CN-370000-GC917-T12CO1.pdf
PDF 1009 KB Posted
- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 1) issued by the Florida Department of Environmental Protection on August 29, 2022. The document involves OKEECHOBEE COUNTY as the contractor, with Dianna May serving as the Contractor Representative and Roger Ruiz as the DEP Contract Manager. The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Teresa Booeshaghi on August 30, 2022.
The change order increases funding for Ethanol/Biodiesel Inspections by $630, resulting in a net increase to the task amount. The original task amount was $50,745, and with this change order, the total task amount with all change orders is $51,375. The task completion date remains June 30, 2023. Funding is allocated from two budget sources: $50,745.00 from Org. Code 37450104000, E.O. JD, Object Code 132500, Special Category 100029; and $630.00 from Org. Code 37450104000, E.O. JG, Object Code 132500, Special Category 087889. Both allocations are charged to Budget Entity 37450300. Copies of the executed change order were distributed to the Procurement Section (MS93) and the Bureau of Finance & Accounting (MS78).
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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:
GC917-12 08/29/2022 1
OKEECHOBEE COUNTY
Dianna May
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $630.
A net increase of $630.
50,745 50,745
50,745 50,745
+630 +630
51,375 51,375
06/30/23 06/30/23 +630 06/30/23
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 $ 50,745.00
37450104000 JG 132500 37450300 087889 00 $ 630.00
Digitally signed by Dianna May DN: OU="Florida Department of Health ", CN=" Dianna May ", E=dianna.may@flhealth.gov Reason: I have reviewed this document Location: your signing location here Date: 2022-08-30 11:54:24 Foxit Reader Version: 9.7.1
Dianna May 08/30/2022 Roger Ruiz Digitally signed by Roger Ruiz Date: 2022.08.30 12:32:06 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.08.30 12:54:04 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.08.30 16:16:24 -04'00'
File details come from the government source that posted it. Updated .