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Docusign Envelope lD: A5542800-F078-88E3-82CC-81 C8A3BDE84C <br />1) Complete and preferred: Shows amendment on new line' <br />AMENDMENT: (clreck a ll that aPPIY)E rime Exten5ion <br />lncrease <br />Decrea5e <br />2l complete and preferred: shows prior paid amounts in Previous Mlc <br />AMENDMENT: (chEck all that aPP E ri*e Extension E Incred9e <br />! oecrease <br />3) NOT COMPLETE/INCORRECT - only lists amendment amount. <br />E lnc.ease <br />fl Decrease <br />An'roLrnt 6f <br />Amendmentl <br />Am0unt of <br />Amendr'ent: <br />$ 321,98.0.00 <br />$ 50.825.GO <br />Am6unl of <br />,lmendmeni: <br />$ .r,1$s,372-ooTrt;l of ContractName change/addE other: <br />End 0ate:Start Date: <br />1,1&S.872.00Contrart fost: <br />Sales <br />aost:Total El <br />How To Encum ber and Disburse: <br />rCoMa <br />{Reqilrred for 5tnEle-yeJr Operating Approprlatlon5 & <br />c0ntracts extending beyond currenl bierrnium ) <br />Totals <br />Current 8l <br />FY: 2t20 <br />Current BlPrior Bien'9 <br />866,892.00 <br />321,980.i10321,980.00 <br />red information: <br />P ro i ect- 5u b- Proi <br />o009J831 <br />oaay&2L <br />Mlc <br />xJzE-07 <br />xJzS-47 <br />fund/EAl <br />23N/Ar.3 <br />23N/A13 <br />L,1&8,872.00 <br />Fiscal Staff: <br />Misc:9ubsidia6L;Budget Total must equal Total Eligible Cost <br />Budget <br />$ 248,010.cF!tota I 6f Corrtract <br />iflFr A0rP!rdrllerll!; <br />Add deliverables farE other: <br />7r.h2/2:024End oate:$/t4l\fiLeStart Date: <br />248.010.t10Contract Colt: <br />$SaletTax {P!V onlY}: <br />$ z48.o1o.ooTotal Eligible co5t:Prosram Budget Manaeer ComDletes <br />How To EDcutnber and Disburse: <br />(Hequrred for 5f n gle-yeat upercttng Apllrsprlat'ons & <br />contracts extending beyond eurrent bienniuml <br />Tota ls <br />Current El <br />FY:2t <br />Current Bl <br />FY, <br />Prior Bien's <br />197,re5.O0L97,Lss.Og <br />38,LrB.V538,11S.75 <br />L2,706.25Lzla6.75 | <br />Required information; <br />Fund/EAl Froiect sub.Prai <br />EOlPLOAO <br />F6NTROAO <br />gWG6_EM <br />9WD2'MN <br />Mlc (B char) <br />Prior-BN <br />23P/AAA <br />23?l_o!! <br />Fieca I staf{: <br />Misc:GL:Subsidiary:Oud6et Total mutt eguql Totol El igiblc cost <br />Budget <br />AMENDMENT: (check all that aPPIY)E Tin e ExtPnsion s s,630.o0