State Of Arkansas Amendment To Professional Consultant Services Contract Page 2
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1
2STATE OF ARKANSAS
AMENDMENT TO PROFESSIONAL CONSULTANT SERVICES CONTRACT
CONTRACT #:
AMENDMENT #:
7. AGENCY CONTACTS FOR QUESTION(S) REGARDING THIS CONTRACT:
Contact #1 – Agency Representative submitting/tracking this contract
(Name)
(Title)
(Telephone #)
(Email)
Contact #2 – Agency Representative with knowledge of this project (for general questions and responses)
(Name)
(Title)
(Telephone #)
(Email)
Contact #3 – Agency Representative Director or Critical Contact (for time sensitive questions and responses)
(Name)
(Title)
(Telephone #)
(Email)
8.
SOURCE OF FUNDS:
Complete appropriate box(es) below to total 100% of the funding in this contract to date.
Fund
% of Total
Fund Source
Identify Source of Funds
Fund
Amount of Funding
Center
Contract Cost
Other Funds
$
Other Funds
$
Other Funds
$
Other Funds
$
$
Other Funds
TOTALS
$
100%
* MUST BE SPECIFIC (i.e. fees, tuition, agricultural sales, bond proceeds, donations, etc.)
** “State Funds” is defined as and deemed State General Revenue Dollars. If other state funds are being used such as tobacco funds,
general improvement funds, etc., these should be noted. Special revenue funds from taxes or fees generated for the agencies should be
shown as “Other” and the actual source of the funds should be clarified in the “Identify Source of Funds.”
*** Funding and percentages shall reflect the total of the contract including all amendments to date.
FORM PCS-1A
Page 2 of 2
8/1/2015
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