CN-370000-GC916-T12CO2.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 on April 13, 2023. The document modifies an existing task assignment (GC916-12) between the Florida Department of Environmental Protection and Brevard County, represented by contractor Douglas Divers, with Roger Ruiz serving as the DEP Contract Manager.
The change order increases funding for Variable Inspections by $11,148, bringing the total task amount from $52,437 to $63,585. The original task amount was $52,227, with the net increase of $11,148 reflected across the fee schedule. The task completion date remains June 30, 2023, with no extension to the timeline. Funding is allocated across three budget line items under organizational code 37450104000, with amounts distributed as follows: $52,227.00 under special category 100029, $210.00 under special category 087889, and $11,148.00 under special category 100029. All approvals, including signatures from the contractor representative, DEP Contract Manager, Budget Representative (Tameshia N. Reid), and Contractual Authority (Teresa Booeshaghi), were completed on April 13, 2023.
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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 04/13/2023 2
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Variable Inspections for $11,148.
A net increase of $11,148.
52,227 52,227
52,437 52,437
+11,148 +11,148
63,585 63,585
06/30/23 06/30/23 +11,148 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 $ 52,227.00
37450104000 JG 132500 37450300 087889 23 $ 210.00
37450104000 JD 132500 37450300 100029 00 $ 11,148.00
Divers, Doug Digitally signed by Divers, Doug Date: 2023.04.13 10:19:33 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2023.04.13 10:28:55 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.04.13 10:45:14 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.04.13 11:45:09 -04'00'
File details come from the government source that posted it. Updated .