CN-370000-GC916-T11CO1.pdf
PDF 1 MB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on August 1, 2022. The change order involves Brevard County as the contractor, with Douglas Divers serving as the contractor representative and Roger Ruiz as the DEP Contract Manager. The task assignment is identified as GC916-11, and this represents Change Order No. 1.
The change order increases funding for Ethanol/Biodiesel Inspections by $210, resulting in a net increase to the original task amount of $194,662. The revised task amount with all change orders is $194,872. The task completion date remains June 30, 2023, with no modification to the timeline. Funding for the increase is allocated across two budget lines: $210.00 under Special Category 087889 and $194,662.00 under Special Category 100029, both utilizing Organization Code 37450104000, E.O. codes JG and JD, Object Code 132500, and Budget Entity 37450300. The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Teresa Booeshaghi on August 1, 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:
GC916-11 08/01/2022 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $210.
A net increase of $210.
194,662 194,662
194,662 194,662
+210 +210
194,872 194,872
06/30/23 06/30/23 +210 06/30/23
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 JG 132500 37450300 087889 23 $ 210.00
37450104000 JD 132500 37450300 100029 00 $ 194,662.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.08.01 11:32:21 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.08.01 12:37:40 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.08.01 14:00:49 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.08.01 14:36:16 -04'00'
File details come from the government source that posted it. Updated .