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Home My WebLink Aboutcontract status checklist.r Info Provider: Carol Cann Return to Sarah Perez Mail Station: 6114 Suncom # of Info Provider 429-5126 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION CONTRACT STATUS CHANGE/CHECKLIST STATE COMPTROLLER USE: Received date: Approved date: Approved by: FORM 350.020.06 COMPTROLLER - FIN ADMIN • 05/98 Page 1 of 3 CONTRACT NUMBER: C-8286 SITE/DISTRICT 6 Total Executed Contract Amount: $ 1,107,500.00 / $ 1,107,500.00 To date This action Status Code (choose one) ' 10 = Executed Contract i 4X or 6X = Audit Status (Indicate Year) 20 = In Claims 99 = Post Design Service - 50 = CompletefTerminated Contract Original Contract Award Time Extension LETTING DATE: NIA Amendment (Indicate #) ' Supplemental (Indicate #) Close Contract Renewal Addition (Indicate #) Letter of Authorization (Indicate #) -. Other Changes (must include comments) AWARD DATE: NIA DATE OF CONTRACT EXECUTION (Last Signed Date): 03/19/02 If last date signed > contract start date you must submit emergency certification (287.059 F.S. (2) 1) or Certificate of noncompliance (287.059 F.S. (2)) or settlement document (CM4(87-88) or CM11 (91-92)). CONTRACT BEGINNING DATE: 03/19/02 ENDING DATE: 03/19/07 SERVICES BEGINNING DATE: 03/19/02 SERVICES ENDING DATE: 03/19/04 VENDOR NAME: Consul -Tech Transportation, Inc. VENDOR NUMBER (FEID/SS): VF 592197377-008 PROJECT NUMBER: 41165813201 PROJECT NUMBER: 41165913201 PROJECT NUMBER: PROJECT NUMBER: CAN THIS CONTRACT BE RENEWED? YES NO SERVICE TYPE: 973340 PAGE NUMBER RENEWAL CLAUSE IN CONTRACT: Comments: Certification Statement: I certify that the above information is correct and a true reflection of information contained in the above referenced contract Professional Services Admini 3%7 Approved by: (Printed or t Approval Signature: Ron Fountain Approval Date: ;.a pket • FORM :150.020-06 COMPTROLLER • FIN ADMIN .05f95 Page 2 of 3 ' Denotes areas to be completed by Project Manager. ' SAMAS Operating Level Agency Code: 55 CONTRACT SAMAS ACCOUNT CODE: Example: 55102540001-5590000000 (Category = 6 digits) (Year = 2 digits) 55062020629-55100100 088809 - 02 55063030643 088849 - 02 '10 Deliverables/Milestones - (Must be clear, detailed, concise language, i.e., tasks, % complete, time frame or milestones, goods, services) '11, CONTRACT DOCUMENT - Mandatory Provisions (insert where referenced from contract in the space provided, if applicable) A3,SPSAT 215.422(5) EXH NB 287,058(1)(d) N/A 287.058(4) N/A 216.347 PAGE 1 287,058(1)(e) A4,SPSAT 287.0582 A2,SPSAT 287.058(1)(a) N/A 287.058(1)(f) A6,SPSAT 287.133(2)(a) A3,SPSAT 287.058(1)(b) PAGE 2 287,058(2) N/A Rule 60A-1.017, FAC A5,SPSAT 287.058(1)(c) NIA 287.058(3) SPSAT = Standard Professional Services Agreement Terms SCSAT = Standard Contractual Services Agreement Terms '12 Method of Procurement CCN - Consultants Competitive Negotiation Act (C) '13. Method of Payment (FR, LS, CR, CP, AD) A. Fixed Rate (FR) - specify unit and rates (may be multiple units & rates) See Exhibit "B' (Provide documentation, where applicable) B. Lump Sum (LS) - specify partial payment criteria and identify what constitutes completion and acceptance See Exhibit "B" C. Cost Reimbursement (CR) (216.346 F.S. must be complied with) - Provide budget break-outiRe-cap of expenses. D. Cost Plus (any combination of these) (CP) E Advance funded (AD) - Yes AD No If yes, compliance with 216.181(14)(b) or 215.422(14) must be documented '14 Amendmentslrenewals/extenslons Executed prior to the end of the contract and in compliance with 215.425 FS. Renewals in compliance with 287 057(12) Extensions in compliance with 287.012(10), (11) 11 FORM 350-020-06 COMPTROLLER - FIN AOMIN - 05126 Page 3of3 '15. Amendments/renewals/extensions are effective on the last date signed. '16 Method of Procurement will be required if additional services are added to existing contract. '17, Information Technology Resources (ITR) acquisitions Attach approvals, if applicable [see 282.311 and 287.073(5)(a), FS) '18. OTHER SERVICES REQUIRING SPECIAL APPROVALS (Attach, if applicable) Private attorney services Consultant and professional services contracts entered into by agencies under the Governor and Cabinet •19, Purchase of communication equipment or services in excess of Threshold Category it requires approval of the DMS Division of Communications (Rule 60C). Management Controls - a) All the foregoing statements are true and correct; the undersigned management represents that controls are in place to insure that goods/services are received, and payments are made in accordance with contract terms. b) Alf completed work will be verified in a certified statement signed by the contract manager or higher authority prior to payment. The undersigned understands that the State Comptrotler's office reserves the right to either appoint special contract monitors on contracts or to conduct periodic site post -audits of any contracts. c) Certification Statement: I certify that the above information is correct and a true reflection of information contained in the above referenced contract. '21. Management Name (please print) Ron Fou g '22. Management Approval Signature '23. Management Title Professional Services Administrator "24. Management Approval Date RECYCLED PAPER