CN-370000-GC918-T3CO2.pdf
PDF 654 KB Posted
- Contract number
- GC918
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) on January 9, 2019. The document pertains to a contract with Alachua County, with Ted Goodman serving as the Contractor Representative and Roger Ruiz as the DEP Contract Manager. The change order is identified as Change Order No. 2 under Task Assignment Number GC918-3.
The change order increases the task assignment amount by $24,000.00 to fund additional variable inspections. The original task amount was $322,485.00, and with this change order, the total task amount with all change orders becomes $346,485.00. The task completion date remains June 30, 2019. Funding information indicates the total amount of $346,485.00 is allocated under Organizational Code 37450104000, Budget Entity 37450300, Special Category 100029, with Object Code 132500. The change order was approved by Budget Representative Jennifer Vickers on January 25, 2019, and by Contractual Authority Tim J. Bahr on January 30, 2019.
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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:
GC918-3 01/09/2019 2
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $24,000.00.
322,485.00 322,485.00
322,485.00 322,485.00
+24,000.00 +24,000.00
346,485.00 346,485.00
06/30/19 06/30/19 +24,000.00 06/30/19
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 $ 346,485.00
Ted A. Goodman Digitally signed by Ted A. Goodman DN: cn=Ted A. Goodman, o=ACEPD, ou, email=tgoodman@alachuacounty.us, c=US Date: 2019.01.09 10:23:26 -05'00'
01/09/2019 Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.01.24 09:43:31 -05'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2019.01.25 00:52:14 -05'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2019.01.30 10:22:58 -05'00'
File details come from the government source that posted it. Updated .