HomeMy WebLinkAboutNYS DOS Contract C006877 Appendix X APPENDIX X
MODIFICATION AGREEMENT FORM
Agency Code: 19000/DOS01 Contract No.: C006877
Contract Period:08/15/09 to 12/31/12 Funding for Period: $0.00
This is an AGREEMENT between THE STATE OF NEW YORK,acting by and through the New York State Department of State,
having its principal office in Albany,New York(hereinafter referred to as the STATE),and Town of Southold(hereinafter referred to
as the CONTRACTOR),for modification of the contract number noted above,as amended herein and noted belo v
Type of contract modification-
El Renewal: Revised total contract value: $ (renewals only)
® No cost time extension
❑ Amendment: _— MAR 19 2012
❑ Attached Appendices:
All other provisions of said AGREEMENT shall remain in full force and effect. DEPL OF LAND
PRESERVATION
IN WITNESS WHEREOF,the parties hereto have executed this AGREEMENT as of the dates appearing under ineir signatures
CON ACTOR SIGNATURE NYS DEPARTMENT OF STATE
By: G�fiJ�� --- B y — --
Scott A. RuA!5-ell 106's-'r-a CA"a
(print name) (printgame)
DIRECTOR OF FINANCIAL ADMINISTRATION
Title: Southold Town Supervisor Title.
Date: _12L 20111 Date: -- ?_1 I y /I L
State Agency Certification. "In addition to the acceptance of this contract,I also certify that original copies of this signature page will be attached to as other
exact copies of this contract"
State of New York )
County of Suffolk —_)ss:
On this Lls day of Decem4er in the year 20_L!__,before me personally appeared
Scott A. Russell to me known and known to me to be the person who is the Supervisor of the
Town of Southold ,the organization described in and which executed the above instrument;and that he/ske
has the authority to sign on behalf of said organization;and that he/she executed the foregoing agreement for and on behalf of said
organization
JENNIFER ANDALORO,
Notary Public:,State of NOW York
/IUA-kA No.02ANS09MG
TACP UBLIC owdu ed in 8uif&Ooltnry
C'ff►rtlsalon F.*res January 14,20 I a
ATTORNEY GENERAL'S SIGNATURE: STATE OMATft0PLF.R'$, Vtg
//x,11
DEPT OF AUDIT.jt CONTROL
By: — By: — IAO 9 2012
Date: Date: I _ „ :4-c',FOR (HE STAT'-",11MIPTRDLLER