CN-370000-GC916-T9CO2.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. 2) issued by the Florida Department of Environmental Protection (FDEP) on February 22, 2022. The form documents a modification to an existing task assignment (GC916-9) with Brevard County, with Douglas Divers serving as the contractor representative and Roger Ruiz as the DEP Contract Manager.
The change order modifies performance measures for the Brevard County task assignment due to personnel changes. Specifically, the second performance measures period, occurring after eight months, has been adjusted to require completion of 61 percent or 164 Routine Compliance Inspections. The original task amount remains $186,727, with no change to the task completion date of June 30, 2022. Funding is allocated from Organizational Code 37450104000 under object code 132500 with budget entity 37450300 and special category 100029. The change order was approved by all required parties, including the Budget Representative (Tameshia N. Reid) and Contractual Authority (Teresa Booeshaghi), on February 22, 2022.
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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:
GC916-9 02/22/2022 2
BREVARD COUNTY
Douglas Divers
Roger Ruiz
Performance Measures:
Due to personnel changes GC916-9 Brevard County, for the second Performance Measures after (8) eight months shall complete (61 %) or 164 Routine Compliance Inspections.
186,727 186,727
06/30/22
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 $ 186,727.00
Divers, Doug Digitally signed by Divers, Doug Date: 2022.02.22 07:45:28 -05'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.02.22 08:09:31 -05'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.02.22 10:51:40 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.02.22 11:31:02 -05'00'
File details come from the government source that posted it. Updated .