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Revised 06/21 <br /> <br />ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br />NORTH CAROLINA <br /> <br />______________________________________________________________________________________________________________ <br />Date: 03/08/2023 Project: Southern Human Services HVAC Controls Change Order No. 02 Department: <br />AMS Department Address: 306 Revere Road Project: Southern Human Services HVAC Controls Contractor: Siemens <br />Industry, Inc. Contractor Address: 215 Southport Drive, Ste 900 Effective date of original contract: 10/7/2022 <br /> <br />This change order increases decreases the contract time by 00 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: This change order is to correct the original contract sum and total sum that was incorrectly listed on change <br />order 01. <br /> <br />Reason for Change: Administrative Correction to contract sums. The original contract sum listed on change order 1 was $2,000 more <br />than the actual contract. <br />_______________________________________________________________________________________________________________ <br /> <br />Original contract sum: $ 203,450.00 <br /> <br />Contract sum prior to this change order: $ 203,450.00 <br /> <br />Amount of this change order: $ 12,397.90 <br /> <br />Total sum of the contract including this change order: $ 215,847.90 <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 10th day of April, 2023. <br />_______________________________ _____________________________ _____________________________ <br />Contractor Owner Architect (when retained) <br /> <br />By:____________________________ By:___________________________ By:___________________________ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: 0E0D62F3-875B-49B3-9518-B1702B962423 <br />Branch General Manager <br />4/18/2023 <br />County Manager <br />4/20/2023