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HomeMy WebLinkAbout2023-209-E-AMS-Siemens Industry-Southern Human Services tie generator into the fire alarm panel program and monitorRevised 04/23 ORANGE COUNTY CHANGE ORDER REQUEST NORTH CAROLINA ______________________________________________________________________________________________________________ Date: 5/5/2023 Project: Southern Human Services Fire Alarm Replacement Change Order No. 02 Department: AMS Department Address: 306 Revere Road, Hillsborough NC 27278 Project: Southern Human Services Fire Alarm Replacement Contractor: Siemens Industry, Inc. Contractor Address: 215 Southport Drive, Suite 900, Morrisville, NC 27560 Effective date of original contract: 10/7/2022 This change order increases decreases the contract time by 90 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: August 31, 2023 _______________________________________________________________________________________________________________ Full Description of Change: Install monitoring points from the Generator's panel to the Fire Alarm system, programming, and testing. Reason for Change: The generator was not a part of the initial proposal, however during the work with all the fire alarm systems we determined that we need to add all the generators into the Fire Alarm system for monitoring and programming. _______________________________________________________________________________________________________________ Original contract sum: $ 121,514.00 Contract sum prior to this change order: $ 127,119.69 Amount of this change order: $ 8,332.19 Total sum of the contract including this change order: $ 135,451.88 _______________________________________________________________________________________________________________ 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 May, 2023. _______________________________ _____________________________ _____________________________ Contractor Owner Architect (when retained) By:____________________________ By:___________________________ By:___________________________ DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 Branch General Manager 5/8/2023 5/10/2023 County Manager Revised 04/23 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Siemens Industry, Inc. Vendor Contact Person: Antony Tejada-Puella (antony.tejada-puello@siemens.com) Phone: 919.469.5095 Address: 215 Southport Drive, Suite 900 City Morrisville State: NC Zip: 27560 Department: AMS Amount: $8,332.19 Purpose: Southern Human Services, Tie Generator into the Fire Alarm Panel, program and monitor Budget Code(s): 61370035-880000-30001 Vendor # 53325 Vendor Status with NCSOS: Active Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: 10/7/2022) (Most Recent Amendment 3/10/2023) Effective Date 5/8/2023 End Date 8/31/2023 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by AMS Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: 30001 Facility Accessibility, Security & Safety) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(#Sourcewell) Department Affirmation 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. Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services 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 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: Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 5/8/2023 5/9/2023 5/10/2023 5/10/2023 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 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 1,000,000 10/01/2023 N/A GLD1110114 X TWXJUB-7440L338-TIL-22 (OH) NYC-009196547-31 1,000,000 UB-8P79233A-22-51-R (AZ,MA,WI) X 25674 of Marsh USA LLC N X10/01/2022 10/01/2023 N/A N/A TC2J-CAP-7440L34A-TIL-22 B 10,000,000 1,000,000 X '''''''''''$500K LIMIT / $500K SIR''''''''''' 25658 Travelers Property Casualty Co. of America 1,000,000 X X 05/02/2023 4433 10/01/2022 10/01/2022 RE: JOB NO. N/A X 10/01/2022 PO BOX 8181 HILLSBOROUGH, NC 27278 ORANGE COUNTY SEE ATTACHED A B The Travelers Indemnity Company CN102147003-RAM--22/23 100,000 10/01/2023 2,000,000 C INCL 41343 1,000,000 RENTA 1,000,000 X UB-8P83929A-22-51-K (AOS) 445 SOUTH STREET MARSH USA, LLC. MORRISTOWN, NJ 07960-6454 1000 DEERFIELD PARKWAY SIEMENS INDUSTRY, INC. BUFFALO GROVE, IL 60089-4513 10/01/2022 ATTN: RISK MANAGEMENT NOC60 B ... 10/01/2023 10/01/2023 HDI Global Insurance Company DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86 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: � 22 UMBRELLA IS FOLLOW FORM OF PRIMARY SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. � � Morristown RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. � 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 WAIVER OF SUBROGATION IS EFFECTUAL WHERE REQUIRED BY WRITTEN CONTRACT. � � � RE: JOB NO. N/A� LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED THE ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NON-CONTRIBUTORY INSURANCE TO THE ORANGE COUNTY, ITS OFFICERS, OFFICIAL AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED UNDER THE ABOVE REFERENCED GENERAL LIABILITY AND AUTOMOBILE Certificate of Liability Insurance CN102147003 � TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. � MARSH USA, LLC.� 1000 DEERFIELD PARKWAY� SIEMENS INDUSTRY, INC.� BUFFALO GROVE, IL 60089-4513 25 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 DocuSign Envelope ID: C1F103A3-F806-4950-9384-0FE781D3DE86