CN-370000-GC917-T8CO1.pdf
PDF 1008 KB Posted
- Contract number
- GC917
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 1) issued by the Florida Department of Environmental Protection (FDEP) dated November 23, 2020. The change order modifies Task Assignment Number GC917-8 with Okeechobee County as the contractor. Tiffany Collins serves as the Contractor Representative, and Roger Ruiz is the DEP Contract Manager. The document was approved by Monica J. Brady (Budget Representative) on November 30, 2020, and Teresa Booeshaghi (Contractual Authority) on December 1, 2020.
The change order increases funding for Variable Inspections by $1,000, resulting in a net increase to the total task amount. The original task amount of $44,356 was increased by $1,000, bringing the task amount with all change orders to $45,356. The completion date remains June 30, 2021, with no change to the task period. Funding for this modification is allocated through Organization Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, and Year 00, with a total amount of $45,356.00. The change order was distributed to the Procurement Section (MS93) and Bureau of Finance & Accounting (MS78) for processing.
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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:
GC917-8 11/23/2020 1
OKEECHOBEE COUNTY
Tiffany Collins
Roger Ruiz
Increase in funds for Variable Inspections for $1,000.
A net increase of $1,000.
44,356 44,356
+1,000 +1,000
45,356 45,356
45,356 45,356
06/30/21 06/30/21 +1,000 06/30/21
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 $ 45,356.00
Digitally signed by Tiffany L_ Collins DN: OU=Florida Department of Health, O=Okeechobe County, CN=Tiffany L_ Collins, E=Tiffany.Collins@flheatlh.gov Reason: I am the author of this document Location: your signing location here Date: 2020-11-30 16:25:31 Foxit Reader Version: 9.6.0
Tiffany L_ Collins
11/30/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.11.30 16:39:41 -05'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2020.11.30 17:34:48 -05'00'
11/30/2020
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.12.01 11:55:35 -05'00'
12/01/2020
File details come from the government source that posted it. Updated .