CN-370000-PL352-T4CO1.pdf
PDF 1 MB Posted
- Contract number
- PL352
- 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). The document serves as a formal amendment to Task Assignment Number 4 PL352 between the FDEP and contractor F4 TECH, represented by Mark Milligan. The change order was executed on June 1, 2016, and signed by Jim Singleton (DEP Contract Manager), Johnson_TT (Budget Representative), and Lennie Zeiler (Contractual Authority).
The change order reflects a time extension only, adding six months to the task completion date, moving the deadline from June 30, 2016, to December 31, 2016. No financial adjustments were made; all cost reimbursement and fee schedule amounts remain at $0.00, with the total task amount remaining $0.00. The funding information indicates a budget allocation of $45,000.00 for fiscal year 16 under Organization Code 37101000000, E.O. QH, Object Code 139900, with no specific grant identified. The change order was distributed to the Procurement Section (MS93) and Bureau of Finance & Accounting (MS78) for processing.
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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:
4 PL352 06/01/2016 1
F4 TECH
Mark Milligan 850-309-3940
Jim Singleton 850-245-3085
Added Six (6) month to the completion date of this Task Assignment, $0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
June 30, 2016 June 30, 2016 Added Six Months December 31, 2016
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
37101000000 QH 139900 37100400 080811 N/A 16 $ 45,000.00
Digitally signed by Mark Milligan DN: cn=Mark Milligan, o=F4 Tech, ou, email=mmilligan@thinkf4.com, c=US Date: 2016.05.31 17:54:08 -04'00'
05/31/2016 Jim Singleton Digitally signed by Jim Singleton Date: 2016.06.01 08:10:23 -04'00' 06/01/2016
Johnson_TT Digitally signed by Johnson_TT Date: 2016.06.01 08:45:51 -04'00'
06/01/2016
Lennie Zeiler Digitally signed by Lennie Zeiler Date: 2016.06.03 14:50:33 -04'00'
File details come from the government source that posted it. Updated .