CN-370000-GC924-T2CO4.pdf
PDF 534 KB Posted
- Contract number
- GC924
- Issued by
- Florida
About this file
Task Assignment Change Order Summary
This is a Task Assignment Change Order Form (Form OOO-012) issued by the Florida Department of Environmental Protection on April 17, 2019. The document pertains to Task Assignment GC924-2 and modifies an existing contract with Gulf County. The contractor representative is Sarah Hinds, and the DEP Contract Manager is Roger Ruiz. The change order has been approved by Fletcher Herrald as both Budget Representative and Contractual Authority.
The change order increases task assignment funding by $4,200.00 to cover an increase in variable inspections. The original task amount of $62,935.00 is increased to a total of $67,135.00 with all change orders applied. The task completion date remains June 30, 2019. Funding is allocated from Organizational Code 37450104000 under E.O. JD with Object Code 132500, Budget Entity 37450300, and Special Category 104138, with Year Code 00. The modified contract amount of $67,135.00 is charged to this funding source.
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Other files
| File | Type | Posted |
|---|---|---|
| CN-370000-GC924-A2.pdf.crdownload | CRDOWNLOAD file | |
| CN-370000-GC924-T1.pdf | ||
| CN-370000-GC924-T1CO2.pdf | ||
| CN-370000-GC924-T2CO5.pdf | ||
| CN-370000-GC924-T3CO2.pdf | ||
| CN-370000-GC904-CMC3.pdf | ||
| CN-370000-GC924-ARC1.pdf | ||
| CN-370000-GC924-T1CO1.pdf | ||
| CN-370000-GC924-T3.pdf | ||
| CN-370000-GC924-T3CO1.pdf | ||
| CN-370000-GC924-T4.pdf | ||
| CN-370000-GC924-T5.pdf | ||
| CN-370000-GC924-T5CO1.pdf | ||
| CN-370000-GC924-T7CO1.pdf | ||
| CN-370000-GC924-T7CO2.pdf | ||
| CN-370000-GC924-T9.pdf | ||
| CN-370000-GC924-A2.pdf | ||
| CN-370000-GC924-T2.pdf | ||
| CN-370000-GC924-T2CO1.pdf | ||
| CN-370000-GC924-T2CO2.pdf | ||
| CN-370000-GC924-T2CO3.pdf | ||
| CN-370000-GC924-T6.pdf | ||
| CN-370000-GC924-T7.pdf | ||
| CN-370000-GC924-A3.pdf | ||
| CN-370000-GC924-T8.pdf |
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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 .