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Revised 06/21 <br /> <br />ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br />NORTH CAROLINA <br /> <br />______________________________________________________________________________________________________________ <br />Date: 12/30/2021 Project: Bus Shelter Installation Change Order No. 01 Department: AMS Department <br />Address: 300 West Tryon Street Hillsborough NC 27278 Project: 10062 Contractor: ASJ Wilson Construction, LLC <br /> Contractor Address: 415 Pisgah Church Road, PMB 128 Greensboro, NC 27455 Effective date of original contract: 6/1/2021 <br /> <br />This change order increases decreases the contract time by 33 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: February 28, 2022 <br />_______________________________________________________________________________________________________________ <br /> <br />Full Description of Change: Bus Shelter located on North Churton Street: Provide labor, materials and equipment to excavation unknown <br />6" concrete from beneath existing pavers to install the concrete bus shelter pad. Bus Shelter located at Home Depot NC Hwy 86 South: <br />provide all labor, materials and install to install a retaining wall around the new shelter pad. <br /> <br />Reason for Change: This change order is to increase the existing contract amount and schedule due to the following: The North Churton <br />street location had 4 to 6 inches of existing concrete beneath the existing pavers that had to be removed and hauled off site the site in <br />order to pour the new concrete pad. The existing concrete was not noted on the drawings and the existing concrete did not meet the <br />design standards therefore it must be removed. The 2nd portion of this change request is to install a segmental block retaining wall <br />around the bus shelter pad to keep water from up the hill from flowing or standing on the new concrete pad, this is a concern for safety <br />when the tempertures are cold, and for the longivity of the concrete pad and shelter. <br />_______________________________________________________________________________________________________________ <br /> <br />Original contract sum: $ 34,534.00 <br /> <br />Contract sum prior to this change order: $ 34,534.00 <br /> <br />Amount of this change order: $ 5,021.00 <br /> <br />Total sum of the contract including this change order: $ 39,555.00 <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 day of , 20 . <br />_______________________________ _____________________________ _____________________________ <br />Contractor Owner Architect (when retained) <br /> <br />By:____________________________ By:___________________________ By:___________________________ <br /> <br /> <br /> <br />DocuSign Envelope ID: DC5B2AF0-5D05-4958-9D51-19C713A82630 <br />1/5/2022 <br />Manager County Manager <br />229January