CN-370000-GC923-T5CO2.pdf
PDF 655 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 (FDEP) on February 21, 2022. The change order modifies an existing task assignment with Polk County under Task Assignment Number GC923, with Ralph Meder serving as the contractor representative and Roger Ruiz as the DEP Contract Manager.
The change order adjusts performance measures for the second evaluation period occurring after eight months of contract performance. Due to unforeseen circumstances, Polk County is required to complete 222 Routine Compliance Inspections, representing 52% of the expected performance metrics by the completion date of June 30, 2022. The task amount remains at $267,672.00 with no change in total cost or completion timeline. Funding is allocated from Organizational Code 37450104000 under object code 132500, with the amount of $267,672.00 distributed to Special Category 37450300, code 100029. The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Teresa Booeshaghi on February 21, 2022, with copies directed to the Procurement Section and Bureau of Finance & Accounting.
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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 02/21/2022 2
POLK COUNTY
Ralph Meder
Roger Ruiz
Performance Measures:
Due to unforeseen circumstances GC923 Polk County, for the second Performance Measures after (8) eight months shall complete (52%) or 222 Routine Compliance Inspections.
267,672 267,672
06/30/22
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 $ 267,672.00
Ralph J. Meder, P.G.
Digitally signed by Ralph J. Meder, P.G.
Date: 2022.02.21 08:24:36 -05'00'
02/21/2022 Roger Ruiz Digitally signed by Roger Ruiz Date: 2022.02.21 08:43:04 -05'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.02.21 08:55:13 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.02.21 13:23:14 -05'00'
File details come from the government source that posted it. Updated .