CN-370000-GC923-T7CO4.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. 4) issued by the Florida Department of Environmental Protection (FDEP) on May 22, 2024. The document modifies an existing task assignment (GC923-7) between FDEP and Polk County. The contractor representative is Ralph Meder, and the FDEP contract manager is Roger Ruiz.
The change order addresses performance measures for invoice 12, requiring Polk County to complete 43 percent, or 146 Routine Compliance Inspections, due to personnel issues. The task amount remains unchanged at $96,000.00, with no net increase or decrease. The task completion date remains June 30, 2023. Funding is allocated from organizational code 37450104000 with object code 132500 under budget entity 37450300, special category 100029. The original task amount totaled $282,789.46, with cumulative change orders bringing the total task amount to $96,000.00. The change order was approved by Budget Representative Tameshia N. Reid and Contractual Authority Tim Bahr on May 22, 2024.
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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:
GC923-7 05/22/2024 4
POLK COUNTY
Ralph Meder
Roger Ruiz
Performance Measures:
Due to personnel issues, for invoice 12, GC923-7 Polk County, shall complete (43%) or 146 Routine Compliance Inspections.
282,789.46 282,789.46
96,000 96,000
96,000 96,000
06/30/23 06/30/23
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 $ 282,789.46
37450104000 JD 132500 37450300 100029 00 $ 96,000.00
Ralph J Meder, P.G., CPG
Digitally signed by Ralph J Meder, P.G., CPG
Date: 2024.05.22 13:25:04 -04'00'
05/22/2024 Roger Ruiz Digitally signed by Roger Ruiz Date: 2024.05.22 13:37:24 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2024.05.22 14:07:05 -04'00'
Tim Bahr Digitally signed by Tim Bahr Date: 2024.05.22 14:47:22 -04'00'
File details come from the government source that posted it. Updated .