CN-370000-GC917-T1CO1.pdf
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- Contract number
- GC917
- Issued by
- Florida
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Document Summary
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection on August 2, 2017. The change order applies to Task Assignment Number GC917-1 with the contractor Okeechobee County, represented by Tiffany Collins. The contract manager is Roger Ruiz. The document was approved by Jennifer Vickers (Budget Representative) and Fletch Herrald (Contractual Authority) on August 16, 2017.
The change order modifies the pricing structure for routine inspection services, increasing the reimbursement rate from $510.40 to $515.50 per routine inspection, representing a net increase of $5.10 per inspection. The increase became effective September 1, 2017, with all inspections conducted through August 31, 2017 paid at the original rate of $510.40. The net increase to the task amount is $880.36, bringing the total task amount with all change orders to $88,985.61. The task completion date remains June 30, 2018. The funding is allocated through Org. Code 37450104000, E.O. code JD, Object Code 132500, and Special Category 37450300, with Grant Number 100029.
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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:
GC917-1 08/02/2017 1
OKEECHOBEE COUNTY
Tiffany Collins
Roger Ruiz
Amount increase per Routine Inspection from $510.40 to $515.50.
A net increase of $5.10 per Routine Inspection.
The increase will become effective September 1, 2017. All inspections conducted through August 31, 2017, will be paid at the rate of $510.40.
88,105.25 88,105.25
88,105.25 88,105.25
880.36 880.36
88,985.61 88,985.61
06/30/18 06/30/18 880.36 06/30/18
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 $ 88,985.61
Digitally signed by Tiffany L_ Collins DN: CN=Tiffany L_ Collins, OU=FDOH-Okeechobee, O=FDOH-Okeechobee, E=Tiffany.Collins@flhealth.gov Reason: I am the author of this document Location:
Date: 2017-08-14 14:10:39
Tiffany L_ Collins
Roger Ruiz Digitally signed by Roger Ruiz Date: 2017.08.14 14:19:35 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2017.08.16 09:27:19 -04'00'
08/16/2017
Fletch Herrald Digitally signed by Fletch Herrald Date: 2017.08.16 10:29:52 -04'00'
File details come from the government source that posted it. Updated .