CN-370000-CN220-T15CO1.pdf

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:

CN220 15 1 61230C

Ellie Schiller Homosassa Springs Wildlife State Park Ranger Residence

Dewberry Engineers Inc.

Deji Ajose-Adeogun 850-523-0062 AAjose-Adeogun@Dewberry.com

Philip Stone 850-245-2570 Philip.Stone@FloridaDEP.gov

This no-cost change order is to extend the expiration date for a year per the attached email dated 10/15/2020.

$ 1,100.00 $ 59,585.54 $ 60,685.54 $ 1,100.00 $ 59,585.54 $ 60,685.54

$ 0.00 $ 0.00 $ 0.00 $ 1,100.00 $ 59,585.54 $ 60,685.54

8/6/2019

12/31/2020

12/31/2020

12/31/2021

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2020.10.19 14:29:24 -04'00'

Laura Ross Laura S. Ross Digitally signed by Laura S. Ross Date: 2020.10.19 14:50:15 -04'00'

Philip Stone P.T. Stone Digitally signed by P.T. Stone Date: 2020.10.19 17:06:19 -04'00'

Deji Ajose-Adeogun Digitally signed by Ayodeji Ajose-Adeogun DN: CN=Ayodeji Ajose-Adeogun, OU=A01410C000001720DFB7ED00000EF01, O=Dewberry, C=US Reason: I agree to the terms defined by the placement of my signature on this document Date: 2020.10.20 09:32:18-04'00'

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

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2020.10.26 13:47:46 -04'00'

$ 0.00

Ross, Laura S.

From: Ajose-Adeogun, Ayodeji <AAjose-Adeogun@Dewberry.com> Sent: Thursday, October 15, 2020 4:18 PM To: Ross, Laura S.

Subject: Extension Request TA15

Follow Up Flag: Follow up Flag Status: Flagged

Good afternoon Laura, This is formal request to extend TA15 to 12/31/2021.

Thank you, Deji Ajose-Adeogun, PE Senior Project Manager Dewberry 101 N. Monroe Street, Suite 710 Tallahassee, FL 32301 850.354.5181 www.dewberry.com

Visit Dewberry’s website at www.dewberry.com If you’ve received this email even though it’s intended for someone else, then please delete the email, don’t share its contents with others, and don’t read its attachments. Thank you.