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DocuSign Envelope ID: EEC95C86-425F-4B19-8B7B-D793E7A74AE5 <br /> Brock PH(919)570-1300 Request for Change Order <br /> contract FAX(9I9)570-1305 <br /> P.Q.BOX 33415 Attention: JASON KEPLEY <br /> services RALEIGH,NC 27636 Customer PO: s6714 <br /> P <br /> Strength • service spry c,tna atliyr Dale: 3/8/2018 <br /> Project#: 30357 <br /> Request#: I CO#: 0 <br /> 63431 Manager: DAMON A BROCK <br /> Ship To JM PASSMORE FITUP .bill To HM KERN CORPORATION <br /> 103 MEADOWLANDS DRIVE <br /> IGREENSBORO,NC <br /> HILLSBOROUGH,NC <br /> Contacts JUSTIN GRAVES Contacts IASON KEPLEY <br /> Phone:(336)601-8672- Phone: Phone: <br /> Cell: Cell: Cell: <br /> Pager: Pager: Pager: <br /> Fax: Fax: Fax: <br /> Description of Change Order Request: <br /> DELETE CARPET,ADD RESILIENT <br /> Additional Information: DELETE CARPET,ADD RESILIENT <br /> DELETE <br /> ANUFACTU.RER: __ 7yLE; <br /> COLOR NAME: COLOR NUMBER: UOM: QUANTITY.• UNIT PRICE: TOTAL PRICE. <br /> 1 C-1 CARPET SUPPLIED AND INSTALLED- <br /> BROCK CONTRACT SERVICES MATERIAL AND LABOR <br /> TBD Sy (130.00) (34.568) (4,493.89) <br /> Total DELETE ($ 4,493.89) <br /> ADD­ <br /> MANUFACTURER;_ _ 7_YLE: _ <br /> COLOR_NAME: COLOR NUMBER: UOM: QUANTITY. UNIT PRICE: TOTr�C PRICE. <br /> 1 LW-1 LUXURY VINYL TILE SUPPLIED AND INSTALLED- <br /> ARMSTRONG 1PARRALLEL b"X 36" I2 MIL VINYL PLANK <br /> TBD SF 1,170.00 .1. 3.876 1 4,534.92 <br /> Total ADD S 4,534.92 <br /> Total This Option - Tax Included : S 41.03 <br /> SALESMAN$SIGNATURE <br /> CUSTOMER'S A UTHORIZATION <br /> 311212018 Job No:30357 <br /> !'age 1 of I <br />