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Revised 07/20 <br />ORANGE COUNTY <br />CHANGE ORDER REQUEST <br />NORTH CAROLINA <br />_____________________________________________________________________________________________________________ <br />_ Date: 06/30/2021 Project: Veterans Memorial- Chapel Hill Change Order No. 02 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 />This change order increases decreases the contract time by 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 />______________________________________________________________________________________________________________ <br />_ <br />Full Description of Change: Extra digging and Gravel Installation. Labor and machine time to excavate to find suitable soil to build on <br />top of, add 12" gravel bed to fill void to pour concrete on top of <br />Reason for Change: Veterans Memorial Change Order Due to Bad Soils <br /> _____________________________________________________________________________________________________________ <br />__ Original contract sum: $ 98338.00 <br />Contract sum prior to this change order: $ 100124.00 <br />Amount of this change order: $ 3150.00 <br />Total sum of the contract including this change order: $ 103274.00 <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 30th day of June, 2021. <br />_______________________________ _____________________________ _____________________________ <br />Contractor Owner Architect (when retained) <br />By:____________________________ By:___________________________ By:___________________________ <br />DocuSign Envelope ID: C4F8AB9A-2D70-4779-B46E-144CAEA17EBB <br />7/2/2021 7/8/2021