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 17 3 6M104

St. Andrews State Park Jetty Area Repairs - Hurricane Michael

Dewberry

Deji Ajose-Adeogun, PE 850-354-5181 AAjose-Adeogun@Dewberry.com

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

Time only task assignment extension to allow consultant to complete previously tasked construction administration services. See email dated 12/8/20 attached.

$ 100.00 $ 27,774.16 $ 27,874.16 $ 600.00 $ 55,491.72 $ 56,091.72 $ 0.00 $ 0.00 $ 0.00

$ 600.00 $ 55,491.72 $ 56,091.72

8/20/2019

12/31/2019

12/31/2020

12/31/2021

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2020.12.10 12:46:33 -05'00'

Craig Roberts Craig Roberts Digitally signed by Craig Roberts Date: 2020.12.10 11:49:03 -05'00'

Philip Stone P.T. Stone Digitally signed by P.T. Stone Date: 2020.12.10 13:34:22 -05'00'

Deji Ajose-Adeogun, P.E.

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: 2020.12.14 09:44:53-05'00'

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

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2020.12.14 13:39:41 -05'00'

$ 0.00

$ 0.00

From: Ajose-Adeogun, Ayodeji To: Rowe, Richard J.

Cc: Matson, David; Roberts, Craig (Stephen) C Subject: Time Extension for TA17 - St. Andrews, Hurricane Michael Jetty Area Pavilion Replacements Date: Tuesday, December 8, 2020 10:43:58 AM

Good morning Richard, This email serves as request to extend the expiration data TA17 to 12/31/2021 to allow for construction and close out of the above referenced project.

Thanks, Deji Ajose-Adeogun, PE Senior Project Manager Dewberry 850.354.5181

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.

mailto:AAjose-Adeogun@Dewberry.com mailto:Richard.J.Rowe@dep.state.fl.us mailto:David.Matson@dep.state.fl.us mailto:Craig.Roberts@dep.state.fl.us https://secure-web.cisco.com/1gmc6zHAmmWMsYgC8X1V6k_FtpcMnd8cia25G7q2I1ZUY1nTOD21yrlBg4NL-tI5YkD6yqQHPc5OEOaNpkDfcqS9vhEPn9iSuk0EWb8j2XEDzXWvSzMEJXFGk2kRFaNx3yN1ZfDcnWVEIcWs0SiUIqV2F8Ou2c_wQTMszFB3v3Kw6s4LkmIuhvdFIwCY5qlhxMz5AOhcgZqdtfPdrORXuyvVguLuZV-veYtfeTrF30T3V6qo7pvqHCr3ARq61ORbWxs_t40tpKPbQQlxcBSCIXvuLtLZh5kIkaOThsxFa8gtfmiFZnFhBOwt1itjOOst1/https%3A%2F%2Fwww.dewberry.com