CN-370000-GC923-T3CO1.pdf
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- Contract number
- GC923
- Issued by
- Florida
About this file
Task Assignment Change Order Summary
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) for task assignment GC923-3 involving Polk County. The change order was executed on January 29, 2020, with an effective date of January 31, 2020, and was approved by FDEP on February 5, 2020. The contractor is identified as Polk County, with Steve Jarrett serving as the contractor representative and Roger Ruiz as the FDEP contract manager.
The change order increases the total task funding by $8,400, comprised of $400 for travel allotment and $8,000 for variable inspections. The original task amount of $272,165 is increased to $280,565 following this change order, with no modification to the task completion date of June 30, 2020. The funding is allocated under organizational code 37450104000, object code 132500, with budget entity 37450300 and special category code 100029. The total contract amount of $280,565.00 is charged to year 00. Copies of the approved change order were distributed 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:
GC923-3 01/29/2020 1
POLK COUNTY
Steve Jarrett
Roger Ruiz
The total increase in funds for GC923-3 Polk County is $8,400.
$400 for Travel Allotment.
$8,000 for Variable Inspections.
272,165 272,165
272,165 272,165
+8,400 +8,400
280,565 280,565
06/30/20 06/30/20 +8,400 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 $ 280,565.00
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: your signing location here Date: 2020-01-31 08:45:22 Foxit Reader Version: 9.7.0
Steven Jarrett 01/31/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.02.03 07:22:07 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.02.03 09:34:29 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 14:58:17 -05'00'
File details come from the government source that posted it. Updated .