CN-370000-GC923-T3CO2.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. 2) issued by the Florida Department of Environmental Protection on February 10, 2020. The document modifies an existing task assignment (GC923-3) with Polk County. The contractor representative is Steve Jarrett, and the DEP Contract Manager is Roger Ruiz. The change order was approved by Griffin Kolchakian (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order addresses recent medical personnel changes affecting performance requirements for Polk County. After eight months of performance, the second performance level for GC923-3 Polk County shall be adjusted to complete fifty-nine percent (59%) of Routine Compliance Inspections, equivalent to 254 inspections. The task amount remains unchanged at $280,565, with no net increase or decrease in funding. The original completion date of June 30, 2020 (06/30/20) is maintained with no extension to the task period. Funding is charged to Organizational Code 37450104000, Executive Order JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, in the amount of $280,565.00.
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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 02/10/2020 2
POLK COUNTY
Steve Jarrett
Roger Ruiz
Due to recent medical personnel changes for GC923-3 Polk County, after Eight (8) months, the second performance Level for GC923-3 Polk County shall be to complete fifty nine percent (59%) of Routine Compliance Inspections, or 254 Routine Compliance Inspections.
272,165 272,165
280,565 280,565
0 0
280,565 280,565
06/30/20 06/30/20 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: 2020-02-10 10:39:23 Foxit Reader Version: 9.7.1
Steven Jarrett 02/10/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.02.10 12:19:13 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.02.10 13:25:24 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.10 13:35:49 -05'00'
File details come from the government source that posted it. Updated .