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DocuSign Envelope ID:84061484-66C3-4BCA-9FFF-FO9ACOA0012D <br /> nn DS <br /> ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br /> NORTH CAROLINA <br /> Date: 02/01/2022 Project: Orange County Parking Deck Change Order No. 1 Department: AMS <br /> Department Address: PO Box 8181, Hillsborough NC Project: Orange County Parking Deck Contractor: Pine Shore <br /> Energy LLC Contractor Address: PO BOX 443, Brevard, NC 28712 Effective date of original contract: 10/01/2021 <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 /> Full Description of Change: Additional work required to accomplish the project originally described in Quote#1044. Please see attached <br /> Quote dated 01/27/2022. <br /> Reason for Change: Additional Work required for the Orange County Parking Deck <br /> Original contract sum: $ 17392.40 <br /> Contract sum prior to this change order: $ 17392.40 <br /> Amount of this change order: $ 22150.10 <br /> Total sum of the contract including this change order: $ 39542.50 <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 /> D cuSigned b Signed by: <br /> �p rovgd and executed this 1st day of Februar , yy . <br /> E <br /> M ft,Omrsm& 6ln t, (�AtMtMWS�t <br /> Ceonfr'act4o'r Owner e'ssEa77... Architect (when retained) <br /> By; 2/2/2022 By: 2/16/2022 By: <br /> Revised 06/21 <br />