CN-370000-CN202-T32CO4.pdf

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 32 4 61299C

Highlands Hammock State Park Residence Electrical and Plumbing Repairs

Michael Baker International

Jeff Roberts, PE, RSP1 850-701-2303 jeff.roberts@mbakerintl.com

Ralph Perkins 850-245-2460 Ralph.Perkins@FloridaDEP.gov

Extension of time only to allow for project completion and project close-out as per attached email dated 6/6/2022 from Michael Baker International.

$ 18,308.40 $ 18,308.40 $ 100.00 $ 77,898.61 $ 77,998.61

$ 0.00 $ 100.00 $ 77,898.61 $ 77,998.61

11/12/2020

6/30/2022

6/30/2022

12/31/2022

Diane Langston Diane Langston Digitally signed by Diane Langston Date: 2022.06.07 08:32:02 -04'00'

John Goss John Goss Digitally signed by John Goss Date: 2022.06.07 08:35:45 -04'00'

Ralph Perkins Ralph M Perkins Digitally signed by Ralph M Perkins Date: 2022.06.07 08:50:05 -04'00'

Jeff Roberts, PE, RSP1 Jeff Roberts Digitally signed by Jeff Roberts Date: 2022.06.07 10:33:20 -04'00'

Michael Foster Michael W. Foster Jr., P.E.

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2022.06.13 09:04:45 -04'00'

$ 0.00

June 6, 2022

Stephen Pindel Assistant Project Manager Bureau of Design and Construction Florida Department of Environmental Protection 3900 Commonwealth Boulevard 260K, MS 520 Tallahassee, FL 32399

RE: Statewide Contract: CN202, Task Assignment 32 – Change Order #4 (Time Extension Only)

Highlands Hammock State Park Residence Electrical and Plumbing Repairs Highlands County, FL

Dear Mr. Pindel:

To align with anticipated construction progress on the subject project, Michael Baker International, Inc., is requesting a time extension to the current expiration date of June 30, 2022.

We request the expiration of this Task Assignment be extended to 12/31/22 to allow for completion of Task 6 (Pre-Construction Meeting), Task 7 (RFI and Shop Drawing Review) and Task 8 (Site Inspections).

Please let me know if there are any questions or comments.

Sincerely, Jeff Roberts, P.E.

Associate Vice President

Change Order #4 (Time Extension Only)

Highlands Hammock State Park Electrical & Plumbing Rehab Highlands County, FL

Statewide Contract CN202, Task Assignment 32

Project Schedule:

Project Schedule is based from estimated duration of calendar days for the contractor to complete each subtask. Schedule assumes consecutive subtasks in order shown unless concurrent subtasks are noted.

Schedule dates will be established after approved and executed contract has been received.

Activity

Subtask Duration (Calendar Days)

Amended Completion Date

Subtask 6 TBD Dec. 31, 2022

Subtask 7 TBD Dec. 31, 2022

Subtask 8 TBD Dec. 31, 2022

Subtask 9 Completed under CO ‘s 2 and 3 n/a