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Revised 04/23 <br /> <br />ORANGE COUNTY <br /> CHANGE ORDER REQUEST <br />NORTH CAROLINA <br /> <br />______________________________________________________________________________________________________________ <br />Date: 6/14/2023 Project: Southern Human Services Fire Alarm Replacement Change Order No. 03 Department: AMS <br /> Department Address: 306 Revere Road, Hillsborough NC 27278 Project: Southern Human Services Fire Alarm Replacement <br /> Contractor: Siemens Industry, Inc. Contractor Address: 215 Southport Drive, Suite 900, Morrisville, NC 27560 Effective date of <br />original contract: 10/7/2022 <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 completion is: <br />_______________________________________________________________________________________________________________ <br /> <br />Full Description of Change: Provide monitoring services for the fire alarm system <br /> <br />Reason for Change: This change is to provide the monitoring services for the fire alarm system <br />_______________________________________________________________________________________________________________ <br /> <br />Original contract sum: $ 121,514.00 <br /> <br />Contract sum prior to this change order: $ 135,451.88 <br /> <br />Amount of this change order: $ 5,400.00 <br /> <br />Total sum of the contract including this change order: $ 140,851.88 <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, project, services, or <br />work in any other manner. All other terms of the Original Contract remain in effect. <br />Approved and executed this 16th day of June, 2023. <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: 5449B711-C8F9-4EB9-8E11-9F57E894325A <br />Branch General Manager <br />6/15/2023 6/16/2023 <br />County Manager