Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

(Revised 9-26-2018) Page 1 of 1

Required Signatures: Adobe Signature

FDEP Contract No.: Task Assignment No.: Change Order No.: Project No.:

Project Location: Project Name:

Consultant Name:

Consultant Representative: Phone: Email:

FDEP Contract Manager: Phone: Email:

Description and Justification of Change:

Change in Task Amount:

Item Reimbursement Fixed Fee Total

Original Task Amount:

Task amount including all previous Change Orders:

Net increase/decrease in task amount for this Change Order:

Total Amounts with all Change Orders:

Change in Task Time:

Original Task Execution Date:

Original Task End Date:

Present Task End Date:

Net Change in Days:

New Task End Date:

Approval Signatures:

Budget Representative, FDEP Signature Date

Project Manager, FDEP Signature Date

Contract Manager, FDEP Signature Date

Consultant Signature Date

Contract Authority, FDEP Signature Date

Project # Grant # Org Code Cat/Year Fund Module Object Code EO Amount

29 Digit FLAIR Code: Total:

CN202 30 02 61274C

Paynes Creek Historic State Park Pedestrian Bridge Repair

Michael Baker International

Jeff Roberts, P.E. 850-701-2303 jeff.roberts@mbakerintl.com

Alyssa Skehan 850-245-2781 Alyssa.Skehan@FloridaDEP.gov

Change order for time only to allow for completion of construction administration and remaining services per the attached letter request dated 2/19/2021.

$ 250.00 $ 45,240.78 $ 45,490.78 $ 250.00 $ 48,280.79 $ 48,530.79

$ 0.00 $ 250.00 $ 48,280.79 $ 48,530.79

4/2/20

6/30/21

6/30/21

12/31/21

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2021.02.19 12:27:50 -05'00'

Theresa Carron Theresa Carron Digitally signed by Theresa Carron Date: 2021.02.19 13:25:32 -05'00'

Alyssa Skehan Alyssa Skehan Digitally signed by Alyssa Skehan Date: 2021.02.19 13:43:20 -05'00'

Jeff Roberts, P.E. Jeff Roberts Digitally signed by Jeff Roberts Date: 2021.02.19 13:55:11 -05'00'

Michael W. Foster Jr. P.E. P.T. Stone Digitally signed by P.T. Stone Date: 2021.02.22 13:10:56 -05'00'

$ 0.00

2316 Killearn Center Blvd, Tallahassee, FL 32309

Office: 850-205-0460

February 19, 2021

Theresa R. Carron Project Manager Bureau of Design and Construction Florida Department of Environmental Protection 3900 Commonwealth Boulevard 260K, MS 520 Tallahassee, FL 32399

RE: Contract Change Order #2 – Time Extension Request

Statewide Contract: CN202, Task Assignment 30 Paynes Creek Historic Park Suspension Bridge Repairs Hardee County, FL

Ms. Carron, Due to unforeseen delays with Army Corps of Engineers review and permitting, we are submitting this official time extension request for the subject project. We request that the end date for the completion of our contract be extended from 6/30/21 to 12/31/21. This will allow us adequate time to complete our post design services for FDEP as originally contracted, assuming a summer or fall 2021 construction for the project.

Please let me know if there are any questions on this request.

Sincerely, Chad A. Schroeder, PE Senior Project Manager

Chad.Schroeder Image