CN-370000-GC912-T1CO4.pdf
PDF 655 KB Posted
- Contract number
- GC912
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 4) issued by the Florida Department of Environmental Protection on May 10, 2018. The change order modifies an existing task assignment (GC912-1) with Duval County. Jean Richards serves as the Contractor Representative, and Roger Ruiz is the DEP Contract Manager. The document has been approved by Jennifer Vickers (Budget Representative) and Tim J. Bahr (Contractual Authority).
The change order increases funding for Variable Inspections by a net amount of $45,000.00. The task amount prior to this change order was $414,717.30, resulting in a revised total task amount of $459,717.30 following all change orders. The completion date for the task remains unchanged at June 30, 2018. The funding is allocated from Organizational Code 37450104000 with E.O. designation JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, and is budgeted for fiscal year 2018. The full amount of $459,717.30 has been approved and is documented in the Change in Funding Information section for distribution to the Procurement Section and Bureau of Finance & Accounting.
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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:
GC912-1 05/10/2018 4
DUVAL COUNTY
Jean Richards
Roger Ruiz
Increase in funding for Variable Inspections.
A net increase of $45,000.00
375,960.64 375,960.64
414,717.30 414,717.30
45,000.00 45,000.00
459,717.30 459,717.30
06/30/18 06/30/18 83,756.66 06/30/18
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 2018 $ 459,717.30
Jean E. Richards Digitally signed by Jean E.
Richards Date: 2018.05.10 13:09:11 -04'00'
05/10/2018 Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.05.10 13:13:09 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.05.10 17:03:54 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.05.11 08:43:27 -04'00'
File details come from the government source that posted it. Updated .