CN-370000-GC916-T9CO3.pdf
PDF 657 KB Posted
- Contract number
- GC916
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) on April 19, 2022. The change order modifies an existing contract (GC916-9) between FDEP and Brevard County, with Douglas Divers serving as the contractor representative and Roger Ruiz as the DEP Contract Manager.
The change order extends the deadline for routine compliance inspections of storage tank systems at 269 facilities within Brevard County from May 31, 2022, to June 30, 2022. The task amount remains unchanged at $186,727.00, with no modifications to cost reimbursement or fee schedule. The funding is allocated from Org. Code 37450104000 under budget entity 37450300, special category 100029, with the amount of $186,727.00. The change order was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on April 20, 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 04/19/2022 3
BREVARD COUNTY
Douglas Divers
Roger Ruiz
This change revises the sentence in Task Assignment #5 for DEP Contract GC916-9 reading:
"Conduct routine compliance inspections for storage tank systems at the 269 facilities within Brevard County, identified in Exhibit #1, by May 31, 2022.", to read:
"Conduct routine compliance inspections for storage tank systems at the 269 facilities within Brevard County, identified in Exhibit #1, by June 30, 2022."
186,727 186,727
06/30/22 06/30/22
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: 2022.04.19 16:22:56 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2022.04.20 07:51:38 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.04.20 09:26:43 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.04.20 10:05:22 -04'00'
File details come from the government source that posted it. Updated .