CN-370000-GC923-T2CO3.pdf
PDF 534 KB Posted
- Contract number
- GC923
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 3) issued by the Florida Department of Environmental Protection (FDEP) on April 10, 2019, for Polk County. The form documents modifications to Task Assignment GC923-2 and was executed by Contractor Representative Steve Jarrett and DEP Contract Manager Roger Ruiz, with approval from Budget Representative and Contractual Authority Fletcher Herrald.
The change order revises the language in the current task assignment regarding inspection staff attendance at an annual meeting scheduled for Spring 2019. The original task specified reimbursement "at a rate of $400 per staff member," which has been removed to ensure that travel cost reimbursement complies with Chapter 112, Florida Statutes. The modification is administrative in nature with no changes to the funding amount, cost reimbursement, fee schedule, or task timeline. The task completion date remains June 30, 2019, and the change order affected no other contract information or financial terms. Distribution of the approved change order includes the Procurement Section (MS93) and two copies to 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 04/10/2019 3
POLK COUNTY
Steve Jarrett
Roger Ruiz
“Revising sentence in current task assignment from reading :
‘Inspection staff to attend annual meeting Spring 2019 at a rate of $400 per staff member.’
To read:
Inspection staff to attend annual meeting Spring 2019.”
This is necessary to ensure reimbursement for travel costs shall be in compliance with Chapter 112, FS.
No changes in funding amount or information effected by this Task Assignment Change Order (TACO).
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
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: 2019-04-10 17:53:41 Foxit Reader Version: 9.4.0
Steven Jarrett 04/10/2019 Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.04.11 08:51:08 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.11 09:18:58 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.11 09:19:15 -04'00'
File details come from the government source that posted it. Updated .