HomeMy WebLinkAbout2023-258-E-AMS-Siemens Industry-Southern Human Services,Monitoring ServicesRevised 04/23
ORANGE COUNTY
CHANGE ORDER REQUEST
NORTH CAROLINA
______________________________________________________________________________________________________________
Date: 6/14/2023 Project: Southern Human Services Fire Alarm Replacement Change Order No. 03 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 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: Provide monitoring services for the fire alarm system
Reason for Change: This change is to provide the monitoring services for the fire alarm system
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Original contract sum: $ 121,514.00
Contract sum prior to this change order: $ 135,451.88
Amount of this change order: $ 5,400.00
Total sum of the contract including this change order: $ 140,851.88
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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 16th day of June, 2023.
_______________________________ _____________________________ _____________________________
Contractor Owner Architect (when retained)
By:____________________________ By:___________________________ By:___________________________
DocuSign Envelope ID: 5449B711-C8F9-4EB9-8E11-9F57E894325A
Branch General Manager
6/15/2023 6/16/2023
County Manager
Revised 04/23
ORANGE COUNTY—INTERNAL USE ONLY
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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: $5400.00 Purpose: Southern Human Services,Monitoring Services
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 5/5/2023)
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 pro ject 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 rela ted 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: 5449B711-C8F9-4EB9-8E11-9F57E894325A
6/15/2023
6/16/2023
6/16/2023
6/16/2023