CN-370000-GC918-T4CO6.pdf
PDF 654 KB Posted
- Contract number
- GC918
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on May 13, 2019. The change order involves Alachua County as the contractor, with Ted Goodman serving as the contractor representative and Roger Ruiz as the FDEP contract manager. The task assignment number is GC918-4, and this represents Change Order No. 6 to the existing agreement.
The change order authorizes an increase of funds in the amount of $7,800.00 for variable inspections services. The original task amount was $116,095.00, which had been increased to $129,040.00 prior to this change order. With the additional $7,800.00 increase, the total task amount with all change orders is now $136,840.00. The task completion date remains June 30, 2019. Funding is allocated from Org. Code 37450104000 with Object Code 132500, Budget Entity 37450300, and Special Category 100029, with the total amount of $136,840.00 charged to year 00. The change order was approved by Fletcher Herrald as both Budget Representative and Contractual Authority on May 14, 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:
GC918-4 05/13/2019 6
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $7,800.00
116,095.00 116,095.00
129,040.00 129,040.00
+7,800.00 +7,800.00
136,840.00 136,840.00
06/30/19 06/30/19 +7,800.00 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 $ 136,840.00
Ted A. Goodman Digitally signed by Ted A. Goodman DN: cn=Ted A. Goodman, o=ACEPD, ou, email=tgoodman@alachuacounty.us, c=US Date: 2019.05.14 11:22:29 -04'00'
05/14/2019 Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.05.14 12:41:07 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.05.14 14:14:17 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.05.14 14:14:41 -04'00'
File details come from the government source that posted it. Updated .