CN-370000-GC915-T3CO1.pdf

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Master Agreement FL|GC915|cb5ecb1bc3c7ba4bc0fe3459697a71a2
Contract number
GC915
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 work performed by Hillsborough County. The document, dated January 28, 2020, serves as Change Order No. 1 to Task Assignment GC915-3. The contractor representative is Hooshang Boostani, and the FDEP Contract Manager is Roger Ruiz. The change order was approved by Griffin Kolchakian (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on January 29, 2020, and February 5, 2020, respectively.

The change order increases funding for Variable Inspections by $26,000, raising the total task amount from $503,296 to $529,296. The task completion date remains June 30, 2020, with no modification to the timeline. The funding is allocated through FDEP's Organizational Code 37450104000 under E.O. JD with Object Code 132500, Budget Entity 37450300, and Special Category 100029. The total modified contract amount is $529,296.00, funded through the state's general revenue in fiscal year 00. Copies of this change order were distributed to the Procurement Section (MS93) and 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:

GC915-3 01/28/2020 1

HILLSBOROUGH COUNTY

Hooshang Boostani

Roger Ruiz

Increase in funds for Variable Inspections for $26,000.

503,296 503,296

503,296 503,296

+26,000 +26,000

529,296 529,296

06/30/20 06/30/20 +26,000 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 $ 529,296.00

Hooshang Boostani

Digitally signed by Hooshang Boostani Date: 2020.01.29 10:12:27 -05'00'

01/29/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.01.29 10:20:44 -05'00'

Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.01.29 11:17:16 -05'00'

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 14:46:16 -05'00'

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