CN-370000-GC923-T2CO2.pdf
PDF 535 KB Posted
- Contract number
- GC923
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection dated December 26, 2018. The document pertains to Task Assignment GC923-2 and represents Change Order No. 2. The contractor is Polk County, represented by Steve Jarrett, with Roger Ruiz serving as the DEP Contract Manager. The change order has been approved by Jennifer Vickers (Budget Representative) and Fletcher Herrald (Contractual Authority).
The change order increases funding for variable inspections in the amount of $25,500.00. The original task amount was $259,950.00, and with all change orders, the total task amount is now $285,450.00. The task completion date remains June 30, 2019. The funding is allocated under Org. Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, with Year 00 and a total amount of $285,450.00. The change order is directed to be copied to the Procurement Section (MS93) and the 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:
GC923-2 12/26/2018 2
POLK COUNTY
Steve Jarrett
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $25,500 .00
259,950.00 259,950.00
259,950.00 259,950.00
+25,500.00 +25,500.00
285,450.00 285,450.00
06/30/19 06/30/19 25,500.00 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 00 $ 285,450.00
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: 2018-12-26 13:32:22 Foxit Reader Version: 9.3.0
Steven Jarrett 12/26/2018 Roger Ruiz Digitally signed by Roger Ruiz Date: 2018.12.26 13:37:49 -05'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.12.27 00:39:38 -05'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2018.12.27 14:21:12 -05'00'
File details come from the government source that posted it. Updated .