CN-370000-GC918-T4CO5.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. 5) issued by the Florida Department of Environmental Protection (FDEP) on May 9, 2019. The document modifies an existing task assignment (GC918-4) with Alachua County, with Ted Goodman serving as the Contractor Representative and Roger Ruiz as the DEP Contract Manager. The change order was approved by Fletcher Herrald (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order increases funding for variable inspections by $5,000.00, raising the total task amount from $124,039.00 to $129,039.00. The task completion date remains unchanged at June 30, 2019. Funding is sourced from Organizational Code 37450104000 under Object Code 132500, with Budget Entity 37450300 and Special Category 100029. The total amount of $129,039.00 is allocated for the fiscal year ending in year 00. No changes to the task timeline were implemented with this modification.
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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:
GC918-4 05/09/2019 5
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $5,000.00
116,095.00 116,095.00
124,039.00 124,039.00
+5,000.00 +5,000.00
129,039.00 129,039.00
06/30/19 06/30/19 +5,000.00 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 $ 129,039.00
Ted A. Goodman Digitally signed by Ted A. Goodman DN: cn=Ted A. Goodman, o=ACEPD, ou, email=tgoodman@alachuacounty.us, c=US Date: 2019.05.09 15:47:29 -04'00'
05/09/2019 Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.05.09 15:52:11 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.05.09 17:00:59 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2019.05.09 20:43:23 -04'00'
File details come from the government source that posted it. Updated .