CN-370000-GC916-T4CO2.pdf
PDF 655 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 (DEP) for a task assignment with Brevard County, represented by Douglas Divers. The change order is dated February 26, 2019, for Task Assignment Number GC916-4 and was approved by DEP Contract Manager Roger Ruiz.
The change order reflects a decrease of funds in the amount of $8,900.00 for Variable Inspections, reducing the task amount from $55,145.00 to $46,245.00. The task completion date remains unchanged at June 30, 2019. The funding adjustment is reflected in the budget coding (Org. Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029) with the revised total allocation of $46,245.00. All required signatures, including the contractor, DEP Contract Manager, Budget Representative Jennifer Vickers, and Contractual Authority Fletcher Herrald, were obtained on February 27-28, 2019.
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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:
GC916-4 02/26/2019 2
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Decrease of Funds for Variable Inspections in the amount of $8,900.00
55,145.00 55,145.00
55,145.00 55,145.00
-8,900.00 -8,900.00
46,245.00 46,245.00
06/30/19 06/30/19 -8,900.00 06/30/19
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 $ 55,145.00
37450104000 JD 132500 37450300 100029 00 -$ 8,900.00
$ 46,245.00
Douglas Divers Digitally signed by Douglas Divers Date: 2019.02.27 15:52:54 -05'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2019.02.27 15:56:24 -05'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2019.02.28 07:51:17 -05'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.02.28 09:09:54 -05'00'
File details come from the government source that posted it. Updated .