CN-370000-GC919-T3CO1.pdf
PDF 654 KB Posted
- Contract number
- CN817
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form from the Florida Department of Environmental Protection, involving Collier County as the contractor. The change order is dated 07/18/2019 and is identified with the task assignment number GC919-3. The key personnel include Phil Snyderburn as the Contractor Representative and Roger Ruiz as the DEP Contract Manager.
The change order increases the task amount by $13,879.00 for Variable Inspections, bringing the total task amount from $100,073.00 to $113,952.00. The task completion date remains unchanged at 06/30/20. The funding information includes an organizational code of 3745010400, an object code of 132500, and a budget entity of 3745030, with a special category of 100029. The document is fully executed with digital signatures from the contractor representative, contract manager, budget representative, and contractual authority.
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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:
GC919-3 07/18/2019 1
COLLIER COUNTY
Phil Snyderburn
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $13,879.00.
100,073.00 100,073.00
100,073.00 100,073.00
+13,879.00 +13,879.00
113,952.00 113,952.00
06/30/20 06/30/20 +13,879.00 06/30/20
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 $ 113,952.00
Phil Snyderburn Digitally signed by Phil Snyderburn Date: 2019.07.18 14:27:23 -04'00' Roger Ruiz Digitally signed by Roger Ruiz
Date: 2019.07.18 15:38:20 -04'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2019.07.18 15:56:09 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2019.07.22 12:09:38 -04'00'
File details come from the government source that posted it. Updated .