CN-370000-GC130-T3CO3.pdf

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

OOO-012 (Effective 10-13-2017) Page 1 of 2

Required Signatures: Adobe Signature

Task Assignment Number: Date: Change Order No.

Contractor Name:

Contractor Representative:

DEP Contract Manager:

Description of Change (Use additional sheets if necessary):

Change in Task Amount

Item Cost Reimbursement Fee Schedule Total Original Task Amount:

Task amount prior to this change order:

Net increase/decrease in task amount:

Task amount with all change orders:

Change in Task Time

Original task completion date:

Completion date prior to this change:

Net increase/decrease in task period:

Completion date with all change orders:

3 1/29/19 3

NorthStar Contracting Group

Kristy Trueblood

Robert Perlowski

1,889,017.72 1,889,017.72

2,005,345.72 2,005,345.72

93,000.00 93,000.00

2,098,345.72 2,098,345.72

6/30/19

6/30/19

N/A

6/30/19

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

OOO-012 (Effective 10-13-2017) Page 2 of 2

Change in Funding Information

Budget Entity Project # Grant # Org Code Fund Special Category

Object Code

EO Amount

Total:

CONTRACTOR FLORIDA DEPARTMENT OF

ENVIRONMENTAL PROTECTION

Contract Manager Date Contract Manager Date

Program Administrator Date

APPROVED:

Budget Representative Date

Division Director Date

Deputy Secretary Date

Secretary Date cc: Procurement Section (MS93) Bureau of Finance & Accounting (MS78) - 2 copies

37450300 GC130 37450201000 780001 101492 131300 ZB 93,000.00

1/29/19 1/29/19

93,000.00

1/29/19

Kristy Trueblood

Digitally signed by Kristy Trueblood Date: 2019.01.29 14:32:16 -05'00'

Robert Perlowski Digitally signed by Robert Perlowski Date: 2019.01.29 14:23:59 -05'00'

Teresa Booeshaghi

Digitally signed by Teresa Booeshaghi Date: 2019.01.29 15:06:02 -05'00'

Monica Brady Digitally signed by Monica Brady Date: 2019.01.29 15:17:39 -05'00'

FLORIDA DEPARTMENT OF

Environmental Protection

Bob Martinez Center

2600 Blair Stone Road

Tallahassee, FL 32399-2400

Ron DeSantis Governor

Jeanette Nuñez

Lt. Governor

Noah Valenstein

Secretary

Task Assignment Change Order Contract GC130, Task Assignment 3, Change Order 3

Description of Change:

This Change Order authorizes the addition of $93,000.00 to Task Assignment 3, Task 15: general Administrative and Accounting, for Contractor staff to work on VCTC Applications for the Division of Waste Management. Contracted staff will be agreed upon by DEP and the Contractor, and conform to the staff designations and hourly rates as defined in Contract GC130.

The funding source for these positions will be added to Contract GC130 as follows;

Organization Code: 37450201000

EO: ZB

Object Code: 131300 Fund: 780001 Category: 101492 Year: 00 Project Number: GC130 Total Amount: $93,000.00

This increase in funding is being made to reflect actual program workloads, and will result in a net increase to the original funding amount.

End of Change Order Description

Change in Task Amount