CN-370000-CN210-TA26 CO1.pdf
PDF 2 MB Posted
- Contract number
- CN210
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) for contract CN210, Task Assignment TA26, Change Order 01. The document modifies a construction administration services contract with CPH, Inc., a full-service architecture and engineering firm. The project involves the Weeki Wachee Springs State Park Headspring Erosion Control initiative located in Florida. Key personnel include Ariel Elvambuena (Consultant Representative) and Alyssa Skehan (FDEP Contract Manager). The change order was executed on April 16-19, 2021, with approvals from FDEP budget, project management, and contract authority representatives, as well as the consultant.
The change order extends the task execution period by 124 days, with the original task end date of April 30, 2021 extended to August 31, 2021. This is a time extension only with no change in task amount. The fixed fee remains $13,553.48, representing the total reimbursable amount for construction administration services. No reimbursement items are included in this change order. The funding is tracked under FDEP's 29-digit FLAIR code system for state budgeting and accounting purposes. The modification was requested in response to a proposal dated April 5, 2021, to provide additional time for completing construction administration activities on the headspring erosion control project.
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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 TA26 01 61241C
Weeki Wachee Springs State Park Headspring Erosion Control
CPH, Inc.
Ariel Elvambuena 813-288-0233 aelvambuena@cphcorp.com
Alyssa Skehan 850-245-2781 Alyssa.Skehan@FloridaDEP.gov
This is a time extension only for the construction administration services at Weeki Wachee Springs, Headspring Erosion Control project. Please see proposal request dated April 5, 2021.
$ 0.00 $ 13,553.48 $ 13,553.48 $ 0.00 $ 13,553.48 $ 13,553.48 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 13,553.48 $ 13,553.48
11/04/2020
04/30/2021
04/30/2021
8/31/2021
Gregg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2021.04.16 16:18:22 -04'00'
Donald Finkbeiner Donald J. Finkbeiner Digitally signed by Donald J.
Finkbeiner Date: 2021.04.16 16:22:37 -04'00'
Alyssa Skehan Alyssa Skehan Digitally signed by Alyssa Skehan Date: 2021.04.16 16:27:02 -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: 2021.04.19 12:52:28-05'00' Foxit PhantomPDF Version: 10.1.1
Jason L Toole
Michael W. Foster Jr., P.E. Michael W. Foster Jr.
Digitally signed by Michael W.
Foster Jr.
Date: 2021.04.19 15:30:53 -04'00'
$ 0.00
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