CN-370000-GC912-T5CO1.pdf
PDF 654 KB Posted
- Contract number
- GC912
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Form OOO-012) issued by the Florida Department of Environmental Protection (FDEP) dated October 25, 2021. The change order modifies task assignment number GC912-5 and is identified as Change Order No. 1. The contractor is Jean Richards, with Roger Ruiz serving as the DEP Contract Manager. The change order was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order addresses performance measures for the Duval County task assignment due to unforeseen circumstances. Specifically, the contractor is required to complete 30 percent (171) of Routine Compliance Inspections within the first four months of performance. The task amount remains at $424,860.00 with no increase or decrease. The completion date for all change orders is June 30, 2022. Funding is sourced from Organizational Code 37450104000 under Executive Order JD, Object Code 132500, Budget Entity 37450300, and Special Category 100029, with a year designation of 00.
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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:
GC912-5 10/25/2021 1
Jean Richards
Roger Ruiz
Performance Measures:
Due to unforeseen circumstances GC912-5 Duval County, for the first Performance Measures after (4) four months shall complete (30%) or 171 Routine Compliance Inspections.
424,860 424,860
06/30/22
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 $ 424,860.00
Jean E. Richards Digitally signed by Jean E.
Richards Date: 2021.10.25 13:56:26 -04'00'
10/25/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.10.25 14:28:11 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2021.10.25 14:47:50 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.10.25 14:52:03 -04'00'
File details come from the government source that posted it. Updated .