043-14 - WA State Public Works Board - Contract Amendment 5f
Washington State Department of
� Hea I t h
CONTRACT AMENDMENT
1. NAME OF CONTRACTOR
2. CONTRACT NUMBER
City of Port Orchard
DOH Contract #
DM13-952-185/DWL24355
l a. ADDRESS OF CONTRACTOR (STREET)
2a. AMENDMENT NUMBER
216 Prospect Street
5
1 b. CITY, STATE, ZIP CODE
Port Orchard, WA 98366-5326
3. ® THIS ITEM APPLIES ONLY TO BILATERAL AMENDMENTS.
The Contract identified herein, including any previous amendments thereto, is hereby amended as set forth in Ttem 5
below by mutual consent of all parties hereto.
4. ❑ THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS.
The Contract identified herein, including any previous amendments thereto, is hereby unilaterally amended as set forth
in item 5 below pursuant to that changes and modifications clause as contained therein.
5. DESCRIPTION OF AMENDMENT: The purpose of this amendment is to deobligate remaining funds. Original
contract amount is $6,060,000. $290,676.07 of billed amount was withheld to meet the 10% withholding amount.
Contract was not finalized and changed to a new preconstruction loan.
Original Loan Amount: $6,060,000.00
Deobligated Amount: $546,000.00
New Loan Amount: $5,514,000.00
5a. Consideration: This amendment decreases the Contract Consideration by $546,000.00; therefore, the revised
maximum consideration of this contract and all amendments shall not exceed $5,514,000.00.
Source of Funds for this Amendment: (FED) $0; (ST $} 1); [Other) $0; Total 546,000.00
Contractor agrees to comply with applicable rules and regulations associated with these federal funds.
5d. Period of Performance: remains unchanged through 12/31/2021.
5e. The Effective Date of this Amendment: is the Date of Execution.
6. All other terms and conditions of the original contract and any subsequent amendments thereto remain in full force and
effect.
7. ❑This is a unilateral amendment. Signature of contractor is not required below.
® Contractor hereby acknowledges and accepts the terms and conditions of this amendment. Signature is required below.
8. CONTRACTOR SIGNATURE (also, please print/type your name)
DATE
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9. DOH CONTRAcTTNG OFFTCER SIGNATURE
DATE
09/10/2021
I his document has been approved as to form only by the Assistant Attorney General.
DOH Amendment # 5
Commerce Contract # DM13-952-185/DWL24355
Revision 11/17
DWL24355-5 Kr Signed City of Port Orchard
Final Audit Report 2021-09-10
Created: 2021-09-10
By: Tonja Christensen (tonja.christensen@doh.wa.gov)
Status: Signed
Transaction ID: CBJCHBCAABAAMDIgxka2Hydk9-vB_XwpuigOOD-OFW4-
"DWL24355-5 Kr Signed City of Port Orchard" History
Document created by Tonja Christensen (tonja.christensen@doh.wa.gov)
2021-09-10 - 4:07:25 PM GMT- IP address: 192.230.13.106
Document emailed to WA Department of Health Contracts Office (dohcon.mgmt@doh.wa.gov) for signature
2021-09-10 - 4:07:50 PM GMT
Email viewed by WA Department of Health Contracts Office (dohcon.mgmt@doh.wa.gov)
2021-09-10 - 7:42:04 PM GMT- IP address: 192.230.13.106
dp Document e-signed by WA Department of Health Contracts Office (dohcon.mgmt@doh.wa.gov)
Signature Date: 2021-09-10 - 7:42:34 PM GMT - Time Source: server- IP address: 192.230.13.106
Agreement completed.
2021-09-10 - 7:42:34 PM GMT
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