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Revised 06/21 <br /> <br />ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br />NORTH CAROLINA <br /> <br />______________________________________________________________________________________________________________ <br />Date: Project: Change Order No. Department: Department Address: <br />Project: Contractor: Contractor Address: Effective date of original contract: <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: <br /> <br />Reason for Change: <br />_______________________________________________________________________________________________________________ <br /> <br />Original contract sum: $ <br /> <br />Contract sum prior to this change order: $ <br /> <br />Amount of this change order: $ <br /> <br />Total sum of the contract including this change order: $ <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 /> <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: BBF56E0A-3618-497E-AA70-92F097E8F598