CN-370000-GC928-T4CO2.pdf

DEP Contract No. GC928, Attachment D, Page 1 of 2

Required Signatures: Adobe Signature

Task Assignment Number: GC928-4 Date: 10/3/2018 Change Order No. 2

Contractor Name: Florida Department of Health Citrus County Health Department

Contractor Representative: Will Bryant

DEP Contract Manager: Roger Ruiz

Description of Change (Use additional sheets if necessary):

Increase of Funds for Variable Inspections in the amount of $7,000.00.

Change in Task Amount

Item Cost Reimbursement Fee Schedule Total Original Task Amount: $ 34,610 $34,610

Task amount prior to this change order: 34,610 34,610

Net increase/decrease in task amount: + 7,000 + 7,000

Task amount with all change orders: $ 41,610 $41,610

Change in Task Time

Original task completion date: 6 /30/2019 Completion date prior to this change: 6/30/2019 Net increase/decrease in task period: + $ 7,000 Completion date with all change orders: 6/30/2019

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

DEP Contract No. GC928, Attachment D, Page 2 of 2

Change in Funding Information

Org. Code

37450104000

E.O.

JD

Object Code

132500

Budget Entity 37450300

Special Category 100029

Grant # Year

Amount

$ 41,610

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

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2018.10.05 09:19:39 -04'00'

Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2018.10.05 14:58:34 -04'00'

Fletcher Herrald Digitally signed by Fletcher Herrald Date: 2018.10.05 15:13:01 -04'00'

Bryantgw Typewriter 10/04/2018