CN-370000-CN204-T16CO2.pdf
PDF 2 MB Posted
- Contract number
- CN204
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) for Contract No. CN204. The document reflects a modification to an existing task assignment between FDEP and consultant AMEC Foster Wheeler for the Alafia-Chicora project located in Polk County, Florida. The change order was approved by FDEP representatives Rhonda Massey (Budget Representative), Marisa Rhian (Project Manager), and Mae Roth (Contract Manager), along with Michael D. Phelps (Consultant) and Orlando E. Rivera (Contract Authority), with final signatures dated June 28-30, 2017.
The change order addresses a modification to the task timeline due to construction delays. The original task execution date was July 1, 2016, with an original end date of June 30, 2017. This change order extends the task completion date by 365 days to June 30, 2018. The task amount remains unchanged at $38,958.12 in reimbursement costs plus a $100.00 fixed fee, totaling $39,058.12. No adjustment to the contract amount was required; the change order solely addresses the time extension necessary to complete the assigned work. Task Assignment No. 16 and Project No. 600408.5 identify the specific assignment under this modification.
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Text version
Florida Department of Environmental Protection
TASK ASSIGNMENT CHANGE ORDER FORM
OOO – 012 (Effective 5-19-2016) 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:
CN204 16 2 600408.5
Chicora Tract - Polk County Alafia - Chicora
AMEC Foster Wheeler
David Butcher 863-667-2345 david.butcher@amecfw.com
Mae Roth 850-245-2781 mae.roth@dep.state.fl.us
Change in Task End Date due to construction delay. Additional time needed to complete task.
$ 29,532.82 $ 100.00 $ 29,632.82 $ 38,958.12 $ 100.00 $ 39,058.12
$ 0.00 $ 0.00 $ 0.00 $ 38,958.12 $ 100.00 $ 39,058.12
07/01/2016
06/30/2017
06/30/2017
06/30/2018
Rhonda Massey Rhonda Massey Digitally signed by Rhonda Massey Date: 2017.06.28 15:20:02 -04'00' 6/28/2017
Marisa Rhian Digitally signed by Marisa Rhian Date: 2017.06.28 15:24:10 -04'00' 06/28/2017
Mae Roth Mae Roth Digitally signed by Mae Roth Date: 2017.06.30 12:04:04 -04'00'
Michael D. Phelps 06/30/2017
Orlando E. Rivera Orlando E. Rivera Digitally signed by Orlando E.
Rivera Date: 2017.06.30 15:06:02 -04'00' 6/30/2017
$ 0.00
Michael D. Phelps Digitally signed by Michael D. Phelps DN: cn=Michael D. Phelps, o=Amec Foster Wheeler Environment Infrastructure Inc., ou, email=mike.phelps@amecfw.com, c=US Date: 2017.06.30 13:09:08 -04'00'
File details come from the government source that posted it. Updated .