T2621 Appendix B - NJDEP Contract Modification Proposal and Acceptance 042A Form 9.29.26.pdf
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- Solicitation number
- 26DPP01289
- Issued by
- New Jersey
About this file
This is a Contract Modification Proposal and Acceptance Form (DWM-042A) issued by the New Jersey Department of Environmental Protection (NJDEP) for the Contaminated Site Remediation & Redevelopment program. The form serves as the standard document for proposing modifications to existing NJDEP general contracts. The form requires contractors to provide a detailed description of the proposed modification and a corresponding cost breakdown itemizing quantities, unit prices, and costs for each line item. The contractor must certify the accuracy of the proposal and acknowledge that no work is authorized until the modification is accepted by NJDEP and executed by the Commissioner or their designee. Contractors waive any claim for compensation for costs incurred under the modification that are not included in the submitted cost breakdown.
The approval authority for contract modifications is determined by modification cost: Section Chiefs approve modifications of $50,000 or less; Bureau Chiefs approve modifications exceeding $50,000 up to $100,000; Assistant Directors approve modifications exceeding $100,000 up to $250,000; Directors approve modifications exceeding $250,000 up to $500,000; and the Assistant Commissioner approves modifications exceeding $500,000. The Assistant Director of Financial Services must approve all contract modifications regardless of amount. The form requires signatures from the applicable approval authorities, the Assistant Director of the Division of Remedial Management, the Director of the Division of Remedial Management, and the Director of the Division of Enforcement & Financial Operations before execution. Copies are distributed to the contractor, initiating division, and Financial Services Element upon completion.
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Text version
DWM-042A
7/2024
New Jersey Department of Environmental Protection (NJDEP) Contaminated Site Remediation & Redevelopment
CONTRACT MODIFICATION PROPOSAL AND ACCEPTANCE FORM
GENERAL CONTRACTS
Let’s protect our earth
PI NUMBER:
ACTIVITY NUMBER:
JOB CODE:
PO #: ______________
C-Number: _______________
PI/PROJECT NAME AND LOCATION FUNDING AUTHORIZATION NO
and/or COOP. AGREEMENT NO.
CONTRACT NO.
ENGAGEMENT AND
MODIFICATION NOS.
I. PROPOSAL
A. DESCRIPTION OF MODIFICATION □ (Check if continued on additional sheets)
B. COST BREAKDOWN FOR MODIFICATION □ (Check if continued on additional sheets)
Item Quantity Unit Price Cost (+)
SUBTOTAL (from this page)
SUBTOTAL (from any attached pages)
TOTAL COST OF MODIFICATION
C.CERTIFICATION AND EXECUTION BY CONTRACTOR
I certify that this proposal is accurate. I understand that no work is authorized under this proposal until the proposal is accepted by the NJDEP and executed by the Commissioner or their designee. I hereby waive any claim for compensation for costs incurred under this modification but not contained in the cost breakdown.
Name and Title (Typed or Printed) Signature Date
Name of Company
Address
II. NJDEP APPROVAL AND EXECUTION
Staff: As per individual Job Specifications; Section Chief - $50,000 or less; Bureau Chief: >$50,000 up to and including $100,000; Assistant
Director: >$100,000 up to and including $250,000; Director: >$250,000 up to and including $500,000; Assistant Commissioner: Over $500,000. Assistant Director Financial Services Element: All Contract Modifications regardless of amount.
SECTION/BUREAU CHIEF Name (Typed or Printed) Signature Date
ASST DIRECTOR, DRM Name (Typed or Printed) Signature Date
DIRECTOR, DRM Name (Typed or Printed) Signature Date
ASST. DIRECTOR, FSE Name (Typed or Printed) Signature Date
ASST. COMMISSIONER,
CSRR
Name (Typed or Printed) Signature Date
III. EXECUTION BY DIRECTOR, DIVISION OF ENFORCEMENT & FINANCIAL OPERATIONS
Name (Typed or Printed) Signature Date
Copy Distribution: Contractor, Initiating Division, FSE
APPENDIX B
File details come from the government source that posted it. Updated .