CN-370000-GC917-T4CO3.pdf
PDF 534 KB Posted
- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Form OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on April 17, 2019. The change order modifies an existing task assignment with Okeechobee County, represented by Contractor Representative Tiffany Collins, under the oversight of DEP Contract Manager Roger Ruiz. The task assignment number is GC917-4, and this represents Change Order No. 3.
The change order increases the task funding by $594.00 to cover Variable Inspections, bringing the total task amount from $46,690.00 to $47,284.00. The task completion date remains June 30, 2019, with no change to the original timeline. Funding is allocated from Organization Code 37450104000 using Budget Entity JD, Object Code 132500, Special Category 37450300, and Special Category code 100029 in the amount of $47,284.00. The change order was approved by Fletcher Herrald, the Budget Representative and Contractual Authority, with digital signatures executed on April 24-25, 2019. Distribution copies were directed 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:
GC917-4 04/17/2019 3
OKEECHOBEE COUNTY
Tiffany Collins
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $594.00
46,690.00 46,690.00
46,690.00 46,690.00
+594.00 +594.00
47,284.00 47,284.00
06/30/19 06/30/19 +594 06/30/19
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 $ 47,284.00
Digitally signed by Tiffany L_ Collins DN: CN=Tiffany L_ Collins, O=DOH-Okeechobee, E=Tiffany.Collins@flhealth.gov Reason: I am the author of this document Location:
Date: 2019-04-24 15:29:38
Tiffany L_ Collins
04/24/2019 Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.04.25 07:02:43 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.25 09:51:35 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.25 09:51:50 -04'00'
File details come from the government source that posted it. Updated .