CN-370000-GC928-T5CO2.pdf
PDF 534 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 dated May 12, 2020. The document modifies an existing task assignment (GC928-5) with Citrus County as the contractor. Glenn W. Bryant serves as the contractor representative, and Roger Ruiz acts as the DEP Contract Manager. The change order has been approved by Fletch Herrald (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order increases funding for Variable Compliance Inspections under task assignment GC928-5 by $1,835. The original task amount was $93,779, which increased to $95,329 prior to this change order, resulting in a new total task amount of $97,164. The task completion date remains June 30, 2020, with no extension to the timeline. The funding is allocated from Organizational Code 37450104000 under the JD E.O. with Object Code 132500, Budget Entity 37450300, and Special Category 100029, with a total authorized amount of $97,164.00.
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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 05/12/2020 2
CITRUS COUNTY
Glenn W. Bryant
Roger Ruiz
Increase in funds for GC928-5 for Variable Compliance Inspections in the amount of $1,835.
93,779 93,779
95,329 95,329
+1,835 +1,835
97,164 97,164
06/30/20 06/30/20 +1,835 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 $ 97,164.00
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: 2020-05-14 11:17:00 Foxit Reader Version: 9.3.0
Glenn W_ Bryant
05/14/2020 Roger Ruiz Digitally signed by Roger Ruiz Date: 2020.05.14 12:33:56 -04'00'
Fletch Herrald Digitally signed by Fletch Herrald Date: 2020.05.14 13:17:11 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.05.14 13:35:58 -04'00'
File details come from the government source that posted it. Updated .