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DocuSign Envelope ID:A6E80449-4F51-48F6-85DB-7136A80CD513 <br /> CHANGE PROPOSAL FORM <br /> Project: Efland to Mebane$S <br /> Contract: <br /> Contractor: JF Wilkerson Contracting Inc. <br /> Utility <br /> Construction Proposal# <br /> Project# C IP 300" <br /> Contractor C077 <br /> Description of Change: <br /> install a Reverse Tap and lower bore pit 3 vertical feet due to Conflict with gas line <br /> Materials are for additional raterials. All other items will be paid by unit pricing in the contract. <br /> Materials <br /> SUBTOTALS <br /> 1. Total Dire;:Cost of Materials S 974.52 <br /> See Attached Sheet <br /> 2. Overrhead&Profit on Item 1 15 °/, S 146.1a <br /> 3_ Sales Tax 7.25 % 5 70,55 <br /> 4. Shipping&Transportation S S 1,191.35 <br /> Labor <br /> 5. Total Man-hours: 0 MH @ s0.40 Ihr S <br /> See Attached Sheet <br /> 6. Overhead&Profit on item 5 15 % 5 247.68 <br /> 7. Payrolt Taxes&Insurance 31.2 % 5 515.17 S 2.414.05 <br /> Equipment Rental <br /> 8. Equipment Rental ."nS <br /> See Attached Sheet <br /> 9. Overhead&Prord on Item 6 15 % S 857.15 S 2.814.83 <br /> Subcontractors <br /> 10. Subcontractors S C.00 <br /> See Attached Sheet <br /> 11. Overhead&Profit on Item 10 5 % S 0.00 S 0.00 <br /> SUBTOTAL OF PROPOSAL S <br /> ,3,420.23 <br /> 12. Bonds(%or subtotal of proposal) 54.20 5 54.20 <br /> TOTAL OF CHANGE PROPOSAL ,q� / S 5,484.43 <br /> T'me extension request ✓ - days. Schedule Actvity+Affected� ST�i77-.'s�G�O./7��i0� <br /> The Contractor agrees to perform the work o neo this ch a proposal for amount specified above and in accordance with the <br /> Contract documents if the work is authofip6 b e Own <br /> ooGus ianea by: <br /> Contractor's Signature: +�e , 2: A? _/Z—/712/14/2018 <br /> ... <br /> Approval Recommended ,sign Consultant: ?Yy �r=7=,rzCzA423 Date: <br /> 12/14/2018 <br /> �-H V' 12/17/2018 <br /> Owner's Representative Approval:�L GIs. ` Date: <br /> CPR 001 <br />