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Enterprise Edition Powered By. CobbleStone Systems Corp. <br /> Application Version:12.4.3.121231 (.GL Peg Mason May 09 2018 16:01:34 <br /> [ Home Contracts Tho1'<.nei,-'- rAn <br /> Contract Detai: <br /> Add New <br /> Details <br /> Contract <br /> CMS Identification# (*§): 108362 Create Contract <br /> Contract Title(§): AMEND1-LOAN- & Link <br /> HOLITA DAM i., Attachments <br /> REHABILITATION j Tasks&E-mails <br /> Fiscal Year: 2018 — ✓ Checklist <br /> Contractor/Vendor(t§): CORSENTINO <br /> Price/Cost Line <br /> DAIRY FARM, INC. Li Items <br /> FEIN: 0934 Assign <br /> Contract Administrator: Mason, Peg _. Employees <br /> Program Manager: Mauss,Anna _ Add(itional) <br /> Agency/IHE(Department) Name(*§): Department of ' Companies <br /> Natural Resources Assign <br /> Agency/IHE(Department)Code: PDA-WATER Departments <br /> CONSERVATION Assign Locations <br /> BOARD A Notes <br /> Unique Department Contract Number: ,�,: Print <br /> Original Contract CLIN or other Identifying Number: ORIG CMS 102868 _ <br /> Purchase Order or Encumbrance Number: CT2018-980 Refresh <br /> Link Contract <br /> Modification , ." <br /> Contract Group/Type (§): <br /> Document Status: N/A ti View History, <br /> Effective Date: 5/9/2018 Financials <br /> Is this a Statutory Violation?: ;i1 Company Info <br /> If this Modification is to renew/extend a contract, has the contractor's work to Q5 Copy. <br /> date been certified as complying with the terms of the contract AND the Master <br /> CMS contract record updated?: E-mail <br /> If applicable,enter date of MOST RECENT annual certification of contractor View Ratings <br /> work.: <br /> Does this Modification CHANGE the DOLLAR amount of the Contract?: Yes Document <br /> If the Modification Adds or Subtracts money,what is the dollar amount of the 27,270.00 <br /> change?: Processing: <br /> Does this Modification change the length of the Contract?: No <br /> If the Modification changes the length of the Contract,what is the new -- XC Delete Contract <br /> Performance End Date?: <br /> If the Modification is not for money or time, describe the purpose for the Field Entry Notes: <br /> modification.: * - Public <br /> Notes: Website Field for <br /> Custom Field 1: _ applicable contract <br /> Custom Field 2: <br /> types <br /> Custom Field 3: _ <br /> Entered By: Mason, Peg § - Required by <br /> Statute for <br /> Entered on Date: 3/8/2018 10:52:02 <br /> applicable contract <br /> AM <br /> Updated By: Mason, Peg types <br /> Updated on Date: 5/9/2018 4:01:32 <br /> PM Full Help Text <br /> available on OSC <br /> website LINK <br /> Files/Attachments (Updated 8123/11), <br />