CN-370000-GC916-T10CO2.pdf
PDF 657 KB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) on April 19, 2022. The document modifies an existing task assignment under DEP Contract GC916-10 with Brevard County contractor Douglas Divers, represented by contractor representative Douglas Divers and FDEP Contract Manager Roger Ruiz.
The change order revises Task Assignment #5 to extend the completion date for routine compliance inspections of storage tank systems at 81 facilities within Indian River County from May 31, 2022 to June 30, 2022. The task amount remains unchanged at $49,838.00. Funding is sourced from Organizational Code 37450104000 using Budget Entity 37450300, Object Code 132500, and Special Category 100029. The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Teresa Booeshaghi on April 20, 2022.
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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:
GC916-10 04/19/2022 2
BREVARD COUNTY
Douglas Divers
Roger Ruiz
This change revises the sentence in Task Assignment #5 for DEP Contract GC916-10 reading:
"Conduct routine compliance inspections for storage tank systems at the 81 facilities within Indian River County, identified in Exhibit #1, by May 31, 2022.", to read:
"Conduct routine compliance inspections for storage tank systems at the 81 facilities within Indian River County, identified in Exhibit #1, by June 30, 2022."
49,838 49,838
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 $ 49,838.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.04.19 16:23:28 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.04.20 07:46:05 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.04.20 09:41:34 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.04.20 10:04:19 -04'00'
File details come from the government source that posted it. Updated .