CN-370000-GC924-T2CO4.pdf
PDF 534 KB Posted
- Contract number
- GC148
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form from the Florida Department of Environmental Protection, involving Gulf County as the contractor. The form is dated 04/17/2019 and is Change Order No. 4 for Task Assignment Number GC924-2. The key parties include Sarah Hinds as the Contractor Representative and Roger Ruiz as the DEP Contract Manager.
The change order increases the task amount by $4,200.00 for Variable Inspections, bringing the total task amount from $62,935.00 to $67,135.00. The task completion date remains unchanged at 06/30/19. The funding information includes an Org. Code of 3745010400, Object Code 132500, Budget Entity 3745030, and Special Category 104138, with a total funded amount of $67,135.00. The document is digitally signed by the Contractor Representative, Contract Manager, and a Budget Representative, indicating approval of the change order.
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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:
GC924-2 04/17/2019 4
GULF COUNTY
Sarah Hinds
Roger Ruiz
Increase of Funds for Variable Inspections in the amount of $4,200.00
62,935.00 62,935.00
62,935.00 62,935.00
+4,200.00 +4,200.00
67,135.00 67,135.00
06/30/19 06/30/19 +4,200.00 06/30/19
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 104138 00 $ 67,135.00
Digitally signed by Sarah Hinds DN: O=Florida Dept of Health, CN=Sarah Hinds, E=sarah.hinds@flhealth.gov Reason: I am the author of this document Location:
Date: 2019-04-24 09:19:55 Foxit Reader Version: 9.1.0
Sarah Hinds Roger Ruiz Digitally signed by Roger Ruiz Date: 2019.04.24 09:25:33 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.24 09:37:29 -04'00'
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2019.04.24 09:37:44 -04'00'
File details come from the government source that posted it. Updated .