CN-550000-C9140-00020000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

TASK WORK ORDER AMENDMENT FORM

FOR PROFESSIONAL SERVICES

375.030-26

PROCUREMENT

7/16

Consultant:

Inwood Consulting Engineers, Inc.

Address:

3000 Dovera Drive, Suite 200, Oviedo, FL 32765

Contract Number:

C-9140

(To be entered upon execution of Task Work Order Amendment) Date: a— 8, _02 0/ 7

Amendment No. 002 to Task Work Order No. 012 Payment FM No. (must be the same as original Task Work Order):

43020262201

Purpose of Amendment:

SR A1A Concept Revision TWO Extension to 04/30/2017

Check all applicable terms:

The time for completion of services for the subject task work order is extended thru 4/30/2017

0 The subject task work order is hereby closed. Final payment for the task work order has been paid. No additional services or charges are authorized against this task work order beyond the date of execution of this amendment. The following amount Is the remaining work order balance to be recovered from this task work order $ Note: for Prof. Serv. Task Work Order Amendments, the encumbrance line should never be closed (Status 50) by Financial Services staff based on this selection.

The subject task work order is hereby canceled (no work has been performed and no payment is due). The total amount of the task work order which is recovered is $

The total amount for services performed under this task work order is increased by $

The additional funds will be allocated to the following compensation elements described below.

p The total amount for services performed under this task work order is decreased by $

The decrease in funds will be allocated to the following compensation elements described below.

0 There is no increase/decrease in he task work order amount, funds are only redistributed between compensation elements. Revised compensation elements are described below.

Compensation Element Description

Method of Compensation

Previous Amount

This Amendment Amount

Subtotal Check if Estimate

SR A1A Concept Revision (LS2) Lump sum paid based on % of completion $28,755.87 $28,755.87 .

$0.00 .

$0.00 II

$0.00 I

$0.00 III

$0.00 II

Page 1 subtotals $0.00 $28,755.8

Page 2 through 6 subtotals

This Amendment Total Total

$0.00 $28,755.87 ❑ Other Notes:

Attachments:

Total Contract Authorizations to Date Including this Amendment $ 790,807.21

Departmental Approval:

Amy Sirmans, P.E. Project Development Manager

(name) (title)

(s. )

Consultant Acceptance:

David Dangel, P.E. Principal

(name) (title)

(signature)`

Distribution:

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