IL 60089-4513 25 Certificate of Liability Insurance CN102147003 Morristown RE: JOB NO. N/A COUNTY OF ORANGE; ASSET MANAGEMENT SERVICES IS INCLUDED AS ADDITIONAL INSURED UNDER THE ABOVE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED THE ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NON-CONTRIBUTORY INSURANCE TO THE EXTENT THAT A CLAIM ARISES FROM THE NEGLIGENCE OF SIEMENS INDUSTRY, INC. OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE INSURED BUT ONLY WITH RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER UP TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. DocuSign Envelope ID: 2F5C94F1-CA8F-4BFA-AB1A-A727A16433E8