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Orange County - Board of Elections <br />PM Initials <br />DOC Initials <br />Project Name Reference: (RFI, RFP, ASI, BD) <br />Proposal 2 CONTRACT: Board of Elections - Site Improvements <br />CONTRACTOR:ASJ Wilson Construction CONTRACTOR #: <br />DESCRIPTION OF CHANGE:SE Downspout - add roof liter & tie into 12" HDPE pipe; SW Downspout - add roof liter & run to existing <br />yard inlet; Materials -- Install paver flume and infill masonry vent opening <br />Materials (Attach list with qty, item, unit mh, total mh, OT mh, Total $) <br />1 Total direct cost of materials -$ <br />2 Sales Tax 6.75%-$ <br />3 Shipping and transportation -$ <br />4 Overhead and Profit on Items 1-3 -$ (10% maximum). (Includes small tools & consumables) <br />Materials Subtotal -$ <br />Labor (include time sheets if requested) <br />5 Total man-hours:13 @ 75 975.00$ <br />6 Payroll taxes and insurance@.34%331.50$ (40% maximum) <br />7 Overhead and Profit on Items 5 & 6 130.65$ <br />Labor Subtotal 1,437.15$ <br />Equipment Rental (includes quotes and pick-up / delivery tickets) <br />8 Equipment Rental (crew truck+fuel)(2 day)-$ <br />9 Overhead and Profit on Item 8 -$ (10%maximum) <br />Equipment Rental Subtotal -$ <br />Subcontractors (includes quotes with material and equipment backup) <br />10 Subcontractors 4,600.00$ <br />11 Overhead and Profit on Item 10 230.00$ (5% maximum) <br />Subcontractor Subtotal 4,830.00$ <br />Subtotal of Proposal 6,267.15$ <br />12 Bonds (___%of subtotal proposal)0%-$ (2% maximum) <br />TOTAL OF CHANGE PROPOSAL 6,267.15$ <br />Rounded Down to $6267 <br />Time Extension Request 0 days Schedule Activity # Affected Schedule Date: 7/26/21-7/27/21 <br />Contractor's Signature: Michael R. Phillips Date:7/23/2021 <br />Architect's Signature:Date: <br />Owner's Signature: Date: <br />Note:Subcontractors must also fill out this form for all requested change orders. <br />Change Order Request Form Section 00 63 57 <br />DATE: __7/23/2021 <br />(10% maximum). (O&P includes supervisor's time). <br />1 <br />DocuSign Envelope ID: CA949BE9-C4E1-4240-9F98-AFB8F9A022BC