CN-370000-GC918-T2CO3.pdf
PDF 654 KB Posted
- Contract number
- GC918
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 3) issued by the Florida Department of Environmental Protection (FDEP) on April 19, 2018, for work performed by Alachua County. The change order was prepared by contractor representative Ted Goodman and approved by FDEP Contract Manager Roger Ruiz, with final approvals from Budget Representative Jennifer Vickers and Contractual Authority Tim J. Bahr.
The change order reflects a reduction in funding for Variable Inspections work under Task Assignment GC918-2, resulting in a net decrease of $8,000.00. The original task amount was $123,807.73; prior to this change order, the task amount had increased to $125,044.84. With this change order applied, the revised task amount with all change orders totals $117,044.84. The task completion date remains June 30, 2018. Funding is allocated from Org. Code 37450104000 using Object Code 132500 under Budget Entity 37450300, Special Category 100029, with an approved amount of $117,044.84 for fiscal year 2018.
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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:
GC918-2 04/19/2018 3
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Reduction on funding for Variable Inspections.
A net decrease of $8,000.00.
123,807.73 123,807.73
125,044.84 125,044.84
(8,000.00) (8,000.00)
117,044.84 117,044.84
06/30/18 06/30/18 (8,000.00) 06/30/18
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 2018 $ 117,044.84
Ted A. Goodman Digitally signed by Ted A. Goodman DN: cn=Ted A. Goodman, o=ACEPD, ou, email=tgoodman@alachuacounty.us, c=US Date: 2018.04.20 09:08:02 -04'00'
04/20/2018 Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.04.20 09:59:41 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.04.23 12:42:29 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.04.23 22:22:16 -04'00'
File details come from the government source that posted it. Updated .