CN-370000-GC928-T14CO1.pdf
PDF 535 KB Posted
- Contract number
- GC928
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection dated October 17, 2023. The change order involves the contractor Citrus County, represented by Glenn W. Bryant, with DEP Contract Manager Roger Ruiz overseeing the modification. The document reflects an approved change to Task Assignment Number GC928-14, designated as Change Order No. 1.
The change order increases funding for Variable Inspections by $4,300, resulting in a net increase to the task amount from $44,220.66 to $48,520.66. The task completion date remains June 30, 2024, with no adjustment to the project timeline. Funding is allocated from Org. Code 37450104000 under E.O. code JD, Object Code 132500, with Budget Entity 37450300 and Special Category 100029. The original allocation of $44,220.66 is supplemented by the additional $4,300.00. All required approvals have been obtained, including signatures from the contractor representative, DEP Contract Manager, Budget Representative Tameshia N. Reid, and Contractual Authority Teresa Booeshaghi, as documented on October 18, 2023.
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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:
GC928-14 10/17/2023 1
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Increase in funds for Variable Inspections for $4,300.
A net increase of $4,300.
44,220.66 44,220.66
44,220.66 44,220.66
+4,300 +4,300
48,520.66 48,520.66
06/30/24 06/30/24 +4,300 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 $ 44,220.66
37450104000 JD 132500 37450300 100029 00 $ 4,300.00
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 15:22:43 Foxit Reader Version: 9.7.1
Glenn W Bryant Roger Ruiz Digitally signed by Roger Ruiz
Date: 2023.10.18 07:28:03 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2023.10.18 09:41:40 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.10.18 12:13:11 -04'00'
File details come from the government source that posted it. Updated .