CN-370000-CN210-T14CO3.pdf.crdownload

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Master Agreement FL|CN210|c74bacc1301afbdccbbd4f57e12bda99
Contract number
CN210
Issued by
Florida

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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:

210 14 3 61202

Blue Spring State Park ADA Boardwalk Replacement

CPH, Inc.

Jason Toole 850-563-1490 jtoole@cphcorp.com

Alyssa Skehan 850-245-2781 alyssa.skehan@floridadep.gov

No Cost time extension for construction administration during the construction period, per attached dated 12/1/21.

$ 675.00 $ 49,260.08 $ 49,935.08 $ 2,835.00 $ 53,379.06 $ 56,214.06

$ 0.00 $ 0.00 $ 2,835.00 $ 53,379.06 $ 56,214.06

3/26/2019

6/30/2020

12/31/2021

12/31/2022

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2021.12.28 11:49:49 -05'00'

Bill Brown William R Brown Digitally signed by William R Brown Date: 2021.12.28 11:55:08 -05'00'

Alyssa Skehan Alyssa Skehan Digitally signed by Alyssa Skehan Date: 2021.12.29 09:36:06 -05'00'

Jason Toole Digitally signed by Toole, Jason L. P.E.

DN: DC=com, DC=cphengineers, DC=cph, OU=1-People, OU=15-PanamaCity, CN="Toole, Jason L. P.E.", E=jtoole@cphcorp.com Reason: I am the author of this document Location: your signing location here Date: 2021.12.29 09:31:50-06'00' Foxit PhantomPDF Version: 10.1.6

Toole, Jason L.

P.E.

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

Digitally signed by Michael W.

Foster Jr.

Date: 2021.12.29 13:57:11 -05'00'

$ 0.00

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