CN-370000-GC916-T7CO3.pdf
PDF 656 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 for Contract GC916-7, dated May 4, 2021. The contractor is Brevard County, represented by Douglas Divers, with Roger Ruiz serving as the DEP Contract Manager. The change order has been approved by Monica J. Brady (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order modifies Task Assignment #7 by extending the completion deadline for routine compliance inspections of storage tank systems at 269 facilities within Brevard County from May 31, 2020, to June 30, 2020. The task amount remains unchanged at $188,170.00, with no net increase or decrease in funding. The completion date with all change orders is set as June 30, 2021. Funding is allocated from Organizational Code 37450104000 under Budget Entity 37450300, with Special Category 100029 and Object Code 132500. The contract was fully executed by all required parties on May 6-7, 2021.
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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 05/04/2021 3
BREVARD COUNTY
Douglas Divers
Roger Ruiz
This change revises the sentence in Task Assignment #7 for DEP Contract GC916-7, reading:
"Conduct routine compliance inspections for storage tank systems at the 269 facilities within Brevard County, identified in Exhibit #1, by May 31, 2020.", to read:
"Conduct routine compliance inspections for storage tank systems at the 269 facilities within Brevard County, identified in Exhibit #1, by June 30, 2020."
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: 2021.05.06 07:56:40 -04'00'
05/06/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.05.06 08:18:20 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2021.05.07 09:57:03 -04'00'
05/07/2021
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.05.07 10:22:10 -04'00'
05/07/2021
File details come from the government source that posted it. Updated .