CN-370000-CN304-T12CO1.pdf

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

( ) 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:

CN304 12 1 61218C

Cross Florida Greenway - Santos Equestrian Trailhead New Restroom

GPI, Inc.

Travis Justice 850-297-2944 tjustice@gpinet.com

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

This agreement adds additional time and funding to provide construction administration services not previously tasked. See proposal dated 12/19/19 and extension request dated 12/12/20 attached.

$ 1,200.00 $ 34,803.11 $ 36,003.11 $ 1,200.00 $ 34,803.11 $ 36,003.11 $ 213.00 $ 12,180.94 $ 12,393.94

$ 1,413.00 $ 46,984.05 $ 48,397.05

12/31/20

12/31/20

12/31/20

12/31/21

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2020.12.11 10:18:43 -05'00'

JR Keen Uyles W. Keen Jr Digitally signed by Uyles W. Keen Jr Date: 2020.12.11 10:27:38 -05'00'

Philip Stone P.T. Stone Digitally signed by P.T. Stone Date: 2020.12.11 10:31:15 -05'00'

Travis Justice Travis K Justice Digitally signed by Travis K Justice Date: 2020.12.11 09:46:27 -06'00'

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

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2020.12.11 14:49:19 -05'00'

61218C 3750300275 088130/20 408001 U3200 131500 PF $ 12,393.94

$ 12,393.94 o o o o o o o o

From: Bill Johnson To: Keen, Uyles (JR) Cc: Matson, David; Rowe, Richard J.; Travis Justice Subject: RE: Time Extension for TA 12 - Cross Florida Greenway, Santos Equestrian Camp Restroom Date: Thursday, December 10, 2020 2:02:51 PM Attachments: image003.png image001.png

JR Keen, It has been indicated that Task 6 (Construction Administration) is to be included in the TA 12 - Cross Florida Greenway, Santos Equestrian Camp Restroom project. Please accept this request that Task 6 be incorporated in the agreement being extended until 12/31/2021. Per the scope, Task 6 has a fixed price cost of $12,393.94.

If you have any questions or need additional information, please contact me at your earliest convenience.

William K. Johnson, P.E., P.S.M., CFM d +1 (850) 297-2930 | c +1 850-251-8799 An Equal Opportunity Employer