CN-370000-CN210-T21CO2.pdf
PDF 3 MB Posted
- Contract number
- CN210
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) for a project at St. Andrews State Park. The consultant performing work under this task assignment is CPH, Inc., represented by Jason Toole, P.E. The FDEP project manager is Donald J. Finkbeiner, with Alyssa Skehan serving as the contract manager. This change order was executed in March 2021 and applies to FDEP Contract No. CN210, Task Assignment No. 21, Change Order No. 02, for Project No. 61109C.
The change order is a time extension only, with no modification to the task amount. The original task amount was $52,165.26, which increased to $62,686.80 with previous change orders, and remains unchanged at $62,686.80 with this change order. The original task execution date was July 11, 2019, with an original end date of March 30, 2021. The change order extends the task completion deadline by 365 days to March 30, 2022, accommodating completion of construction administration tasks. The document was approved by FDEP leadership including the Budget Representative, Project Manager, and Contract Manager, as well as by the consultant representative, all with digital signatures dated between March 17 and March 22, 2021.
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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:
CN210 21 02 61109C
St. Andrews State Park Campground Reinvestment
CPH, Inc.
Jason Toole, P.E. 850-563-1490 jtoole@cphcorp.com
Alyssa Skehan or successor 850-245-2781 Alyssa.Skehan@FloridaDEP.gov
Please see attached request for a time extension only dated March 10, 2021.
$ 52,165.26 $ 52,165.26 $ 62,686.80 $ 62,686.80
$ 0.00 $ 0.00 $ 0.00 $ 62,686.80 $ 62,686.80
7/11/2019
3/30/2021
3/30/2021
3/30/2022
Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2021.03.17 10:12:31 -04'00'
Donald J. Finkbeiner Donald J. Finkbeiner Digitally signed by Donald J.
Finkbeiner Date: 2021.03.18 14:44:33 -04'00'
Alyssa Skehan Alyssa Skehan Digitally signed by Alyssa Skehan Date: 2021.03.22 11:45:37 -04'00'
Jason Toole, P.E.
Digitally signed by Jason L Toole
DN: C=US, O=CPH INC.,
OU=A01427E000001677A3D2EC900002789, CN=Jason L Toole Reason: I am the author of this document Location: your signing location here Date: 2021.03.21 15:35:51-05'00' Foxit PhantomPDF Version: 10.1.1
Jason L Toole
Michael W. Foster Jr., P.E. Michael W. Foster Jr., P.E.
Digitally signed by Michael W.
Foster Jr., P.E.
Date: 2021.03.22 14:00:56 -04'00'
$ 0.00
File details come from the government source that posted it. Updated .