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DocuSign Envelope ID:43FC2FFB-67E2-4FBC-A5DF-06C16A5500B6 <br /> ORANGE COUNTY <br /> CHANGE ORDER REQUE <br /> NORTH CAROLINA <br /> Date: 05/17/2019 Project: Northern Campus- Detention Center Change Order No. 003 <br /> AMS Department Address: Orange County, PO Box 8181 Hillsborough, NC 27278 Project: 10071 Contrac <br /> Surveying, P.A. Contractor Address: 3326 Durham Chapel Hill Blvd, Ste B-100, Durham, NC 27707 Effective date of <br /> contract: 05/21/2018 <br /> This change order® increases❑ decreases the contract time by N/A days. Check here if no impact to contract time [ <br /> Will this change order impact the date of substantial completion? ❑ Yes❑ No. If yes,the amended date of sub< <br /> completion is: <br /> Full Description of Change: additional survey mapping and field survey <br /> Reason for Change: To prepare three exhibits, one for Orange County parcel,to be depicted as Holloway on advice form <br /> one for Orange County parcel west of future Holloway parcel; and one for the Lisa Hall parcel to be entitled Town of Hills <br /> Permanent 20' Sanitary Sewer Easement.The Temporary construction Easement 10' each side as show on plance prepar( <br /> Consultants, Inc. shall also be shown on the exhibits.At minimum, set monmuentation (iron stake) along the centerline o <br /> Easement where it corsses each property line.The Survery/mapping shall conform in all respects with 21 NCAC 56, as per <br /> agreement. <br /> Original contract sum: $ 28,700 <br /> Contract sum prior to this change order: $ 36,100 <br /> Amount of this change order: $ 2,800 <br /> Total sum of the contract including this change order: $ 38,900 <br /> This change order is executed to amend the contract time and/or contract sum. It shall not be construed to impact the o <br /> project, services, or work in any other manner. <br /> Approved and executed this 17th day of May, 2019. <br /> Riley Surveying, P.A. Orange County NC <br /> Contractor Owner Architect (when retainer <br /> DocuSignedby: DocuSigned by: <br /> B / . <br /> PU �� By: FAAA, V6MaJA, By: <br /> B1D3297FKL4A6... 21EF373ACD454EF... <br /> Revised 10/17 <br />