CN-370000-GC923-T5CO3.pdf
PDF 655 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) dated April 19, 2022. The document modifies an existing contract (GC923) with Polk County, represented by contractor Ralph Meder, under the oversight of FDEP Contract Manager Roger Ruiz.
The change order revises the completion deadline for Task Assignment #5, which involves conducting routine compliance inspections for storage tank systems at 430 facilities within Polk and Hardee Counties. The original deadline of May 31, 2022, has been extended to June 30, 2022. The task amount remains unchanged at $267,672.00, with funding sourced from Organizational Code 37450104000 (E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029). The change order has been approved by all required parties, including the contractor, contract manager, budget representative (Tameshia N. Reid), and contractual authority (Teresa Booeshaghi), with all signatures dated April 19, 2022.
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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 04/19/2022 3
POLK COUNTY
Ralph Meder
Roger Ruiz
This change revises the sentence in Task Assignment #5 for DEP Contract GC923 reading:
"Conduct routine compliance inspections for storage tank systems at the 430 facilities within Polk and Hardee Counties, identified in Exhibit #1, by May 31, 2022.", to read:
"Conduct routine compliance inspections for storage tank systems at the 430 facilities within Polk and Hardee Counties, identified in Exhibit #1, by June 30, 2022."
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: 2022.04.19 15:20:39 -04'00'
04/19/2022 Roger Ruiz Digitally signed by Roger Ruiz Date: 2022.04.19 15:40:22 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.04.19 16:11:12 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.04.19 16:17:10 -04'00'
File details come from the government source that posted it. Updated .