CN-370000-GC928-T13CO1.pdf
PDF 535 KB Posted
- Contract number
- GC928
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (Change Order No. 1) issued by the Florida Department of Environmental Protection (FDEP) on October 17, 2023. The document pertains to Task Assignment Number GC928-13 with Citrus County as the contractor, represented by Glenn W. Bryant. Roger Ruiz serves as the DEP Contract Manager. The change order has been approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order reflects a decrease in funds for Variable Inspections in the amount of $2,300, resulting in a net decrease to the overall task assignment. The original task amount of $104,356.41 is reduced by $2,300, bringing the task amount with all change orders to $102,056.41. The task completion date remains unchanged at June 30, 2024. Funding is allocated from Organizational Code 37450104000 under Object Code 132500 with Budget Entity 37450300 and Special Category 100029. The change order maintains the same funding source structure while reducing the total contract obligation by the specified amount.
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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:
GC928-13 10/17/2023 1
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Decrease in funds for Variable Inspections for -$2,300.
A net decrease of -$2,300.
104,356.41 104,356.41
104,356.41 104,356.41
-2,300 -2,300
102,056.41 102,056.41
06/30/24 06/30/24 -2,300 06/30/24
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 $ 104,356.41
37450104000 JD 132500 37450300 100029 00 -$ 2,300.00
Digitally signed by Glenn W Bryant DN: C=US, OU=EPH, O=FL DOH Citrus, CN=Glenn W Bryant, E=glenn.bryant@FLHealth.Gov Reason: I agree to the terms defined by the placement of my signature in this document Location: your signing location here Date: 2023-10-17 15:23:38 Foxit Reader Version: 9.7.1
Glenn W Bryant Roger Ruiz Digitally signed by Roger Ruiz
Date: 2023.10.18 07:29:42 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.10.18 09:05:02 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.10.18 12:11:37 -04'00'
File details come from the government source that posted it. Updated .