CN-370000-GC920-T6CO2.pdf
PDF 670 KB Posted
- Contract number
- GC920
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Form OOO-012) issued by the Florida Department of Environmental Protection (FDEP) for Broward County. The document is dated May 11, 2023, and represents Change Order No. 2 under Task Assignment Number GC920-6. The contractor representative is Ali H. Younes, and the FDEP Contract Manager is Roger Ruiz.
The change order increases funds for Ethanol/Biodiesel Inspections by $419, resulting in a net increase to the task amount. The original task amount was $481,712, with the task amount prior to this change order at $482,131. Following this change order, the total task amount with all change orders is $482,550. The task completion date remains June 30, 2023, with no extension to the timeline. The funding adjustment is allocated across three line items using organization code 37450104000, object code 132500, and budget entity 37450300, with $481,712 distributed under grant 100029 (year 00) and $419 distributed under grant 087889 (year 23). The change order was approved by Tameshia N. Reid (Budget Representative) and Jessica Kramer (Contractual Authority) on May 15, 2023.
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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:
GC920-6 05/11/2023 2
BROWARD COUNTY
Ali H. Younes
Roger Ruiz
Increase in funds for Ethanol/Biodiesel Inspections for $419.
A net increase of $419.
481,712 481,712
482,131 482,131
+419 +419
482,550 482,550
06/30/23 06/30/23 +419 06/30/23
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 $ 481,712.00
37450104000 JG 132500 37450300 087889 23 $ 419.00
37450104000 JG 132500 37450300 087889 23 $ 419.00
Digitally signed by ALI YOUNES Date: 2023.05.11 13:14:39 -04'00' 05/11/2023 Roger Ruiz Digitally signed by Roger Ruiz
Date: 2023.05.15 07:50:11 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.05.15 08:44:47 -04'00'
Jessica Kramer Digitally signed by Jessica Kramer Date: 2023.05.15 14:41:06 -04'00'
File details come from the government source that posted it. Updated .