CN-370000-GC925-T1CO4.pdf
PDF 655 KB Posted
- Contract number
- GC925
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection on June 18, 2018. The change order involves Orange County as the contractor, with David Jones serving as the contractor representative and Roger Ruiz as the DEP Contract Manager. The task assignment number is GC925-1, and this represents Change Order No. 4 to the existing task.
The change order increases the task amount by $25,698.61 to cover costs of inspections. The original task amount was $801,833.30, with the amount prior to this change order at $803,659.35. The final task amount with all change orders totals $829,357.96. The task completion date remains fixed at June 30, 2018 with no extension to the timeline. The funding is allocated from Organizational Code 37450104000 under E.O. JD, Object Code 132500, with Budget Entity 37450300 and Special Category 100029 for fiscal year 2018. All required approvals were obtained through digital signatures from contractor and departmental representatives, including the budget representative and contractual authority.
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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:
GC925-1 06/18/2018 4
ORANGE COUNTY
David Jones
Roger Ruiz
Increase in Task Amount.
A net increase of $25,698.61 to cover costs of inspections.
801,833.30 801,833.30
803,659.35 803,659.35
25,698.61 25,698.61
829,357.96 829,357.96
06/30/18 06/30/18 25,698.61 06/30/18
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 2018 $ 829,357.96
David D. Jones Digitally signed by David D. Jones Date: 2018.06.18 16:38:42 -04'00' 06/18/2018 Roger Ruiz Digitally signed by Roger Ruiz
Date: 2018.06.19 07:11:47 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.06.19 11:24:50 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.06.19 16:10:20 -04'00'
File details come from the government source that posted it. Updated .