AIA®
Document G701° - 2017
Change Order
PROJECT: (Name and address)
CONTRACT INFORMATION:
CHANGE ORDER INFORMATION:
East Hickman High School
Contract For: Contruction
Change Order Number: 002
Agricultural/Vocational Building
7700 TN-7
Date: 10-24-2025
Date: 01-06-2026
Lyles, TN
OWNER: (Name and address)
ARCHITECT: (Name and address)
CONTRACTOR: (Name and address)
Hickman County Schools
Lyle Cook Martin Architects
Fellowship Construction
114 North Central Avenue, Suite 203
310 Franklin Street
2668 Spencer Mill Road
Centerville, TN 37033
Clarksville, TN 37040
Bon Aqua, TN 37025
THE CONTRACT IS CHANGED AS FOLLOWS:
(Insert a detailed description of the change and, if applicable, attach or reference specific exhibits. Also include agreed upon
adjustments attributable to executed Construction Change Directives.)
See attached itemization. Addition of $17,467.84 to the Contract Sum.
The original was
$
580,000.00
The net change by previously authorized Change Orders
$
5,433.92
The prior to this Change Order was
$
585,433.92
The will be increased by this Change Order in the amount of
$
17,467.84
The new including this Change Order will be
$
602,901.76
The Contract Time will be unchanged by Zero (0) days.
The new date of Substantial Completion will be
NOTE: This Change Order does not include adjustments to the Contract Sum or Guaranteed Maximum Price, or the Contract Time,
that have been authorized by Construction Change Directive until the cost and time have been agreed upon by both the Owner and
Contractor, in which case a Change Order is executed to supersede the Construction Change Directive.
NOT VALID UNTIL SIGNED BY THE ARCHITECT, CONTRACTOR AND OWNER.
BnodA.Martin Martin m
ARCHITECT (Signature)
CONTRACTOR (Signature)
OWNER (Signature)
Bradley A. Martin, III
(Printed name Irwin and title) Pres.
(Printed name, title, and
(Printed name and title)
license number if required)
January 6, 2026
1-08-2026
Date
Date
Date
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1
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User Notes:
(695d638e88670f656fd1a995)
LYLE- COOK MARTIN
ARCHITECTS
Project No. 1402.1
East Hickman High School Agriculture/Vocational Building
7700 TN-7
Lyles, TN
January 6, 2026
Change Order #02
1. Relocate Gas
Add $9,561.68
2. Relocate Electrical
Add $7,906.16
Total Add: $17,467.84
01 26 54 - FORM FOR PRICE SUMMARY
SBC Project Number:
Project Name:
East Hickman Vocational Building
Name of General Contractor:
Fellowship Construction
Proposal Number:
RFP 2
Date Itemized:
2-Jan-26
Page
of
pages
Work by Subcontractors
Name of Subcontractor
Costs and Allowances
Move Conduit for exsiting light poles
Optimal Electric
5,969.89
Add another 2 inch conduit in trench
Optimal Electric
1,076.60
Subtotal:
7,046.49
General Contractor mark-up on Subtotal:
10.0000
% =
704.65
Subtotal for General Contractor for work by subcontractors:
7,751.14
Work by General Contractor
Subtotal (including Subcontractors and the General Contractor):
7,751.14
Cells with red underline (if viewed in color)
Bond Premium:
2.0000 % =
155.02
are for you to fill in. Others are protected.
Rounding off is permitted if rounding up for decreases and rounding down
Total:
7,906.16
for increases. Math functions in Excel show rounded to nearest penny, but
carry exact value for calculations. Let embedded math do its work.
This spreadsheet is available on the Owner's Designers' Manual website.
TN Higher Education - Standard Document - May 2018
Page 1of 1
CHANGE ORDER COST ITEMIZATION
Project Number:
East Hickman Ag Barn CO-1
Work itemized below provided by:
McLain Bryant
Proposal Number:
Page
1
of
Pages
Description
Material
Equipment
Labor
Qty
Unit
Cost
Extension
Qty
Unit
Cost
Extension
Qty
Unit
Cost
Extension
extra 2" conduit in the ditch
with the 2-2" already
speced in the drawings
1
652.00
652.00
0.00
0.00
Labor to install (Electrician 2)
0.00
0.00
4
47.43
189.72
0.00
0.00
0.00
existing pole lighting
conduit outside the new
facility footer
1
1,364.00
1,364.00
0.00
0.00
Electrician 1
0.00
0.00
16
65.95
1,055.20
Electrician 2
0.00
0.00
12
47.73
572.76
Mini ex/Skidsteer
0.00
1
1,803.00
1,803.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
0
0.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Materials
Subtotal
2,016.00
Equipment
Labor
Subtotal
1,817.68
9.5
%
Sales Tax
191.52
15
%
Burden
272.65
Cost
2,207.52
Cost
1,803.00
Cost:
2,090.33
Subtotal of Costs of Materials + Equipment + Labor =
6,100.85
10% Overhead allowed on costs =
610.09
Subtotal of Costs + Overhead =
6,710.94
5% Profit allowed on Costs + Overhead =
335.55
Total for this change =
7,046.48
7,046.49
Jcl
SECTION 01 26 55
FORM FOR PRICE OF WORK
SBC Project Number:
Project Name:
CO#1
EAST HICKMAN HS AG BLDG GAS RELOCATION PRICING
Work itemized below provided by:
David Valentine
Proposal Number:
CO#1
Date Itemized:
30-Dec-25
Page
1
of
1
pages
Description
Material
Equipment
Labor
Quantity
Unit
Cost
Extension
Quantity
Unit
Cost
Extension
Quantity
Unit
Cost
Extension
2" ANODELESS RISER
1
EA
286.81
286.81
0.00
0.00
0.00
0.00
2" STAB 90
1
EA
277.59
277.59
2" STAB COUPLING
1
EA
179.42
179.42
0.00
0.00
TRACER WIRE
1
ROLL
205.00
205.00
0.00
0.00
MAGNETIC LOCATOR TAPI
1
ROLL
75.38
75.38
0.00
0.00
2" YELLOW GAS PIPE
150
FT
3.79
568.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
MINI EXCAVATOR
0.00
2
DAY
300.00
600.00
0.00
SKIDSTEER
0.00
2
DAY
300.00
600.00
0.00
DIESEL HEATER
0.00
3
DAY
200.00
600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PLUMBER
0.00
0.00
24
65.00
1,560.00
PLUMBER HELPER
0.00
0.00
24
55.00
1,320.00
0.00
0.00
0.00
0.00
0.00
0.00
Materials
Subtotal
1,592.70
Equipment
Labor
Subtotal
2,880.00
9.750
% Sales Tax =
155.29
33.0
% Burden =
950.40
Cost:
1,747.99
Cost:
1,800.00
Cost:
3,830.40
Subtotal of Costs of Materials + Equipment + Labor = $
7,378.39
10% Overhead allowed on costs = $
737.84
Subtotal of Costs + Overhead = $
8,116.23
5% Profit allowed on Costs + Overhead = $
405.81
Total for this change = $
8,522.04
Jd
8,522.00
Posted in XLS format
Form for Price of Work
July 2012 OFD s012655
01 26 55 - 1
Page 1 of 1
01 26 54 - FORM FOR PRICE SUMMARY
SBC Project Number:
Project Name:
East Hickman Vocational Building
Name of General Contractor:
Fellowship Construction
Proposal Number:
RFP 2
Date Itemized:
31-Dec-25
Page
of
pages
Work by Subcontractors
Name of Subcontractor
Costs and Allowances
Move Gas Line
Schaffer Plumbing
8,522.00
Subtotal:
8,522.00
General Contractor mark-up on Subtotal:
10.0000
% =
852.20
Subtotal for General Contractor for work by subcontractors:
9,374.20
Work by General Contractor
Subtotal (including Subcontractors and the General Contractor):
9,374.20
Cells with red underline (if viewed in color)
Bond Premium:
2.0000 % =
187.48
are for you to fill in. Others are protected.
Rounding off is permitted if rounding up for decreases and rounding down
Total:
9,561.68
for increases. Math functions in Excel show rounded to nearest penny, but
carry exact value for calculations. Let embedded math do its work.
This spreadsheet is available on the Owner's Designers' Manual website.
TN Higher Education - Standard Document - May 2018
Page 1of 1

## Table 1

| The original was | $ 580,000.00 |
| --- | --- |
| The net change by previously authorized Change Orders | $ 5,433.92 |
| The prior to this Change Order was | $ 585,433.92 |
| The will be increased by this Change Order in the amount of | $ 17,467.84 |
| The new including this Change Order will be | $ 602,901.76 |

## Table 2

| ARCHITECT (Signature) | CONTRACTOR (Signature) | OWNER (Signature) |
| --- | --- | --- |
| Bradley A. Martin, III | Irwin Pres. |  |
| (Printed name, title, and license number if required) | (Printed name and title) | (Printed name and title) |
| January 6, 2026 | 1-08-2026 |  |
| Date | Date | Date |

## Table 3

| 1. Relocate Gas | Add $9,561.68 |
| --- | --- |
| 2. Relocate Electrical | Add $7,906.16 Total Add: $17,467.84 |

## Table 4

| Work by Subcontractors | Name of Subcontractor | Costs and Allowances |
| --- | --- | --- |
| Move Conduit for exsiting light poles | Optimal Electric | 5,969.89 |
| Add another 2 inch conduit in trench | Optimal Electric | 1,076.60 |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |

## Table 5

| Description |  |  | Material |  |  |  | Equipment |  |  |  | Labor |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  | Qty | Unit | Cost | Extension | Qty | Unit | Cost | Extension | Qty | Unit | Cost | Extension |
| extra 2" conduit in the ditch with the 2-2" already speced in the drawings | 1 |  | 652.00 | 652.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| Labor to install (Electrician | 2) |  |  | 0.00 |  |  |  | 0.00 | 4 |  | 47.43 | 189.72 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| existing pole lighting conduit outside the new facility footer | 1 |  | 1,364.00 | 1,364.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| Electrician 1 |  |  |  | 0.00 |  |  |  | 0.00 | 16 |  | 65.95 | 1,055.20 |
| Electrician 2 |  |  |  | 0.00 |  |  |  | 0.00 | 12 |  | 47.73 | 572.76 |
| Mini ex/Skidsteer |  |  |  | 0.00 | 1 |  | 1,803.00 | 1,803.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0,00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 | 0 |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0,00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |

## Table 6

|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  | Materials |  | Subtotal | 2,016.00 | Equipment |  |  |  | Labor |  | Subtotal | 1,817.68 |
|  | 9.5 | % | Sales Tax | 191.52 |  |  |  |  | 15 | % | Burden | 272.65 |
|  |  |  | Cost | 2,207.52 |  |  | Cost | 1,803.00 |  |  | Cost: | 2,090.33 |

## Table 7

| of Costs of Materials + Equipment + Labor = | 6,100.85 |
| --- | --- |
| 10% Overhead allowed on costs = | 610.09 |
| Subtotal of Costs + Overhead = | 6,710.94 |
| 5% Profit allowed on Costs + Overhead = | 335.55 |
| Total for this change = | 7,046.48 |

## Table 8

| SBC Project Number: | Project Name: |
| --- | --- |
| CO#1 | EAST HICKMAN HS AG BLDG GAS RELOCATION PRICING |

## Table 9

| Description |  |  | Material |  |  |  | Equipment |  |  |  | Labor |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  | Quantity | Unit | Cost | Extension | Quantity | Unit | Cost | Extension | Quantity | Unit | Cost | Extension |
| 2" ANODELESS RISER | 1 | EA | 286.81 | 286.81 |  |  |  | 0.00 |  |  |  | 0.00 |
| 2" STAB 90 | 1 | EA | 277.59 | 277.59 |  |  |  | 0.00 |  |  |  | 0.00 |
| 2" STAB COUPLING | 1 | EA | 179.42 | 179.42 |  |  |  | 0.00 |  |  |  | 0.00 |
| TRACER WIRE | 1 | ROLL | 205.00 | 205.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| MAGNETIC LOCATOR TAPI | 1 | ROLL | 75.38 | 75.38 |  |  |  | 0.00 |  |  |  | 0.00 |
| 2" YELLOW GAS PIPE | 150 | FT | 3.79 | 568.50 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| MINI EXCAVATOR |  |  |  | 0.00 | 2 | DAY | 300.00 | 600.00 |  |  |  | 0.00 |
| SKIDSTEER |  |  |  | 0.00 | 2 | DAY | 300.00 | 600.00 |  |  |  | 0.00 |
| DIESEL HEATER |  |  |  | 0.00 | 3 | DAY | 200.00 | 600.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
| PLUMBER |  |  |  | 0.00 |  |  |  | 0.00 | 24 |  | 65.00 | 1,560.00 |
| PLUMBER HELPER |  |  |  | 0.00 |  |  |  | 0.00 | 24 |  | 55.00 | 1,320.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |
|  |  |  |  | 0.00 |  |  |  | 0.00 |  |  |  | 0.00 |

## Table 10

| Labor Subtotal | 2,880.00 |
| --- | --- |
| 33.0 % Burden = | 950.40 |
| Cost: | 3,830.40 |

## Table 11

| Subtotal of Costs of Materials + Equipment + Labor = | $ 7,378.39 |
| --- | --- |
| 10% Overhead allowed on costs = | $ 737.84 |
| Subtotal of Costs + Overhead = | $ 8,116.23 |
| 5% Profit allowed on Costs + Overhead = | $ 405.81 |
| Total for this change = | $ 8,522.04 |

## Table 12

| Work by Subcontractors | Name of Subcontractor | Costs and Allowances |
| --- | --- | --- |
| Move Gas Line | Schaffer Plumbing | 8,522.00 |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |
|  |  |  |