CN-370000-GC924-T5CO1.pdf

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Attached to
Master Agreement FL|GC924|c560f091e904e082a29e787f42919918
Contract number
GC924
Issued by
Florida

About this file

This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) on March 14, 2022. The document modifies an existing task assignment (GC924-5) with Gulf County. The contractor representative is Sarah Quaranta, and the FDEP Contract Manager is Roger Ruiz. The change order was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority) on March 16, 2022.

The change order increases funding for Variable Inspections by $10,000, raising the total task amount from $61,984 to $71,984. The task completion date remains June 30, 2022, with no extension to the timeline. The funding is allocated to Organizational Code 37450104000 under E.O. JD, Object Code 132500, with Budget Entity 37450300 and Special Category 100029, resulting in a revised total amount of $71,984.00. Copies of this change order were distributed to the Procurement Section (MS93) and the Bureau of Finance & Accounting (MS78).

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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:

GC924-5 03/14/2022 1

GULF COUNTY

Sarah Quaranta

Roger Ruiz

Increase in funds for Variable Inspections for $10,000.

A net increase of $10,000.

61,984 61,984

61,984 61,984

+10,000 +10,000

71,984 71,984

06/30/22 06/30/22 +10,000 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 $ 71,984.00

Digitally signed by Sarah Quaranta DN: C=US, OU=Administrator, O=Florida Department of Health, CN=Sarah Quaranta, E=Sarah.Quaranat@flhealth.gov Reason: I am the author of this document Location: your signing location here Date: 2022-03-16 14:58:56 Foxit Reader Version: 9.7.1

Sarah Quaranta

03/16/2022 Roger Ruiz Digitally signed by Roger Ruiz Date: 2022.03.16 15:10:07 -04'00'

Tameshia N. Reid Digitally signed by Tameshia N.

Reid Date: 2022.03.16 15:22:31 -04'00'

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.03.16 17:34:51 -04'00'

File details come from the government source that posted it. Updated .