CN-370000-GC917-T16CO3.pdf
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- Contract number
- GC917
- Issued by
- Florida
About this file
Task Assignment Change Order Summary
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection on May 5, 2025. The document involves a contractor in Okeechobee County, with Daniel Buchin serving as the contractor representative and Roger Ruiz as the DEP Contract Manager. This represents Change Order No. 3 to Task Assignment GC917-16.
The change order increases the task funding by $1,000 specifically for Variable Inspections, resulting in a revised task amount of $55,076.29 from the original amount of $54,076.29. The task completion date remains June 30, 2025, with no extension to the schedule. The funding is allocated through Organizational Code 37450104000 under the JD E.O. classification, with Object Code 132500 and Budget Entity 37450300, Special Category 100029. The change order was approved by Tameshia N. Reid (Budget Representative) and Tim Bahr (Contractual Authority), with copies distributed to the Procurement Section (MS93) and 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:
GC917-16 05/05/2025 3
OKEECHOBEE COUNTY
Daniel Buchin
Roger Ruiz
Increase in funds for Variable Inspections for $1,000.
A net increase of $1,000.
54,076.29 54,076.29
54,076.29 54,076.29
+1,000 +1,000
55,076.29 55,076.29
06/30/25 06/30/25 +1,000 06/30/25
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 $ 54,076.29
37450104000 JD 132500 37450300 100029 00 $ 1,000.00
Digitally signed by Daniel Buchin DN: CN=Daniel Buchin, E=daniel.buchin@ flhealth.gov Reason: I am the author of this document Location:
Date: 2025.05.05 15:53:12-04'00' Foxit PDF Editor Version: 13.1.2
Daniel Buchin 05/05/2025 Roger Ruiz Digitally signed by Roger Ruiz Date: 2025.05.05 15:58:34 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2025.05.05 20:50:27 -04'00'
Tim Bahr Digitally signed by Tim Bahr Date: 2025.05.06 14:24:12 -04'00'
File details come from the government source that posted it. Updated .