CN-370000-GC923-T4CO1.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 dated February 18, 2021. 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 has been approved by Monica J. Brady (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order modifies performance measures for Task Assignment GC923-4 Polk County due to personnel health issues. After eight months of performance, the second performance measure requirement has been adjusted to completion of 55 percent, or 237 Routine Compliance Inspections, rather than the original full requirement. The task amount remains unchanged at $280,565.00, and the completion date remains June 30, 2021. Funding for this task is allocated from Org. Code 37450104000 under Object Code 132500, Budget Entity 37450300, Special Category 100029, with the amount of $280,565.00 charged to Year 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:
GC923-4 02/18/2021 1
POLK COUNTY
Steve Jarrett
Roger Ruiz
Performance Measures:
Due to personnel health issues, GC923-4 Polk County after (8) eight months, the second performance measures for GC923-4 Polk County shall be to complete (55%) or 237 Routine Compliance Inspections.
280,565 280,565
06/30/21 06/30/21
06/30/21
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: 2021-02-18 09:47:41 Foxit Reader Version: 9.7.2
Steven Jarrett 02/18/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.02.18 11:32:36 -05'00'
Monica J. Brady Digitally signed by Monica J.
Brady Date: 2021.02.18 14:16:31 -05'00'
02/18/2021
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.02.18 14:30:23 -05'00'
02/18/2021
File details come from the government source that posted it. Updated .