CN-370000-GC923-T1CO1.pdf
PDF 1 MB Posted
- Contract number
- GC923
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection on August 2, 2017. The change order pertains to a task assignment with Polk County (Contract Number GC923-1), with Steve Jarrett serving as the Contractor Representative and Roger Ruiz as the DEP Contract Manager. The document was approved by Jennifer Vickers (Budget Representative) and Tim J. Bahr (Contractual Authority) on August 7, 2017.
The change order modifies the pricing for routine inspection services, increasing the amount per routine inspection from $510.40 to $515.50, representing a net increase of $5.10 per inspection. This price adjustment became effective September 1, 2017, with all inspections conducted through August 31, 2017, paid at the original rate of $510.40. The net increase in task amount is $2,785.11, raising the total task amount from $278,729.44 to $281,514.55. The task completion date remains June 30, 2018. Funding is allocated from Org. Code 37450104000 under Budget Entity 37450300, Special Category 100029, with the total amount of $281,514.55 to be charged to this account.
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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:
GC923-1 08/02/2017 1
POLK COUNTY
Steve Jarrett
Roger Ruiz
Amount increase per Routine Inspection from $510.40 to $515.50.
A net increase of $5.10 per Routine Inspection.
The increase will become effective September 1, 2017. All inspections conducted through August 31, 2017, will be paid at the rate of $510.40.
278,729.44 278,729.44
278,729.44 278,729.44
2,785.11 2,785.11
281,514.55 281,514.55
06/30/18 06/30/18 2,785.11 06/30/18
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 $ 281,514.55
Steven Jarrett Digitally signed by Steven Jarrett DN: cn=Steven Jarrett, o=Florida Department of Health in Polk County, ou=Storage Tank Regulation, email=steven.jarrett@flhealth.gov, c=US Date: 2017.08.04 10:11:38 -04'00'
08/04/2017 Roger Ruiz Digitally signed by Roger Ruiz Date: 2017.08.07 09:17:55 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2017.08.07 12:50:23 -04'00'
08/07/2017
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2017.08.07 17:07:58 -04'00'
File details come from the government source that posted it. Updated .