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To:Date:8/5/2022 <br />Project:PCCO #: <br />Project ID#:HH Project #: <br />Contractor:Contractor #: <br />Description of change: <br />GC Materials (Attach list with Qty, Item, Unit $, Unit mh, total mh, OT mh, Total $)SUBTOTALS <br />1. Total Direct Cost of Materials 0 $0.00 <br />2. Sales Tax (NC, Wake County) 7.25% 0 $0.00 <br />3. Shipping, Transportation, Fees $0.00 <br />4. Total for Materials & Shipping $0.00 <br />5. Overhead and Profit on Item 4 10%$0.00 <br />(10% maximum)$0.00 <br />GC Labor:(Attach list(s) with Labor Scope(s), Labor Rate(s), Labor Hour(s) <br />6. Total Labor:-$ <br />7. Total Supervison:-$ <br />8. Payroll Taxes & Insurance 40.0%$0.00 <br />9. Total Labor + Burden (6+7+8)$0.00 <br />10. Overhead and Profit on Item 9 10.0%$0.00 <br />(10% maximum on straight labor cost, not premium)$0.00 <br />Equipment Rental: (Attach quotes) <br />11. Equipment Rental (Includes 7.5% Sales Tax, Delivery Fees)$0.00 <br />12. Waste/Dump Fees $0.00 <br />13. Total for Equipment Rental $0.00 <br />14. Overhead and Profit 10.0%$0.00 <br />(10% maximum)$0.00 <br />Subcontractors: (Attach quotes with material and labor backup) <br />15. Subcontractors $1,973.40 <br />16.Overhead and Profit on Item 15 5.0%$98.67 <br />(5% maximum)$2,072.07 <br />Subtotal Before Bonds and Insurance $2,072.07 <br />GC Bonds and Insurance: <br />17.Insurance (1% of of direct cost subtotal)$20.72 <br />18. Bonds (1% of direct cost sustotal)$20.72 o)$41.44 <br />Total:$2,113.51 <br />Time Extension Request of:0 day(s) is being requested for this change in scope of work. <br />Notice to Proceed Date: 7/11/2022 <br />Original/Revised Contract Days to Complete:120 <br />Original/Revised Substantial Completion Date:11/8/2022 <br />Additional Contract Days to Complete: <br />Adjusted Contract Days to Complete: <br />Adjusted Substantial Completion Date: 11/8/2022 <br />Contractor's Signature: ___________________________________________________________Date: ________________ <br />Approval Recommended by Design Consultant: ___________________________________________________________Date: ________________ <br />Owner's Representative Approval: ___________________________________________________Date: ________________ <br />cc: <br />PRIME CONTRACT CHANGE ORDER PROPOSAL WORKSHEET <br />WB Brawley <br />The Contractor agrees to perform the work outlined in this change proposal for the amount specified above and in <br />accordance with the Contract documents if the work is authorized by the Owner. <br />Owner request to remove white boards and repair wall areas ready for paint. Provide salvagable white boards to Owner for <br />storage. <br />21-094 <br />01 <br />2022108 <br />Leah Filomena, HH Architecture <br />West Campus 3rd Floor Office Upfit <br />DocuSign Envelope ID: 40A229C5-D4FB-45FE-AB8A-DFDF4EE51ADF