CN-370000-GC918-T13CO1.pdf
PDF 655 KB Posted
- Contract number
- GC918
- Issued by
- Florida
About this file
Document Summary
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on March 25, 2024. The change order modifies an existing task assignment with Alachua County, identified as Task Assignment Number GC918-13. The contractor is represented by Ted Goodman, with Roger Ruiz serving as the DEP Contract Manager. The change order has been approved by Budget Representative Fletch Herrald and Contractual Authority Teresa Booeshaghi.
The change order increases funding for Variable Inspections by $9,589, resulting in a net increase to the task assignment amount. The original task amount was $372,548.77, and with this change order, the total task amount with all change orders is $382,137.77. The task completion date remains June 30, 2024, with no extension to the timeline. Funding is allocated under Org. Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, and Special Category 100029, with two separate line items documented in the Change in Funding Information section: one for $372,548.77 and one for the additional $9,589.00.
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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:
GC918-13 03/25/2024 1
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Increase in funds for Variable Inspections for $9,589.
A net increase of $9,589.
372,548.77 372,548.77
372,548.77 372,548.77
+9,589 +9,589
382,137.77 382,137.77
06/30/24 06/30/24 +9,589 06/30/24
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 $ 372,548.77
37450104000 JD 132500 37450300 100029 00 $ 9,589.00
Ted A. Goodman, P.G.
Digitally signed by Ted A.
Goodman, P.G.
Date: 2024.03.25 15:44:42 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2024.03.26 07:18:51 -04'00'
Fletch Herrald Digitally signed by Fletch Herrald Date: 2024.03.26 11:04:32 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2024.03.26 19:26:09 -04'00'
File details come from the government source that posted it. Updated .