CN-370000-GC923-T2CO1.pdf
PDF 1008 KB 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 July 19, 2018. The document involves Polk County as the contractor, with Steve Jarrett serving as the contractor representative and Roger Ruiz as the DEP Contract Manager. The change order was approved by the Florida Department of Environmental Protection, with signatures from Jennifer Vickers (Budget Representative) and Tim J. Bahr (Contractual Authority).
The change order pertains to an updated Attachment A - Scope of Work, with an original task amount of $259,950.00 and a completion date of June 30, 2019. The funding is allocated from Org. Code 37450104000 under E.O. JD 132500, with Object Code 132500, Budget Entity 37450300, and Special Category 100029 for fiscal year 2018. The task assignment number is GC923-2, and this represents Change Order No. 1. No net increase or decrease in task amount or completion date is indicated in the change order documentation.
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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:
GC923-2 07/19/2018 1
POLK COUNTY
Steve Jarrett
Roger Ruiz
Updated Attachment A - Scope of Work
259,950.00
06/30/19 06/30/19
06/30/19
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 2018 $ 259,950.00
Digitally signed by Steven Jarrett DN: C=US, OU=Storage Tank Regulation, O=Florida Department of Health in Polk County, CN=Steven Jarrett, E=steven.jarrett@flhealth.gov Reason: I have reviewed this document Location:
Date: 2018-07-31 10:56:38 Foxit Reader Version: 9.2.0
Steven Jarrett 07/31/2018 Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2018.08.01 10:29:04 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.08.01 10:41:31 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.08.14 13:51:44 -04'00'
File details come from the government source that posted it. Updated .