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Home My WebLink About2024-095-E-AMS-F A Jenkins Construction-CO 1 Motorpool Epoxy FloorsRevised 04/23 ORANGE COUNTY CHANGE ORDER REQUEST NORTH CAROLINA ______________________________________________________________________________________________________________ Date: 1/26/2024 Project: MOTORPOOL SHOP ROOM RENOVATION Change Order No. 1 Department: AMS Department Address: 306 REVERE RD. HILLSBOROUGH, NC 27278 Project: MOTORPOOL Contractor: FA JENKINS Contractor Address: 402 AVALON DR. MEBANE, NC 27302 Effective date of original contract: 10/03/2023 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: INSTALL NEW EPOXY FLOORING IN BREAK ROOM AREA Reason for Change: FLOORS NEED TO BE REDONE DUE TO RENOVATION _______________________________________________________________________________________________________________ Original contract sum: $ 35,950.00 Contract sum prior to this change order: $ 35,950.00 Amount of this change order: $ 4,200.00 Total sum of the contract including this change order: $ 40,150.00 _______________________________________________________________________________________________________________ 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 26TH day of JANUARY, 2024. _______________________________ _____________________________ _____________________________ Contractor Owner Architect (when retained) By:____________________________ By:___________________________ By:___________________________ DocuSign Envelope ID: 1EEF8CF7-3E75-4B10-ACA9-4C9E6F69423C 2/5/2024 2/13/2024 Revised 04/23 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: F A Jenkins Construction, Inc Vendor Contact Person: Fred Jenkins Phone: 336-260-1001 Address: 402 Avalon Drive City Mebane State: NC Zip: 27302 Department: AMS Amount: $4,200.00 Purpose: CO 1 Motorpool Epoxy Floors Budget Code(s): 61370035-880000-12001 Vendor # 67569 Vendor Status with NCSOS: Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date 1/26/2024 End Date 10/03/2024 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by Steve Arndt 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: ) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) 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: 1EEF8CF7-3E75-4B10-ACA9-4C9E6F69423C 2/2/2024 2/12/2024 2/13/2024 F A Jenkins Construction, Inc 402 Avalon Dr Mebane, NC 27302 Office (336) 260-1001 Mjenkins31@triad.rr.com DATE: JANUARY 26, 2024 TO: Alan Dorman Kate Hamlett Orange County Asset Management Services adorman@orangecountync.gov khamlett@orangecountync.gov JOB Motor Pool Renovations 600 NC-86, Hillsborough, NC 27278 ITEM # DESCRIPTION QUANTITY Install new epoxy flooring in new break room area as discussed. $4,200.00 Total …… $4,200.00 Thank you for your business! CHANGE ORDER - FLOORING DocuSign Envelope ID: 1EEF8CF7-3E75-4B10-ACA9-4C9E6F69423C EIG6230 8/11 AGENT’S NO.NAME AND ADDRESS OF AGENCY DATE ISSUED (MM/DD/YY) NAME AND ADDRESS OF NAMED INSURED This is to certify thaThis is to certify thaThis is to certify thaThis is to certify thaThis is to certify that policies,t policies,t policies,t policies,t policies, as indica as indica as indica as indica as indicated bted bted bted bted by the Policy Number belowy the Policy Number belowy the Policy Number belowy the Policy Number belowy the Policy Number below,,,,, are in f are in f are in f are in f are in force force force force force for the Named Insured aor the Named Insured aor the Named Insured aor the Named Insured aor the Named Insured at the time that the time that the time that the time that the time that the Certificat the Certificat the Certificat the Certificat the Certificate is being issued.te is being issued.te is being issued.te is being issued.te is being issued. COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR POLICY PROJECT LOC GENERAL LIABILITY EXCESS LIABILITY OCCURRENCE RETENTION $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Add’lAdd’lAdd’lAdd’lAdd’l Ins’dIns’dIns’dIns’dIns’d POLICY EXPIRAPOLICY EXPIRAPOLICY EXPIRAPOLICY EXPIRAPOLICY EXPIRATIONTIONTIONTIONTION DADADADADATE TE TE TE TE (((((MM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YY)))))POLICY EFFECTIVEPOLICY EFFECTIVEPOLICY EFFECTIVEPOLICY EFFECTIVEPOLICY EFFECTIVE DADADADADATE TE TE TE TE (((((MM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YY)))))POLICY NUMBERPOLICY NUMBERPOLICY NUMBERPOLICY NUMBERPOLICY NUMBERTYPE OF INSURANCETYPE OF INSURANCETYPE OF INSURANCETYPE OF INSURANCETYPE OF INSURANCE WORKERS COMPENSATION & EMPLOYERS LIABILITY AUTHORIZED REPRESENTATIVE CERTIFICATE OF INSURANCE — THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY — EACH OCCURRENCE LIMITSLIMITSLIMITSLIMITSLIMITS AGGREGATE __________________________ __________________________ GEN’L AGGREGATE LIMIT APPLIES PER: $ $ $ $ AUTOMOBILE LIABILITY BODILY INJURY AND PROPERTY DAMAGE COMBINED PROPERTY DAMAGE $ $ $BODILY INJURY (EACH ACCIDENT) BODILY INJURY (EACH PERSON) $ (OWNED, HIRED, NON-OWNED) STATUTORY BODILY INJURY BY ACCIDENT EACH ACCIDENT DISEASE POLICY LIMIT DISEASE EACH EMPLOYEE $ $ $ FLAGSHIP CITY INSURANCE COMPFLAGSHIP CITY INSURANCE COMPFLAGSHIP CITY INSURANCE COMPFLAGSHIP CITY INSURANCE COMPFLAGSHIP CITY INSURANCE COMPANYANYANYANYANYCo.: GCo.: GCo.: GCo.: GCo.: G Co.: DCo.: DCo.: DCo.: DCo.: D ERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPANYANYANYANYANYCo.: CCo.: CCo.: CCo.: CCo.: C Co.: ECo.: ECo.: ECo.: ECo.: E OWNED HIRED NON-OWNED GARAGE “ANY AUTO” ERIE INSURANCE PROPERERIE INSURANCE PROPERERIE INSURANCE PROPERERIE INSURANCE PROPERERIE INSURANCE PROPERTY & CASUALTY & CASUALTY & CASUALTY & CASUALTY & CASUALTY COMPTY COMPTY COMPTY COMPTY COMPANYANYANYANYANY ERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPERIE INSURANCE COMPANY OF NEW ANY OF NEW ANY OF NEW ANY OF NEW ANY OF NEW YORKYORKYORKYORKYORKCo.: FCo.: FCo.: FCo.: FCo.: F $EACH OCCURRENCE $FIRE DAMAGE (Any One Fire) $MED EXP (Any One Person) PERSONAL & ADV. INJURY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG $ $ $ NAME AND ADDRESS OF CERTIFICATE HOLDER COCOCOCOCO LLLLLTRTRTRTRTR This certificate is issued for information purposes only and confers no rights on the certificate holder. It does not affirmatively or negatively amend, extend, or otherwise alter the terms, exclusions and conditions of insurance coverage contained in the policy(ies) indicated below. The terms and conditions of the policy(ies) govern the insurance coverage as applied to any given situation. Limits shown may have been reduced by claims paid. This certificate of insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder. CANCELLATION:SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIV- ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). ERIE INSURANCE EXCHANGEERIE INSURANCE EXCHANGEERIE INSURANCE EXCHANGEERIE INSURANCE EXCHANGEERIE INSURANCE EXCHANGE Erie Indemnity Co.,Erie Indemnity Co.,Erie Indemnity Co.,Erie Indemnity Co.,Erie Indemnity Co., AttorneAttorneAttorneAttorneAttorney-in-Facty-in-Facty-in-Facty-in-Facty-in-Fact COMPCOMPCOMPCOMPCOMPANYANYANYANYANY(((((IESIESIESIESIES))))) AFFORDING COVERAGEAFFORDING COVERAGEAFFORDING COVERAGEAFFORDING COVERAGEAFFORDING COVERAGE ( )Not Not Not Not Not ApplicaApplicaApplicaApplicaApplicablebleblebleble in NYin NYin NYin NYin NY 402 Avalon Dr Mebane, NC 27302 X X X Q30 0123180 6/1/23 6/1/24 1,000,000 1,000,000 5,000 1,000,000 2,000,000 2,000,000 100,000 300,000 100,000 2/13/242/13/23Q02 1330937 X X 100,000 500,000 100,000 6/1/24Q90 0103892 6/1/23 10/17/23 JJ1628 CENTRAL CAROLINA INSURANCE INC F A Jenkins Construction Inc Orange County po box 8181 Hillsborough, NC 27278 2855 S CHURCH ST STE C BURLINGTON, NC 27215 Page 1 of 1 X Orange County is also listed as an Additional Insured as it relates to General Liability E E E DocuSign Envelope ID: 1EEF8CF7-3E75-4B10-ACA9-4C9E6F69423C