CN-370000-GC916-T8CO3.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 (FDEP) dated May 4, 2021, for DEP Contract GC916-8. The contractor is Brevard County, represented by Douglas Divers, with Roger Ruiz serving as the DEP Contract Manager. The change order modifies Task Assignment #8 under this contract.
The change order revises the completion deadline for conducting routine compliance inspections of storage tank systems at 81 facilities within Indian River County from May 31, 2020, to June 30, 2020. The task amount remains unchanged at $56,756.00, with no net increase or decrease in the overall contract value. The completion date with all change orders is confirmed as June 30, 2021. Funding is allocated through Organizational Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, with the full amount of $56,756.00 charged to year code 00. The change order was approved by Monica J. Brady (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on May 7, 2021, and distributed to the Procurement Section and Bureau of Finance & Accounting.
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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 05/04/2021 3
BREVARD COUNTY
Douglas Divers
Roger Ruiz
This change revises the sentence in Task Assignment #8 for DEP Contract GC916-8 reading:
"Conduct routine compliance inspections for storage tank systems at the 81 facilities within Indian River County, identified in Exhibit #1, by May 31, 2020.", to read:
"Conduct routine compliance inspections for storage tank systems at the 81 facilities within Indian River County, identified in Exhibit #1, by June 30, 2020."
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: 2021.05.06 07:57:14 -04'00'
05/06/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.05.06 08:14:18 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2021.05.07 09:58:13 -04'00'
05/07/2021
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.05.07 10:41:21 -04'00'
05/07/2021
File details come from the government source that posted it. Updated .