CN-370000-GC914-T1CO2.pdf

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Attached to
Master Agreement FL|GC914|8fccc28dda898687f0dd3c309f3a996b
Contract number
GC914
Issued by
Florida

About this file

This is a Task Assignment Change Order Form (Change Order No. 2) issued by the Florida Department of Environmental Protection (FDEP) on June 21, 2018, for a task assignment with Leon County (Contractor Name). Robert Bass serves as the Contractor Representative, and Roger Ruiz is the FDEP Contract Manager responsible for oversight of this modification.

The change order reflects a reduction in funding for Variable Inspections, resulting in a net decrease of $5,000.00 to the task assignment. The original task amount was $128,993.39, which had been increased to $130,282.32 prior to this change order. With the $5,000.00 reduction applied, the task amount with all change orders is now $125,282.32. The task completion date remains unchanged at June 30, 2018. Funding for this modification is allocated from Organization Code 37450104000 under E.O. Code JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, for fiscal year 2018, totaling $125,282.32. The change order was approved by Budget Representative Jennifer Vickers and Contractual Authority Tim J. Bahr on June 25, 2018, with distribution directed to the Procurement Section and the Bureau of Finance & Accounting.

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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:

GC914-1 06/21/2018 2

LEON COUNTY

Robert Bass

Roger Ruiz

Reduction on funding for Variable Inspections.

A net decrease of $5,000.00

128,993.39 128,993.39

130,282.32 130,282.32

(5,000.00) (5,000.00)

125,282.32 125,282.32

06/30/18 06/30/18 (5,000.00) 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 $ 125,282.32

Robert Bass Digitally signed by Robert Bass DN: cn=Robert Bass, o=Leon County Development Support and Environmental Mgmt, ou, email=bassr@leoncountyfl.gov, c=US Date: 2018.06.22 11:16:18 -04'00'

Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.06.23 13:45:25 -04'00'

Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.06.25 09:37:29 -04'00'

Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.06.25 10:16:07 -04'00'

File details come from the government source that posted it. Updated .