CN-370000-GC928-T3CO1.pdf
PDF 1008 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 July 25, 2018. The document modifies an existing task assignment (GC928-3) with contractor Citrus County, represented by Glenn W. Bryant. The change order was processed through FDEP's Contract Manager Roger Ruiz and approved by multiple FDEP officials, including Budget Representative Jennifer Vickers and Contractual Authority Tim J. Bahr.
The change order pertains to an updated Attachment A - Scope of Work with no modifications to the task amount or completion timeline. The original task amount of $86,915.00 remains unchanged, with the completion date maintained at June 30, 2019. Funding is sourced from Org. Code 37450104000 under E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, in year 00. The change order was digitally signed and approved on August 2, 2018, with copies distributed to the Procurement Section (MS93) and 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:
GC928-3 07/25/2018 1
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Updated Attachment A - Scope of Work
$86,915.00
06/30/19 06/30/19
06/30/19
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 $ 86,915.00
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 am approving this document Location:
Date: 2018-08-02 09:38:45
Glenn W_ Bryant
Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2018.08.02 10:12:41 -04'00'
Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.08.02 13:26:15 -04'00'
Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2018.08.02 15:27:09 -04'00'
BryantGW Typewriter 2018-08-02
File details come from the government source that posted it. Updated .