CN-370000-GC917-T16CO4.pdf
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- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 4) issued by the Florida Department of Environmental Protection (DEP) for Task Assignment GC917-16 with Okeechobee County. The form is dated June 4, 2025, and involves Contractor Representative Daniel Buchin and DEP Contract Manager Roger Ruiz. The change order has been approved by Budget Representative Tameshia N. Reid and Contractual Authority Fletch Herrald.
The change order modifies Task Assignment #8 of DEP Contract GC917 due to personnel issues, reducing the scope of routine compliance inspections for storage tank systems from 61 facilities to 33 facilities (54% completion) within Glades and Hendry Counties. The original completion deadline of May 31, 2025, has been extended to June 30, 2025. The task amount remains constant at $55,076.29 with no net increase or decrease in the total task cost. Funding is allocated from Organizational Code 37450104000 under Object Code 132500, with a Budget Entity of 37450300 and Special Category 100029 for the fiscal year 00.
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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 06/04/2025 4
OKEECHOBEE COUNTY
Daniel Buchin
Roger Ruiz
Performance Measures:
Due to personnel issues, for Invoice 12, GC917-16 Okeechobee County, shall complete (54%) or 33 Routine Compliance Inspections.
This change revises the sentence in Task Assignment #8 for DEP Contract GC917 reading:
"Conduct routine compliance inspections for storage tank systems at the 61 facilities within Glades and Hendry Counties, identified in Exhibit #1, by May 31, 2025.", to read:
"Conduct routine compliance inspections for storage tank systems at the 33 facilities within Glades and Hendry Counties, identified in Exhibit #1, by June 30, 2025."
54,076.29 54,076.29
55,076.29 55,076.29
55,076.29 55,076.29
06/30/25 06/30/25
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 $ 55,076.29
Digitally signed by Daniel Buchin DN: CN=Daniel Buchin, E=daniel.buchin@ flhealth.gov Reason: I am the author of this document Location:
Date: 2025.06.04 19:23:23-04'00' Foxit PDF Editor Version: 13.1.7
Daniel Buchin 06/04/2025 Roger Ruiz Digitally signed by Roger Ruiz Date: 2025.06.05 08:01:46 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2025.06.05 08:57:20 -04'00'
Fletch Herrald Digitally signed by Fletch Herrald Date: 2025.06.05 09:09:33 -04'00'
File details come from the government source that posted it. Updated .