CN-370000-GC920-T3CO1.pdf
PDF 1 MB Posted
- Contract number
- RP885
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection for contract GC920-3 with Broward County. The change order involves the contractor Ali H. Younes and is managed by DEP Contract Manager Roger Ruiz. The form documents a modification to an existing task assignment, specifically addressing changes in funding and task parameters.
The change order increases the total task amount by $23,900, broken down into $900 for Travel Allotment and $23,000 for Variable Inspections. The original task amount was $453,760, which is now increased to $477,660. The task completion date remains unchanged at 06/30/20. The funding information shows the organizational code 37450104000, with a budget entity of 37450300 and a special category of 100029. The document includes digital signatures from the contractor, contract manager, budget representative, and contractual authority, indicating formal approval of the change order.
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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:
GC920-3 01/28/2020 1
BROWARD COUNTY
Ali H. Younes
Roger Ruiz
The total increase in funds for GC920-3 Broward County is $23,900.
$900 for Travel Allotment.
$23,000 for Variable Inspections.
453,760 453,760
453,760 453,760
+23,900 +23,900
477,660 477,660
06/30/20 06/30/20 +23,900 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 $ 477,660.00
Digitally signed by ALI YOUNES Date: 2020.01.29 08:16:21 -05'00' 01/29/2020 Roger Ruiz Digitally signed by Roger Ruiz
Date: 2020.01.29 08:42:15 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.01.29 11:21:38 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 14:35:21 -05'00'
File details come from the government source that posted it. Updated .