CN-370000-GC928-T5CO1.pdf
PDF 1008 KB Posted
- Contract number
- GC928
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form issued by the Florida Department of Environmental Protection (FDEP) on January 29, 2020. The change order modifies an existing task assignment (GC928-5) with Citrus County, represented by Glenn W. Bryant as the contractor representative. Roger Ruiz serves as the DEP Contract Manager. The document was approved by Griffin Kolchakian (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order increases the total task amount by $1,550, comprised of $350 for travel allotment and $1,200 for variable inspections. The original task amount was $93,779, resulting in a new total task amount with all change orders of $95,329.00. The task completion date remains June 30, 2020, with a net increase of 1,150 days noted in the task period. Funding is allocated from Org. Code 37450104000 under Object Code 132500, Budget Entity 37450300, Special Category 100029, with the total amount of $95,329.00 charged to the specified budget line.
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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:
GC928-5 01/29/2020 1
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
The total increase in funds for GC928-5 is $1,550.
$350 or Travel Allotment.
$1,200 for Variable Inspections.
93,779 93,779
93,779 93,779
+1,550 +1,550
95,329 95,329
06/30/20 06/30/20 +1,150 06/30/20
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 $ 95,329.00
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: 2020-01-29 15:04:21 Foxit Reader Version: 9.3.0
Glenn W_ Bryant
01/29/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.01.29 15:23:41 -05'00'
Griffin Kolchakian Digitally signed by Griffin Kolchakian Date: 2020.01.29 16:14:54 -05'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.02.05 15:00:03 -05'00'
File details come from the government source that posted it. Updated .