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�t <br /> STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 350-02606 <br /> CONTRACT STATUS CHANGE/CHECKLIST COMPTROLLER <br /> 0W02 <br /> Pagel of 3 <br /> STATE COMPTROLLER USE: <br /> Info. Provider: Darryl Wright Received date: <br /> Return to: Karen Maxon Approved date: <br /> Mail Station : Financial services Approved by: <br /> Suncom # of Info Provider: <br /> CONTRACT NUMBER: ANX-78 SITE/DISTRICT <br /> Total Executed Contract Amount: $ 3 ,222,845.87 I $ 0.00 <br /> To date This action <br /> Status Code (choose one) ❑ 10 = Executed Contract ❑ 4X or 6X = Audit Status (Indicate Year) <br /> ❑ 20 = In Claims ❑ 99 = Post Design Service ❑ 50 = Complete/ Terminated Contract <br /> ❑ Original Contract ❑ Amendment (Indicate #) 2 ❑ Renewal ❑ Addition (Indicate #) <br /> ❑ Award ❑ Supplemental (Indicate #) ❑ Letter of Authorization (Indicate #) <br /> ❑ Time Extension ❑ Close Contract ❑ Other Changes (must include comments) <br /> LETTING DATE : AWARD DATE : <br /> DATE OF CONTRACT EXECUTION (Last Signed Date) : <br /> If last date signed > contract start date you must submit emergency certification (287 .059 F.S. (2) 1 ) or <br /> Certificate of noncompliance (287 .059 F.S. (2)) or settlement document (CM4(87-88) or CM11 (91 -92)). <br /> CONTRACT BEGINNING DATE: 3/7/2005 ENDING DATE: 11 /22/2006 <br /> SERVICES BEGINNING DATE : SERVICES ENDING DATE: 11 /22/2006 <br /> VENDOR NAME: Indian River County VENDOR NUMBER (FEID/SS): VF596000673026 <br /> PROJECT NUMBER: PROJECT NUMBER: <br /> PROJECT NUMBER: PROJECT NUMBER: <br /> CAN THIS CONTRACT BE RENEWED? Q YES @I NO SERVICE TYPE: <br /> PAGE NUMBER RENEWAL CLAUSE IN CONTRACT: <br /> Comments: <br /> Certification Statement: I certify that the above information is correct and a true reflection of information contained in the above referenced <br /> contract. <br /> Approved by: (Printed or typed) KAREN MAXON Title: BUDGET COORDINATOR <br /> Approval Signature: Approval Date: <br />