CN-370000-GC917-T6CO1.pdf
PDF 1008 KB Posted
- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on June 16, 2020. The document modifies an existing task assignment (GC917-6) with the contractor identified as Okeechobee County. The contractor representative is Tiffany Collins, and the FDEP contract manager is Roger Ruiz. The change order was approved by budget representative Monica J. Brady and contractual authority Teresa Booeshaghi on June 24, 2020.
The change order increases funding for Variable Compliance Inspections by $85, resulting in a net increase to the total task amount. The original task amount was $44,356, and with this change order, the revised total task amount is $44,441. The task completion date remains June 30, 2020, with no extension to the timeline. Funding is allocated from Organization Code 37450104000 under E.O. JD with Object Code 132500, Budget Entity 37450300, Special Category 100029, and Year 00, with the total budgeted amount of $44,441.00.
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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:
GC917-6 06/16/2020 1
OKEECHOBEE COUNTY
Tiffany Collins
Roger Ruiz
Increase in funds for Variable Compliance Inspections in the amount of $85.
A net increase of $85.
44,356 44,356
44,356 44,356
+ 85 + 85
44,441 44,441
06/30/20 06/30/20 + 85 06/30/20
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 $ 44,441.00
Digitally signed by Tiffany L Collins DN: O=DOH Okeechobee, CN=Tiffany L Collins, E=Tiffany.Colllins@flhealth.gov Reason: I am the author of this document Location: your signing location here Date: 2020-06-23 12:24:12 Foxit Reader Version: 9.6.0
Tiffany L Collins
06/23/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.06.23 12:35:36 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2020.06.24 09:17:45 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.06.24 10:51:23 -04'00'
File details come from the government source that posted it. Updated .