CN-370000-GC912-T7CO1.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 (FDEP) for Duval County on April 22, 2024. The change order modifies an existing contract task assignment numbered GC912-7, with Jean Richards serving as the contractor representative and Roger Ruiz as the FDEP Contract Manager. The form documents Change Order No. 1 and has been approved through appropriate contractual authority.
The change order increases funding for Variable Inspections by $6,000, resulting in a net increase to the task amount from $512,796 to $518,796. The task completion date remains June 30, 2024, with no changes to the project timeline. The funding is allocated to Org. Code 37450104000 under E.O. JD, Object Code 132500, Budget Entity 37450300, with Special Category 100029. The budget allocation shows $442,095.00 from the primary funding source and $6,000.00 from an additional funding line. The change order was signed by the contractor on April 29, 2024, approved by the budget representative on April 29, 2024, and authorized by the contractual authority on May 7, 2024.
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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:
GC912-7 04/22/2024 1
DUVAL COUNTY
Jean Richards
Roger Ruiz
Increase in funds for Variable Inspections for $6,000.
A net increase of $6,000.
512,796 512,796
512,796 512,796
+6,000 +6,000
518,796 518,796
06/30/24 06/30/24 +6,000 06/30/24
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 $ 442,095.00
37450104000 JD 132500 37450300 100029 00 $ 6,000.00
Jean E. Richards Digitally signed by Jean E.
Richards Date: 2024.04.29 09:49:03 -04'00'
04/29/2024 Roger Ruiz Digitally signed by Roger Ruiz Date: 2024.04.29 10:00:59 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2024.04.29 10:17:29 -04'00'
Jessica Kramer Digitally signed by Jessica Kramer Date: 2024.05.07 13:04:26 -04'00' 05/07/2024
File details come from the government source that posted it. Updated .