State Of Arkansas Amendment To Professional Consultant Services Contract
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1
2STATE OF ARKANSAS
AMENDMENT TO PROFESSIONAL CONSULTANT SERVICES CONTRACT
CONTRACT #:
AMENDMENT #:
1.
CONTRACTING PARTIES:
AGENCY NUMBER & NAME
Service Bureau
VENDOR NAME
TRACKING # 1
TRACKING # 2
2.
NEW CONTRACT EXPIRATION DATE:
mm/dd/yyyy (If not extending contract to new date, please leave blank)
3.
PURPOSE OF AMENDMENT:
4.
AMENDED DOLLAR AMOUNT:
For each amendment involving a change in the contract dollar amount, enter the previous contract amounts. Enter this
amendment’s amounts, showing (+) for increase and (-) for decrease, in compensation and/or reimbursable expenses. Enter the
new total compensation and/or reimbursable expenses for this contract. Note: Any increase in the rate of compensation must
be accompanied by a copy of the original contract language authorizing such increase.
PREVIOUS
THIS AMENDMENT
NEW TOTAL
COMPENSATION
$
$
$
EXPENSE
$
$
$
TOTAL
$
$
$
Total dollar amount paid on contract as of this date: $
as of
UPDATED TOTAL PROJECTED COST
$
5.
NEW AND/OR REVISED ATTACHMENTS:
EXCEPT AS SPECIFICALLY AMENDED HEREIN (OR AS ATTACHED) ALL OTHER TERMS AND CONDITIONS OF THE
ABOVE REFERENCED CONTRACT REMAIN UNCHANGED.
6.
SIGNATURES:
VENDOR
DATE
AGENCY DIRECTOR
DATE
TITLE
TITLE
ADDRESS
ADDRESS
APPROVED:
DEPARTMENT OF FINANCE AND ADMINISTRATION
DATE
FORM PCS-1A
Page 1 of 2
8/1/2015
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