CN-370000-GC916-T11CO4.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 (FDEP) for a contract with Brevard County, represented by Douglas Divers as the contractor representative. The change order was processed on June 7, 2023, and is identified as Change Order No. 4 under Task Assignment Number GC916-11. The document was approved by FDEP Contract Manager Roger Ruiz and authorized by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order reflects a reduction in scope and corresponding cost decrease for routine compliance inspection services. Specifically, the number of Routine Compliance Inspections was reduced from 269 to 267 inspections, resulting in a net decrease of $1,090. The original task amount of $195,500 was adjusted through previous change orders to $196,128 prior to this modification, and is now reduced to $195,038 following this change order. The task completion date remains June 30, 2023. Funding for this adjustment is allocated under organizational code 37450104000 with object code 132500 and budget entity 37450300, special category 100029, with the reduction amount of $1,090 reflected in the budget ledger.
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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 06/07/2023 4
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Reduction of 2 Routine Compliance Inspections, from 269 to 267 Routine Compliance Inspections per request from GC916-11 Brevard County.
A net decrease of -$1,090.
195,500 195,500
196,128 196,128
-1,090 -1,090
195,038 195,038
06/30/23 06/30/23 -1,090 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 JD 132500 37450300 100029 00 $ 196,128.00
37450104000 JD 132500 37450300 100029 00 -$ 1,090.00
Divers, Doug Digitally signed by Divers, Doug Date: 2023.06.07 14:47:53 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2023.06.08 14:15:28 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.06.08 14:32:17 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.06.09 10:44:28 -04'00'
File details come from the government source that posted it. Updated .