CN-370000-GC917-T2CO2.pdf
PDF 544 KB Posted
- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 2) issued by the Florida Department of Environmental Protection (FDEP) for Okeechobee County, dated May 1, 2018. The document was signed by contractor representative Tiffany Collins and DEP Contract Manager Roger Ruiz, with approvals from Budget Representative Jennifer Vickers and Contractual Authority F. Joseph Ullo.
The change order reflects a reduction in funding for Variable Inspections, resulting in a net decrease of $7,000.00 to the task assignment. The original task amount was $52,734.53; the task amount prior to this change order was $53,261.46; and the revised task amount with all change orders is $46,261.46. The task completion date remains June 30, 2018. Funding is drawn from Org. Code 37450104000 under E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, for fiscal year 2018, with the final authorized amount of $46,261.46.
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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:
GC917-2 05/01/2018 2
OKEECHOBEE COUNTY
Tiffany Collins
Roger Ruiz
Reduction on funding for Variable Inspections.
A net decrease of $7,000.00
52,734.53 52,734.53
53,261.46 53,261.46
(7,000.00) (7,000.00)
46,261.46 46,261.46
06/30/18 06/30/18 (7,000.00) 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 2018 $ 46,261.46
Digitally signed by Tiffany L_ Collins DN: CN=Tiffany L_ Collins, OU=Administrator, O=FDOH-Okeechobee, E=Tiffany.Collins@flhealth.gov Reason: I am the author of this document Location:
Date: 2018-05-04 09:10:37
Tiffany L_ Collins
05/04/2018 Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.05.07 08:07:14 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.05.07 08:41:07 -04'00'
Digitally signed by F. Joseph Jr.
Ullo Date: 2018.05.09 07:47:31 -04'00'
File details come from the government source that posted it. Updated .