CN-370000-GC928-T3CO4.pdf
PDF 534 KB Posted
- Contract number
- GC928
- Issued by
- Florida
About this file
Task Assignment Change Order Summary
This document is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP) dated June 11, 2019. The change order modifies Task Assignment GC928-3 for Citrus County, with Glenn W. Bryant serving as the contractor representative and Roger Ruiz as the FDEP Contract Manager. The form has been approved by budget representative Griffin Kolchakian and contractual authority Teresa Booeshaghi.
The change order authorizes an increase in funds for variable inspections in the amount of $100.00. The original task amount was $86,915.00, which had been increased to $98,915.00 prior to this change order. With the addition of $100.00, the total task amount with all change orders is now $99,015.00. The task completion date remains unchanged at June 30, 2019. Funding for this change is derived from Org. Code 37450104000 under E.O. JD with Object Code 132500, Budget Entity 37450300, and Special Category 104138, with Year 00 designation.
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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 06/11/2019 4
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Increase in Funds for Variable Inspections in the amount of $100.00
$86,915.00 $86,915.00
$98,915.00 $98,915.00
+ $100.00 + $100.00
$99,015.00 $99,015.00
06/30/19 06/30/19 + $100.00 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 104138 00 $ 100.00
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:
Date: 2019-06-11 09:52:49 Foxit Reader Version: 9.3.0
Glenn W_ Bryant Roger Ruiz Digitally signed by Roger Ruiz
Date: 2019.06.11 10:12:26 -04'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2019.06.11 12:50:57 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2019.06.11 13:36:07 -04'00'
File details come from the government source that posted it. Updated .