CN-370000-SW238-T22CO1.pdf
PDF 94 KB Posted
- Contract number
- SW238
- Issued by
- Florida
About this file
This is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (DEP) dated July 13, 2022. The change order modifies Task Assignment Number 22 with contractor Industrial Divers, Corp. Inc., represented by Rocco Galletta. The DEP Contract Manager is Michell Smith. The document was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority), with contractor authorization from Frances Galletta.
The change order extends the task completion date by 60 days, moving the completion deadline from July 31, 2022 to September 29, 2022. This represents a time extension only, as no changes to the task amount are reflected in the financial section of the form. The Change in Funding Information table remains blank, indicating no budget modifications accompany this extension. The document was distributed to the Procurement Section (MS93) and the Bureau of Finance & Accounting (MS78) per standard DEP procedures.
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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:
22 07/13/2022 1
Industrial Divers, Corp. Inc.
Rocco Galletta
Michell Smith
An extension of the task completion date.
July 31, 2022 July 31, 2022 60 days September 29, 2022
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
Frances Galletta Digitally signed by Frances Galletta Date: 2022.07.13 14:54:20 -04'00' 07/13/2022 Michell M. Smith
Digitally signed by Michell M.
Smith Date: 2022.07.13 09:53:38 -04'00'
07/13/2022
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2022.07.13 15:26:32 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2022.07.13 15:56:17 -04'00'
File details come from the government source that posted it. Updated .