CN-370000-GC910-T6CO1.pdf
PDF 656 KB Posted
- Contract number
- GC910
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 1) issued by the Florida Department of Environmental Protection (FDEP) dated April 6, 2023. The document modifies an existing task assignment (GC910-6) with Escambia County. Gregory Berrian serves as the Contractor Representative, and Roger Ruiz is the DEP Contract Manager. The change order has been approved by Tameshia N. Reid (Budget Representative) and Jessica Kramer (Contractual Authority).
The change order increases the total task amount by $62,210, comprised of two separate increases: $210 for Ethanol/Biodiesel Inspections and $62,000 for Variable Inspections. The original task amount of $387,510 is increased to $449,720 with all change orders. The task completion date remains June 30, 2023. Funding is allocated across three budget lines under Organization Code 37450104000, with amounts of $387,510.00 (Object Code 132500, Special Category 100029, Year 00), $62,000.00 (same coding, Year 00), and $210.00 (Object Code 132500, Special Category 087889, Year 23). All required signatures have been digitally executed as of April 6-7, 2023.
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Text version
OOO-012 (Effective 09-14-2015) Page 1 of 2
Florida Department of Environmental Protection
TASK ASSIGNMENT CHANGE ORDER FORM
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:
GC910-6 04/06/2023 1
Escambia County
Gregory Berrian
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $210.
A net increase of $210.
Increase in funds for Variable Inspections for $62,000.
A net increase of $62,000.
$ 387,510 $ 387,510
$ 387,510 $ 387,510
+$ 62,210 +$ 62,210
$ 449,720 $ 449,720
06/30/23 06/30/23 +62,210 06/30/23
OOO-012 (Effective 09-14-2015) Page 2 of 2
Florida Department of Environmental Protection
TASK ASSIGNMENT CHANGE ORDER FORM
Change in Funding Information
Org. Code E.O. Object Code Budget Entity
Special Category
Grant # Year Amount
CONTRACTOR FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
Contract Manager Date Contract Manager Date
APPROVED:
Budget Representative Date
Contractual Authority Date cc: Procurement Section (MS93) Bureau of Finance & Accounting (MS78) - 2 copies
37450104000 JD 132500 37450300 100029 00 $ 387,510.00
37450104000 JD 132500 37450300 100029 00 $ 62,000.00
37450104000 JG 132500 37450300 087889 23 $ 210.00
Gregory M Berrian Digitally signed by Gregory M Berrian Date: 2023.04.06 07:41:13 -05'00'
04/06/2023 Roger Ruiz Digitally signed by Roger Ruiz Date: 2023.04.06 10:28:55 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.04.06 11:04:10 -04'00'
Jessica Kramer Digitally signed by Jessica Kramer Date: 2023.04.07 08:13:36 -04'00'
File details come from the government source that posted it. Updated .