CN-370000-GC916-T5_CO1.pdf
PDF 1 MB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP). The form modifies an existing task assignment (GC916-5) between FDEP and Brevard County, with Douglas Divers serving as the contractor representative and Roger Ruiz as the DEP Contract Manager. The change order was executed on May 7, 2020, and designated as Change Order No. 1.
The change order increases funding for Variable Inspections by $14,500, raising the total task amount from $173,670 to $188,170. The task completion date remains June 30, 2020, with no extension to the original timeline. The funding modification is recorded under organizational code 37450104000, E.O. code JD, object code 132500, budget entity 37450300, and special category 100029, with the total budgeted amount of $188,170.00. The change order was approved by Fletch Herrald (Budget Representative) and Teresa Booeshaghi (Contractual Authority), with copies distributed to the Procurement Section (MS93) and 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:
GC916-5 05/07/2020 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Increase in funds for Variable Inspections for $14,500.
173,670 173,670
173,670 173,670
+14,500 +14,500
188,170 188,170
06/30/20 06/30/20 +14,500 06/30/20
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 $ 188,170.00
Divers, Doug Digitally signed by Divers, Doug Date: 2020.05.07 10:20:46 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2020.05.07 12:15:41 -04'00'
Fletch Herrald Digitally signed by Fletch Herrald Date: 2020.05.08 09:08:44 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.05.08 09:13:51 -04'00'
File details come from the government source that posted it. Updated .