CN-370000-GC916-T11CO2.pdf
PDF 657 KB Posted
- Contract number
- GC916
- 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) for Brevard County. The document is dated September 12, 2022, and pertains to Task Assignment Number GC916-11. The contractor is Brevard County, represented by Douglas Divers, with Roger Ruiz serving as the FDEP Contract Manager.
The change order increases funding for Ethanol/Biodiesel Inspections by $628, resulting in a net increase to the task amount. The original task amount was $194,872, which remains the same prior to this change order. With the $628 increase, the total task amount with all change orders becomes $195,500. The task completion date remains unchanged at June 30, 2023. Funding for the increase is allocated across two budget categories: $628.00 from Special Category grant 087889 (Year 23) and $194,872.00 from Special Category grant 100029 (Year 00), both under Org. Code 37450104000 and Object Code 132500. The change order was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on September 13, 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 09/12/2022 2
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $628.
A net increase of $628.
194,872 194,872
194,872 194,872
+628 +628
195,500 195,500
06/30/23 06/30/23 +628 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 $ 628.00
37450104000 JD 132500 37450300 100029 00 $ 194,872.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.09.12 14:33:44 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.09.12 14:48:05 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.09.13 16:09:58 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.09.13 16:49:31 -04'00'
File details come from the government source that posted it. Updated .