CN-370000-GC912-T3CO2.pdf
PDF 655 KB Posted
- Contract number
- GC912
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection on January 28, 2020. The change order modifies an existing task assignment (GC912-3) for Duval County. The contractor is represented by Jean Richards, with Roger Ruiz serving as the DEP Contract Manager. The document was approved by Griffin Kolchakian (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on January 29 and February 5, 2020, respectively.
The change order increases the total task assignment amount by $32,366, bringing the total contract value from $421,990 to $454,356. The increase comprises $366 for Travel Allotment and $32,000 for Variable Inspections. The task completion date remains unchanged at June 30, 2020. The funding is charged to Org. Code 37450104000 with Object Code 132500, Budget Entity 37450300, and Special Category 100029, with the total amount of $454,356.00 allocated for the fiscal year.
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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:
GC912-3 01/28/2020 2
DUVAL COUNTY
Jean Richards
Roger Ruiz
The total increase in funds for GC912-3 Duval County is $32,366.
$366 for Travel Allotment.
$32,000 for Variable Inspections.
421,990 421,990
421,990 421,990
+32,366 +32,366
454,356 454,356
06/30/20 06/30/20 +32,366 06/30/20
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 $ 454,356.00
Jean E. Richards Digitally signed by Jean E.
Richards Date: 2020.01.29 08:48:42 -05'00'
01/29/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.01.29 08:58:11 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.01.29 11:27:16 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 14:44:22 -05'00'
File details come from the government source that posted it. Updated .