CN-370000-GC912-T5CO2.pdf
PDF 655 KB Posted
- Contract number
- GC912
- Issued by
- Florida
About this file
Task Assignment Change Order Form Summary
This is a Task Assignment Change Order Form (Change Order No. 2) issued by the Florida Department of Environmental Protection (DEP) for Contract GC912. The form documents a contract modification between DEP and contractor Jean Richards, with Roger Ruiz serving as the DEP Contract Manager. The change order was dated May 17, 2022, and approved by Budget Representative Tameshia N. Reid and Contractual Authority John Truitt.
The change order revises Task Assignment #5 of DEP Contract GC912 by extending the completion deadline for routine compliance inspections of storage tank systems from May 31, 2022, to June 30, 2022. The work scope remains unchanged and involves conducting inspections at 570 facilities located in Duval, Nassau, Baker, and Saint John Counties, as identified in Exhibit #1. The task amount remains at $424,860.00 with no financial adjustment. The funding is allocated from Org. Code 37450104000 under E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, for the year 2022. Copies of the change order were distributed to the Procurement Section (MS93) and two copies to the Bureau of Finance & Accounting (MS78).
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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 05/17/2022 2
Jean Richards
Roger Ruiz
This change revises the sentence in Task Assignment #5 for DEP Contract GC912 reading:
"Conduct routine compliance inspections for storage tank systems at the 570 facilities within Duval, Nassau, Baker and Saint John Counties, identified in Exhibit #1, by May 31, 2022.", to read:
"Conduct routine compliance inspections for storage tank systems at the 570 facilities within Duval, Nassau, Baker and Saint John Counties, identified in Exhibit #1, by June 30, 2022."
424,860 424,860
06/30/22 06/30/22
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: 2022.05.17 11:18:24 -04'00'
05/17/2022 Roger Ruiz Digitally signed by Roger Ruiz Date: 2022.05.17 12:19:31 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.05.17 12:37:36 -04'00'
John Truitt Digitally signed by John Truitt Date: 2022.05.23 10:30:36 -04'00'
File details come from the government source that posted it. Updated .