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Docusign Envelope ID: A5542800-FO7B-88E3-82CC-B1C8A3BDE84C <br />1) Complete and preferred: Shows amendment on new line. <br />831 <br />-I <br />❑ <br />Q Increase <br />Amount of <br />$ <br />321,980.00 <br />AMENDMENT: (check all thatapply) <br />Time Extension <br />[:I Decrease <br />Amendment <br />Name Change/add <br />❑� <br />Total of Contract <br />$ <br />1,138,372.00 <br />Other. suspension <br />after Amendments- <br />TERM: <br />Start Date: i 2/= <br />End Date: <br />11/3Q/2022 <br />CcntractCast <br />$ <br />L183,872.00 <br />How To Encumber and Disburse: <br />Sales Tax (PWonlyj-,j <br />5 <br />Program Budget ManalZer Completes <br />Total Eligible Cost: <br />r,$ <br />1,188,872 W <br />(Required for Single -year operating Appropriations & <br />Required information: <br />contracts extending beyond current biennium) <br />Prior Bieris <br />CurtentBl <br />CurrentBi <br />MIC (3 char) Fund/EW Project -Sub -Prof <br />FY: 2Q <br />FY: 21 <br />Totais <br />/1—XJ28-02 <br />866,892.00 <br />866,892.00 <br />0009J23N <br />0009/831 23N/A13 X128-02 <br />Fiscal Staff: <br />GL: Subsidiary: Misc: <br />321,990.00 <br />Budget Tota11 $ 1,1W,872.0 <br />Budget Total must equal Total Eligible Cost <br />2) Complete and preferred: Shows prior paid amounts in Previous MIC <br />❑� <br />Increase <br />Amount of <br />50 825 00 <br />AMENDMENT: (check <br />all thatapply) <br />Time Extension <br />❑ Decrease <br />Amendment -- <br />Add deliverab les for <br />❑� <br />Total of Contract <br />$ 248,010.00 <br />other: -Z4 <br />after Amendments: <br />TEAM: <br />Start Date: 10/14/2019 <br />End Date: <br />10/37./"24 <br />Contract Cost: <br />$ 248,010.00 <br />How To Encumber and Disburse: <br />Sales Tax tPWonly)- <br />$ <br />Program Budget Manager Completes <br />Total Eligible Cost <br />$ 248,010.00 <br />(Required for Single -year operating Appropriations & <br />Required information: <br />contracts extending beyond current biennium) <br />Prior Bien's <br />Currerrt BI <br />Cuareat Bf <br />MIC (8 char) Fund/EAI <br />Project-sub-Proj_ <br />FY: <br />23 <br />FY: <br />Totals <br />Prior-BN <br />197,185.00 <br />1.97,185.00 <br />E61PLOAO 23P/GAO <br />9WG&EM <br />38,]18.75 <br />,706.5 <br />E6NTROAO 23P/OAO <br />9WD2-MN <br />�• <br />12'66.25 <br />12 <br />(Fiscal Staff: <br />GL I Subsidiary: Misc: <br />SUdgetTotall 248,010.00 <br />Budget Total must equal Total Eligible Cost <br />3) NOT COMPLETE/INCORRECT - only lists amendment amount. <br />` `I` 0 Increase Amount of 8,630.00 <br />AMENDMENT: (check all that apply)( ❑� Time Extension I © ®ecrease Amendment $ <br />