CN-370000-GC916-T7CO1.pdf
PDF 1 MB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on October 26, 2020. The document pertains to Task Assignment GC916-7 with contractor Brevard County, represented by Douglas Divers. The DEP Contract Manager is Roger Ruiz. The change order has been approved by Monica J. Brady (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order modifies performance measures for the task assignment due to personnel changes. Specifically, after the initial four-month period, the first performance measures for GC916-7 Brevard County shall be to complete 28 percent, or 77 Routine Compliance Inspections. The original task amount remains $188,170, with no net increase or decrease in the task amount. The task completion date is established as June 30, 2021, with no change to the original timeline. Funding is allocated from Organizational Code 37450104000 with Object Code 132500, Budget Entity 37450300, and Special Category 100029 in the amount of $188,170.00.
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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:
GC916-7 10/26/2020 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Performance Measures:
Due to personnel changes, GC916-7 Brevard County after (4) four months, the first performance measures for GC916-7 Brevard County shall be to complete (28%) or 77 Routine Compliance Inspections.
188,170 188,170
06/30/21 06/30/21
06/30/21
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: 2020.10.26 14:49:41 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2020.10.26 15:11:22 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2020.10.26 17:20:58 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.10.26 17:39:57 -04'00'
File details come from the government source that posted it. Updated .