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CONTRACT MODIFICATION <br /> STATE OF HAWAII <br /> DEPARTMENT OF HUMAN SERVICES <br /> MODIFICATION NO. 3 Effective Date: 12/1/03 <br /> Contractor: Hawaii County Office of Aging <br /> Contract DHS-02-POS-1208 RFP HMS 601-02 <br /> Contract Title: Adult Chore Services-West Hawaii <br /> A. MODIFICATIONS <br /> The following modifications are to be performed in accordance with all contract stipulations <br /> (specifications, delivery point, rate of delivery, period of performance, price, quantity, or other <br /> provisions by mutual action of the parties to the contract): <br /> 1. Term of Contract: July 1, 2002 to June 30, 2005 <br /> 2. Original Contract Amount: $138,254.00 <br /> 3. Most Recent Contract Amount: $153,721.00 <br /> 4. Change in Funding by Fiscal Yeaz for this Modification: $4,176.00 increase for fiscal yeaz <br /> 2004. <br /> Additional Comments: <br /> B. CONTRACTOR'S QUOTATION <br /> The modifications described in A above will be performed at a contract price X increase or <br /> decrease of $4,176.00 <br /> Contractor will not undertake to perform. the changes in A above until this modification order has <br /> been approved and issued. <br /> Contractor's Signature Title Date <br /> C. STATEMENT OF CONTRACT FUNDS <br /> Original Contract Price: $138,254.00 <br /> Previous Adjusted Contract Price: $153,721.00 <br /> Amount this Change: Plus X Minus $4,176.00 <br /> New Adjusted Contract Price: $157,897.00 <br /> <br /> D. VALIDATION OF CONTRACT MODIFICATION <br /> User Agency Signature Title Date <br /> Director <br /> Head of Purchasing Agency Signature Title Date <br /> <br />