CN-370000-GC918-T15CO2.pdf

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:

GC918-15 05/13/2025 2

ALACHUA COUNTY

Ted Goodman

Roger Ruiz

This change revises the sentence in Task Assignment #15 for DEP Contract GC918 reading:

"Conduct routine compliance inspections for storage tank systems at the 473 facilities within Alachua, Bradford, Clay, Columbia, Dixie, Flagler Gilchrist, Lafayette, Levy, Hamilton, Madison, Putnam, Suwanee, Taylor and Union Counties, identified in Exhibit #1, by May 31, 2025.", to read:

"Conduct routine compliance inspections for storage tank systems at the 437 facilities within Alachua, Bradford, Clay, Columbia, Dixie, Flagler Gilchrist, Lafayette, Levy, Hamilton, Madison, Putnam, Suwanee, Taylor and Union Counties, identified in Exhibit #1, by June 30, 2025."

425,173.77 425,173.77

443,173.77 443,173.77

443,173.77 443,173.77

06/30/25 06/30/25

06/30/25

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 $ 425,173.77

37450104000 JD 132500 37450300 100029 00 $ 18,000.00

Ted A. Goodman, P.G.

Digitally signed by Ted A.

Goodman, P.G.

Date: 2025.05.14 14:51:41 -04'00'

05/14/2025 Roger Ruiz Digitally signed by Roger Ruiz Date: 2025.05.14 16:00:19 -04'00'

Tameshia N. Reid Digitally signed by Tameshia N.

Reid Date: 2025.05.14 16:09:04 -04'00'

John J Truitt Digitally signed by John J Truitt Date: 2025.05.15 08:53:09 -04'00'

05/15/2025