CN-370000-GC916-T8CO1.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 on October 26, 2020. The document involves the contractor Brevard County, represented by Douglas Divers, and the DEP Contract Manager Roger Ruiz. The change order is designated as Change Order No. 1 for Task Assignment GC916-8.
The change order addresses performance measure adjustments for the Brevard (Indian River) County task assignment due to personnel changes. The first performance measures shall be to complete 20 percent, or 17 Routine Compliance Inspections, after a four-month period. The task amount remains $56,756 with no net increase or decrease, and the task completion date is established as June 30, 2021. Funding is allocated from Org. Code 37450104000 under Object Code 132500 with Budget Entity 37450300 and Special Category 100029, totaling $56,756.00. All required approvals were obtained, including signatures from the contractor, contract manager, budget representative Monica J. Brady, and contractual authority Teresa Booeshaghi, all executed on October 26, 2020.
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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:
GC916-8 10/26/2020 1
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Performance Measures:
Due to personnel changes, GC916-8 Brevard (Indian River) County after (4) four months, the first performance measures for GC916-8 Brevard (Indian River) County shall be to complete (20%) or 17 Routine Compliance Inspections.
56,756 56,756
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 $ 56,756.00
Divers, Doug Digitally signed by Divers, Doug Date: 2020.10.26 14:48:35 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2020.10.26 15:03:07 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2020.10.26 17:20:22 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.10.26 17:38:41 -04'00'
File details come from the government source that posted it. Updated .