CN-370000-CN202-T33CO2.pdf
PDF 1012 KB Posted
- Contract number
- CN202
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 02) issued by the Florida Department of Environmental Protection (FDEP) for FDEP Contract No. CN202. The document involves Michael Baker International as the consultant, with Jeff Roberts, PE serving as the consultant representative and Ralph Perkins as the FDEP Contract Manager. The change order pertains to Task Assignment No. 33 for Project No. 61304C located at Highlands Hammock.
The change order is a time-only extension request with no increase to the task amount. The original task end date of June 30, 2022 was extended to June 30, 2023, and this change order further extends the new task end date to June 7, 2024, representing a net increase of 343 days. The extension was requested to allow completion of permitting and conformance of plans. The total task amount remains $184,028.27, comprised of a reimbursement component of $7,000.00 and a fixed fee of $177,028.27. The change order was executed on June 13, 2023, with digital signatures from all required parties including the Budget Representative, Project Manager, Contract Manager, Consultant, and Contract Authority.
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Text version
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 33 02 61304C
Highlands Hammock Campground Electrical, Plumbing & New Layout
Michael Baker International
Jeff Roberts, PE 850-701-2302 jeff.roberts@mbakerintl.com
Ralph Perkins 850-245-2460 Ralph.Perkins@FloridaDEP.gov
Time only change request to allow completion of permitting and conformance of plans per the attached email dated 6/13/2023.
$ 0.00 $ 10,148.02 $ 10,148.02 $ 7,000.00 $ 177,028.27 $ 184,028.27
$ 0.00 $ 7,000.00 $ 177,028.27 $ 184,028.27
12/08/2020
6/30/2022
6/30/2023
6/7/2024
Tamika Bass Tamika Bass Digitally signed by Tamika Bass Date: 2023.06.13 15:06:24 -04'00'
Theresa Carron T.Carron Digitally signed by T.Carron Date: 2023.06.13 12:27:19 -04'00'
Ralph Perkins Ralph M Perkins Digitally signed by Ralph M Perkins Date: 2023.06.13 16:00:52 -04'00'
Jeff Roberts, PE Jeff Roberts Digitally signed by Jeff Roberts Date: 2023.06.13 16:33:31 -04'00'
Bryan Bradner Bryan Bradner Digitally signed by Bryan Bradner Date: 2023.06.22 15:37:34 -04'00'
$ 0.00
Matson_D Text Box
CN202 TA33 CO2
File details come from the government source that posted it. Updated .