CN-370000-GC916-T6CO1.pdf
PDF 1 MB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Form OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on May 27, 2020. The document modifies an existing task assignment with Brevard County under contract GC916-6. The change order was prepared by Contractor Representative Douglas Divers and reviewed by FDEP Contract Manager Roger Ruiz. The form was approved by Budget Representative Monica J. Brady and Contractual Authority Teresa Booeshaghi.
The change order reduces the scope of routine compliance inspections assigned to Brevard County from 81 inspections to 74 inspections, resulting in a net decrease of $3,608.50 due to COVID-19 impact. The original task amount of $56,756 is reduced to $53,147.50 with all change orders applied. The completion date remains June 30, 2020. Funding is allocated from Organizational Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, in Year 00 for the reduced total amount of $53,147.50.
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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:
GC916-6 05/27/2020 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Reduction of 7 Routine Compliance Inspections, from 81 Routine Compliance Inspections assigned, to 74 Routine Compliance Inspections due to COVID-19 impact.
A net decrease of $3,608.50.
56,756 56,756
56,756 56,756
- 3,608.50 - 3,608.50
53,147.50 53,147.50
06/30/20 06/30/20
- 3,608.50 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 $ 53,147.50
Divers, Doug Digitally signed by Divers, Doug Date: 2020.05.27 10:44:10 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2020.05.27 11:13:18 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2020.05.27 15:05:19 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.05.28 08:29:09 -04'00'
File details come from the government source that posted it. Updated .