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Revised 07/20 <br /> <br />ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br />NORTH CAROLINA <br /> <br />______________________________________________________________________________________________________________ <br />Date: 06/24/2021 Project: Veterans Memorial- Chapel Hill Change Order No. 01 Department: AMS <br /> Department Address: 300 West Tryon St Project: Veterans Memorial Contractor: Custom Stone NC, Inc <br /> Contractor Address: 1001 Ellis Road, Durham NC 27703 Effective date of original contract: 10/06/2020 <br /> <br />This change order increases decreases the contract time by days. Check here if no impact to contract time . <br /> <br />Will this change order impact the date of substantial completion? Yes No. If yes, the amended date of substantial <br />completion is: <br />_______________________________________________________________________________________________________________ <br /> <br />Full Description of Change: To add mulch at the Veterans Memorial- labor and material to furnish and spread mulch <br /> <br />Reason for Change: Needed mulch around the Veterans Memorial <br />_______________________________________________________________________________________________________________ <br /> <br />Original contract sum: $ 98338.00 <br /> <br />Contract sum prior to this change order: $ 98338.00 <br /> <br />Amount of this change order: $ 1786.00 <br /> <br />Total sum of the contract including this change order: $ 100124.00 <br /> <br />_______________________________________________________________________________________________________________ <br />This change order is executed to amend the contract time or contract sum. It shall not be construed to impact the original contract, <br />project, services, or work in any other manner. All other terms of the Original Contract remain in effect. <br />Approved and executed this 24th day of June, 2021. <br />_______________________________ _____________________________ _____________________________ <br />Contractor Owner Architect (when retained) <br /> <br />By:____________________________ By:___________________________ By:___________________________ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: F005190C-8558-40C1-8ED1-FECDACCD60F8 <br />6/28/2021 6/30/2021