CN-370000-GC916-T11CO3.pdf
PDF 657 KB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection for task assignment number GC916-11 with Brevard County (contractor). The change order, number 3, was executed on October 5, 2022, and is managed by DEP Contract Manager Roger Ruiz with contractor representative Douglas Divers.
The change order increases funding for Ethanol/Biodiesel Inspections by $628, resulting in a net increase to the task amount from $195,500 to $196,128. The task completion date remains unchanged at June 30, 2023. The funding is allocated across two budget categories: $628.00 from organization code 37450104000 with E.O. code JG (Grant #087889, Year 23) and $195,500.00 from organization code 37450104000 with E.O. code JD (Grant #100029, Year 00). The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Teresa Booeshaghi on October 5, 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 10/05/2022 3
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $628.
A net increase of $628.
195,500 195,500
195,500 195,500
+628 +628
196,128 196,128
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 374503600 100029 00 $ 195,500.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.10.05 10:55:37 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.10.05 12:24:12 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.10.05 13:51:10 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.10.05 15:04:35 -04'00'
File details come from the government source that posted it. Updated .