CN-370000-CN330-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:

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:

CN330 TA 12 01 61316C

Bahia Honda State Park Road Improvements

Cummins Cederberg, Inc.

Jason Cummins. P.E. 305-741-6155 jcummins@cumminscederberg.com

Ralph Perkins 850-245-2460 Ralph.Perkins@FloridaDEP.gov Description and Justification of Change:

This is a time-only extention; see attached dated 12/06/22.

$ 100.00 $ 11,952.60 $ 12,052.60 $ 100.00 $ 11,952.60 $ 12,052.60 $ 0.00 $ 0.00 $ 0.00

$ 100.00 $ 11,952.60 $ 12,052.60

04/26/22

12/31/22

12/31/22

12/25/23

Tamika Bass Tamika Bass Digitally signed by Tamika Bass Date: 2022.12.01 15:07:47 -05'00'

Terry McCullum Jr. Terry McCullum, Jr.

Digitally signed by Terry McCullum, Jr.

Date: 2022.12.01 15:22:33 -05'00'

Ralph Perkins Ralph M Perkins Digitally signed by Ralph M Perkins Date: 2022.12.05 11:20:54 -05'00'

Jason Cummings, P.E.

Digitally signed by Jason R Cummins Date: 2022-12-02 14:12:38

Michael W. Foster Jr., P.E.

61316C

$ 0.00

Michael W. Foster Jr., P.E.

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2022.12.06 16:54:10 -05'00'

EXTERNAL MESSAGE

This email originated outside of DEP. Please use caution when opening attachments, clicking links, or responding to this email.

Hello, I have clarified my request with the following language.

I followed up with our permitting processor for this project and although they have elevated the permitting delay issue to the Section Chief, we feel it would be best to get an extension of 360 days to the completion date for this Task Assignment – No. TA12 for the Bahia Honda road improvement project.

Thank you for your assistance.

Kind regards, Anne Laird, M. Sc., Senior Project Manager/ Marine Scientist

CUMMINS │ CEDERBERG

Coastal & Marine Engineering

T: +1 561-658-1297 C: +1 772-486-8530 alaird@CumminsCederberg.com

Please Note: Our offices will be closed from December 24th, 2022 through January 1st, 2023 in observance of the holidays.

mailto:alaird@CumminsCederberg.com