CN-370000-GC912-T1CO5.pdf
PDF 655 KB Posted
- Contract number
- GC912
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) for Duval County. The change order was executed on June 28, 2018, and represents the fifth modification to Task Assignment Number GC912-1. Jean Richards serves as the Contractor Representative, and Roger Ruiz acts as the DEP Contract Manager. The document was approved by Budget Representative Jennifer Vickers and Contractual Authority Tim J. Bahr.
The change order implements a net decrease in funding for Variable Inspections totaling $6,000.00. The task amount prior to this change order was $459,717.30, which is reduced to $453,717.30 following this modification. The original task amount was $375,960.64. The task completion date remains unchanged at June 30, 2018. Funding is allocated from Organization Code 37450104000 under E.O. JD, with Object Code 132500, Budget Entity 37450300, and Special Category 100029 for the 2018 fiscal year, with a total approved amount of $453,717.30.
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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 06/28/2018 5
DUVAL COUNTY
Jean Richards
Roger Ruiz
Decrease in funding for Variable Inspections.
A net decrease of $6,000.00
375,960.64 375,960.64
459,717.30 459,717.30
(6,000.00) (6,000.00)
453,717.30 453,717.30
06/30/18 06/30/18 77,756.66 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 $ 453,717.30
Jean E. Richards Digitally signed by Jean E.
Richards Date: 2018.06.28 15:38:14 -04'00'
06/28/2018 Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.06.28 15:48:32 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.06.28 16:48:57 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.06.29 08:11:46 -04'00'
File details come from the government source that posted it. Updated .