Form PCS-1A Amendment to Professional Consultant Services Contract - Arkansas

Form PCS-1A or the "Amendment To Professional Consultant Services Contract" is a form issued by the Arkansas Department of Finance & Administration.

The form was last revised in August 1, 2015 and is available for digital filing. Download an up-to-date fillable Form PCS-1A in PDF-format down below or look it up on the Arkansas Department of Finance & Administration Forms website.

ADVERTISEMENT
STATE 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
STATE 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
STATE 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

Download Form PCS-1A Amendment to Professional Consultant Services Contract - Arkansas

938 times
Rate
4.3(4.3 / 5) 47 votes
ADVERTISEMENT
Page of 2