CN-370000-GC916-T4CO3.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. 3) issued by the Florida Department of Environmental Protection (FDEP) for a contract with Brevard County, represented by contractor Douglas Divers, with DEP Contract Manager Roger Ruiz overseeing the modification. The document was executed on February 26, 2019, and processed with digital signatures from all authorized parties, including budget representative Jennifer Vickers and contractual authority Fletcher Herrald.
The change order increases funding for variable inspections in the amount of $3,360.00, bringing the total task amount from $46,245.00 to $49,605.00. The original task amount was $55,145.00, with previous change orders reducing it to $46,245.00 prior to this modification. The task completion date remains June 30, 2019, with no extension to the timeline. Funding is allocated across two budget entries: $46,245.00 charged to Org. Code 37450104000, E.O. JD, Object Code 132500, Special Category 100029, and $3,360.00 charged to Org. Code 37450104000, E.O. JN, Object Code 132500, Special Category 104138, totaling $49,605.00. Distribution of the approved change order includes copies to the Procurement Section (MS93) and two copies to the Bureau of Finance & Accounting (MS78).
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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 3
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $3,360.00
55,145.00 55,145.00
46,245.00 46,245.00
+3,360.00 +3,360.00
49,605.00 49,605.00
06/30/19 06/30/19 +3,360.00 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 $ 46,245.00
37450104000 JN 132500 37450300 104138 00 $ 3,360.00
$ 49,605.00
Douglas Divers Digitally signed by Douglas Divers Date: 2019.02.27 15:55:43 -05'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2019.02.27 16:02:53 -05'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2019.02.28 07:58:20 -05'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.02.28 09:11:27 -05'00'
File details come from the government source that posted it. Updated .