CN-370000-CN202-T34CO4.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 34 4 61276C

Anclote Key Preserve State Park Generator Replacement

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 11/29/2022 from Michael Baker International.

$ 7,156.16 $ 7,156.16 $ 100.00 $ 60,683.52 $ 60,783.52

$ 0.00 $ 100.00 $ 60,683.52 $ 60,783.52

12/8/2020

6/30/2022

12/31/2022

6/30/2023

Tamika Bass Tamika Bass Digitally signed by Tamika Bass Date: 2022.12.01 13:25:28 -05'00'

John Goss John Goss Digitally signed by John Goss Date: 2022.12.01 15:12:05 -05'00'

Ralph Perkins Ralph M Perkins Digitally signed by Ralph M Perkins Date: 2022.12.01 15:50:31 -05'00'

Jeff Roberts, P.E., RSP1 Jeff Roberts Digitally signed by Jeff Roberts Date: 2022.12.02 09:02:38 -05'00'

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

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2022.12.05 11:25:34 -05'00'

$ 0.00

November 29, 2022

John Goss

Construction Project Manager Bureau of Design and Construction Florida Department of Environmental Protection 1843 Tamiami Trail Osprey, FL 34229

RE: Statewide Contract: CN202, Task Assignment 34 – Change Order #4 (Time Extension Only)

Anclote Key Generator Replacement Pinellas & Pasco County, FL

Dear Mr. Goss:

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 December 31, 2022. We request the expiration of this Task Assignment be extended to 06/30/2023 to allow for completion of for completion of construction assistance tasks.

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

Sincerely, Jeff Roberts, P.E.

Associate Vice President