CN-370000-GC916-T12CO1.pdf
PDF 1 MB 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 August 1, 2022, for Brevard County contractor Douglas Divers under Task Assignment Number GC916-12. The change order is the first modification to the original task assignment and has been executed by both the contractor and FDEP representatives, with approvals from the Budget Representative and Contractual Authority.
The change order increases funding for Ethanol/Biodiesel Inspections by $210, resulting in a net increase to the task amount from $52,227 to $52,437. The task completion date remains June 30, 2023, with no extension to the timeline. The funding adjustment is allocated across two special budget categories: $210 allocated to Special Category 087889 (Year 23) and $52,227 allocated to Special Category 100029 (Year 00), both under Organization Code 37450104000, E.O. code JG/JD, Object Code 132500, and Budget Entity 37450300. The change order has been distributed to the Procurement Section and the Bureau of Finance & Accounting for processing.
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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:
GC916-12 08/01/2022 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $210.
A net increase of $210.
52,227 52,227
52,227 52,227
+210 +210
52,437 52,437
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 $ 52,227.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.08.01 11:31:34 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.08.01 12:39:54 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.08.01 14:04:49 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.08.01 14:32:47 -04'00'
File details come from the government source that posted it. Updated .