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Revised 04/23 <br />ORANGE COUNTY <br />CHANGE ORDER REQUEST <br />NORTH CAROLINA <br />______________________________________________________________________________________________________________ <br />Date: 11/21/2023 Project: Southern Human Services Fire Alarm Replacement Change Order No. 04 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 />This change order increases decreases the contract time by 120 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 completion is: <br />12/31/2023 <br />_______________________________________________________________________________________________________________ <br />Full Description of Change: Provide additional labor to cover for delays with mechanical and roofing systems. <br />Reason for Change: This change is to provide the additional labor for delays for the fire alarm system <br />_______________________________________________________________________________________________________________ <br />Original contract sum: $ 121,514.00 <br />Contract sum prior to this change order: $ 140,851.88 <br />Amount of this change order: $ 10,225.77 <br />Total sum of the contract including this change order: $ 151,077.65 <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 27th day of November, 2023. <br />_______________________________ _____________________________ _____________________________ <br />Contractor Owner Architect (when retained) <br />By:____________________________ By:___________________________ By:___________________________ <br />DocuSign Envelope ID: 59880112-32D2-475F-AC46-ACF7BE9CF767 <br />Branch General Manager <br />11/26/2023 <br />County Manager <br />11/28/2023