CN-370000-CN208-T5-CO1.pdf

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:

CN208 TA5 1 CN1704

Biscayne Bay Environmental Center, Miami 40 Year Re-Certification

Calvin, Giordano & Associates

James Messick 954-766-2789 jmessick@cgasolutions.com

Mae Roth 850-245-2781 mae.roth@dep.state.fl.us

Time Only Change Order - project will not be completed within the original contract period. See attached request for additional time.

$ 382.00 $ 14,800.00 $ 15,182.00 $ 382.00 $ 14,800.00 $ 15,182.00 $ 0.00 $ 0.00 $ 0.00

$ 382.00 $ 14,800.00 $ 15,182.00

07/17/2017

12/31/2017

12/31/2017

3/31/2018

Patricia Rose 12/12/2017

Kevin Levern 12/12/2017

Mae Roth 12/12/2017

James Messick, P.E. 12/12/2017

Joanna Walczak 12/26/2017

$ 0.00

From: James Messick [mailto:JMessick@cgasolutions.com] Sent: Friday, December 08, 2017 8:24 AM To: Rose, Patricia <Patricia.Rose@dep.state.fl.us> Cc: Thom Palumbo <TPalumbo@cgasolutions.com>; Levern, Kevin <Kevin.Levern@dep.state.fl.us>;

Manuel Docurro <MDocurro@cgasolutions.com>; Jose Jimenez <JJimenez@cgasolutions.com> Subject: FDEP Task Assignment #5 - Pelican Harbor Site Electric

Patricia, Please consider this email as request to extend the above referenced (and attached) Task Assignment #5 for the Pelican Harbor Site Electric project from 12/31/17 to 3/31/17 to the task 2 – Services During Construction portion of the contract. This extension is due to delays in procuring a qualified vendor as well as delays in permitting for the electrical improvements. Please forward an updated change order so that we can execute and continue to work under an agreed upon Task Assignment for this project.

Thank you, Jimmy Messick, P.E.

Project Manager | Engineering Department (Broward)

Calvin, Giordano & Associates, Inc. | 1800 Eller Drive | Suite 600 | Fort Lauderdale, FL 33316 Office: 954.921.7781 | Direct: 954.766.2789 | Fax: 954.921.8807 Fort Lauderdale | Miami-Dade | West Palm Beach | Clearwater/Tampa | Estero | Port St. Lucie

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