CN-370000-GC921-T3CO1.pdf
PDF 1 MB Posted
- Contract number
- GC921
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 1) issued by the Florida Department of Environmental Protection (FDEP) dated January 28, 2020, for a task assignment with Sarasota County. The contractor representative is John Hickey, PE, and the FDEP Contract Manager is Roger Ruiz. The task assignment number is GC921-3.
The change order increases the task amount by $250 for an increase in travel allotment funds. The original task amount was $123,213, and with this change order, the total task amount becomes $123,463. The task completion date remains June 30, 2020, with no change in the task time period. Funding is charged to Org. Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, for a total amount of $123,463.00. The change order was approved by Griffin Kolchakian (Budget Representative) on February 3, 2020, and Teresa Booeshaghi (Contractual Authority) on February 5, 2020. Copies were distributed to the Procurement Section (MS93) and Bureau of Finance & Accounting (MS78).
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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:
GC921-3 01/28/2020 1
SARASOTA COUNTY
John Hickey, PE
Roger Ruiz
Increase in funds for Travel Allotment for $250.
123,213 123,213
123,213 123,213
+250 +250
123,463 123,463
06/30/20 06/30/20 +250 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 $ 123,463.00
Digitally signed by John Hickey Date: 2020.02.01 08:15:50 -05'00'
02/01/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.02.03 08:18:35 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.02.03 09:36:19 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 14:57:17 -05'00'
File details come from the government source that posted it. Updated .