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Home My WebLink Aboutcontract checklist.fo Provider: Carol Cann Return to Sarah Perez Marl 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 • 05199 Raga 1 al3 CONTRACT NUMBER: C-8286 SITE/DISTRICT 6 Total Executed Contract Amount: $ 1,107,500.00 1 $ 1,107,500.00 To data This action Status Code (choose one) 10 = Executed Contract 4X or 6X = Audit Status (Indicate Year) 20 = In Claims 99 = Post Design Service 50 = Complete/Terminated Contract Original Contract Amendment (Indicate #) Renewal Addition (Indicate #) Award Supplemental (Indicate #) " Letter of Authorization (Indicate #) Time Extension Close Contract Other Changes (must include comments) LETTING DATE: N/A AWARD DATE: N/A ATE 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: _03/19102 SERVICES ENDING DATE: 03119/04 VENDOR NAME: Consul -Tech Transportation, Inc. PROJECT NUMBER: 41165813201 PROJECT NUMBER: VENDOR NUMBER (FEIDISS): VF 592197377-OO8 PROJECT NUMBER: 41165913201 PROJECT NUMBER: CAN THIS CONTRACT BE RENEWED? • YES • NO SERVICE TYPE: 973340 PAGE NUMBER RENEWAL CLAUSE IN CONTRACT: Comments: ,tification Statement 1 certify that the above information ra correct and a true reflection of information contained In the above referenced cowed - Approved by: (Printed or t •ed) Ron Fountain Approval Signature: Professional Services Admini Approval Dale: . r • FORM 350.020.06 COMPTROLLER • FIN AOMIN • 05i96 Paw 2DI3 ' 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 08B849 . 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 287.458(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) N/A 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 8 rates) See Exhibit "B" (Provide documentation, where applicable) 8 Lurnp Sum (LS) - specify partial payment criteria and identify what constitutes completion and acceptance See Exhibit "5" C Cosi Reimbursement (CR) (216.346 F S. must be complied with) - Provide budget break-out/Re-cap of expenses. D. Cost Plus (any combination of these) (CP) E. Advance funded (AD) - T. Yes ;41 No If yes, compliance with 216.181(14)(b) or 215.422(14) must be documented '14 Amendments/renewals/extensions Executed prior to the end of the contract and in compliance with 215 425 F.S. Renewais In compliance with 287 057(12) Extensions in compliance with 287 012(10), (11) 1 FORM 350-020-0e COMPTROLLER f IN ADMMN - owes Page 3of3 5 Amendments/renewals/extensions are effective on the last date signed. • 15. 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 11 requires approval of the DMS Division of Communications (Rule 60C). '20 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) All 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 Comptroller'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. Management Name (please print) Ron Fou '22 Management Approval Signature '23. Management Title Professional Services Administrator '24. Management Approval Date RECYCLED PAPER 19