CN-370000-GC928-T1CO1.pdf
PDF 1010 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 (FDEP) on August 2, 2017. The document modifies an existing task assignment with Citrus County under contract number GC928-1. The change order was executed by Glenn W. Bryant as the Contractor Representative and Roger Ruiz as the FDEP Contract Manager. The document was approved by Jennifer Vickers (Budget Representative) and Fletch Herrald (Contractual Authority) on August 7, 2017.
The change order increases the unit price for Routine Inspections from $510.40 to $515.50, representing a net increase of $5.10 per inspection. This rate adjustment became effective September 1, 2017, with all inspections conducted through August 31, 2017 paid at the original rate of $510.40. The modification resulted in a task amount increase of $952.12, bringing the total task amount with all change orders from $95,286.58 to $96,238.70. The task completion date remained unchanged at June 30, 2018. Funding for this change order is allocated to Organization Code 37450104000 (JD), Object Code 132500, Budget Entity 37450300, Special Category 100029, and charged to year 00 with a total amount of $96,238.70.
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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:
GC928-1 08/02/2017 1
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Amount increase per Routine Inspection from $510.40 to $515.50.
A net increase of $5.10 per Routine Inspection.
The increase will become effective September 1, 2017. All inspections conducted through August 31, 2017, will be paid at the rate of $510.40.
95,286.58 95,286.58
95,286.58 95,286.58
952.12 952.12
96,238.70 96,238.70
06/30/18 06/30/18 952.12 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 00 $ 96,238.70
Digitally signed by Glenn W Bryant DN: CN=Glenn W Bryant, C=US, OU=FL DOH Citrus EPH, E=glenn.bryant@flhealth.gov Reason: I agree to the terms defined by the placement of my signature in this document Location:
Date: 2017-08-07 09:20:14
Glenn W Bryant 08/07/2017 Roger Ruiz Digitally signed by Roger Ruiz
Date: 2017.08.07 10:58:06 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2017.08.07 14:36:59 -04'00'
08/07/2017
Fletch Herrald Digitally signed by Fletch Herrald Date: 2017.08.15 10:12:06 -04'00'
File details come from the government source that posted it. Updated .