CN-370000-GC923-T6CO2.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. 2) issued by the Florida Department of Environmental Protection (FDEP) on February 20, 2023. The change order modifies Task Assignment GC923-6 with Polk County, represented by contractor Ralph Meder. The DEP Contract Manager is Roger Ruiz. The document was approved by Fletch Herrald (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order addresses performance measures for the task due to personnel issues, adjusting the second performance measure milestone to require completion of 8% or 35 Routine Compliance Inspections after eight months. The original task amount of $280,357.00 remains unchanged, with no net increase or decrease in task amount. The task completion date remains June 30, 2023 (06/30/23), with no extension to the task period. The funding is allocated from Org. Code 37450104000 (E.O. JD), Object Code 132500, Budget Entity 37450300, Special Category 100029, in the amount of $280,357.00. The change order was executed with digital signatures from all required parties on February 20, 2023.
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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:
GC923-6 02/20/2023 2
POLK COUNTY
Ralph Meder
Roger Ruiz
Performance Measures:
Due to personnel issues, GC923-6 Polk County, for the second Performance Measures, after (8) eight months shall complete (8%) or 35 Routine Compliance Inspections.
280,357 280,357
06/30/23
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 $ 280,357.00
Ralph J. Meder, P.G.
Digitally signed by Ralph J. Meder, P.G.
Date: 2023.02.20 10:46:14 -05'00'
02/20/2023 Roger Ruiz Digitally signed by Roger Ruiz Date: 2023.02.20 12:59:47 -05'00'
Fletch Herrald Digitally signed by Fletch Herrald Date: 2023.02.20 13:10:01 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.02.20 13:15:19 -05'00'
File details come from the government source that posted it. Updated .