CN-370000-GC918-T7CO4.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) for a task assignment with Alachua County. The change order, numbered 4, was executed on June 21, 2021, with Ted Goodman representing the contractor and Roger Ruiz serving as the FDEP Contract Manager.
The change order increases funding for Variable Inspections by $8,900, raising the total task amount from $326,388 to $335,288. The task completion date remains June 30, 2021, with no extension to the original timeline. Funding is sourced from organization code 37450104000, object code 132500, and budget entity 37450300, with special category 100029. The total approved amount of $335,288.00 was signed and approved by Monica J. Brady (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on June 21, 2021.
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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:
GC918-7 06/21/2021 4
ALACHUA COUNTY
Ted Goodman
Roger Ruiz
Increase in funds for Variable Inspections for $8,900.
A net increase of $8,900.
326,388 326,388
326,388 326,388
+8,900 +8,900
335,288 335,288
06/30/21 06/30/21 +8,900 06/30/21
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 $ 335,288.00
Ted A. Goodman, P.G.
Digitally signed by Ted A.
Goodman, P.G.
Date: 2021.06.21 15:03:07 -04'00'
06/21/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.06.21 15:13:49 -04'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2021.06.21 16:24:56 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.06.21 16:36:38 -04'00'
File details come from the government source that posted it. Updated .