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DocuSign Envelope ID:El 9BECF9-5262-4897-B2D4-1 DA341 E7561 B <br /> ORANGECOUNTY <br /> CHANGE ORDER REQUEST <br /> NORTH CAROLINA <br /> Date:05/20/2019 Project: Northern Campus-Detention Center Change Order No.004 Department: <br /> AMS Department Address:Orange County,PO Box 8181 Hillsborough,NC 27278 Project: 10071 Contractor: Riley <br /> Surveying,P.A. Contractor Address:3326 Durham Chapel Hill Blvd,Ste B-100,Durham,NC 27707 Effective date of original <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 substantial <br /> completion is: <br /> Full Description of Change:proposed Utiilty and Access easement <br /> Reason for Change: This Fourth Addendum to Agreement dated 21 May,2018 is to provide preparation of an Exhibit and description for <br /> the proposed Utility and Access easement through the adjacent NC Dept.of Transportation property.The survey/mapping shall conform <br /> in all respects with 21 NCAC 56. <br /> Original contract sum: $28,700 <br /> Contract sum prior to this change order: $38,900 <br /> Amount of this change order: $750 <br /> Total sum of the contract including this change order: $39,650 <br /> This change order is executed to amend the contract time and/or contract sum. It shall not be construed to impact the original contract, <br /> project,services,or work in any other manner. <br /> Approved and executed this 20th day of May,2019. <br /> Riley Surveying, P.A. orange County NC <br /> Contractor Owner Architect(when retained) <br /> �Do-Signed by- Doousigned by- <br /> B[ PU KbR By:l L.Lt. V6V*Adti, By: <br /> R1D32R7Ffl7r'..i4,1f L 71 FF37,'1AC.n1S4F= <br /> Revised 10/17 <br />