CN-370000-CN220-T16CO3.pdf

Florida Department of Environmental Protection

TASK ASSIGNMENT CHANGE ORDER FORM

(Revised 9-26-2018) Page 1 of 1

Required Signatures: Adobe Signature

FDEP Contract No.: Task Assignment No.: Change Order No.: Project No.:

Project Location: Project Name:

Consultant Name:

Consultant Representative: Phone: Email:

FDEP Contract Manager: Phone: Email:

Description and Justification of Change:

Change in Task Amount:

Item Reimbursement Fixed Fee Total

Original Task Amount:

Task amount including all previous Change Orders:

Net increase/decrease in task amount for this Change Order:

Total Amounts with all Change Orders:

Change in Task Time:

Original Task Execution Date:

Original Task End Date:

Present Task End Date:

Net Change in Days:

New Task End Date:

Approval Signatures:

Budget Representative, FDEP Signature Date

Project Manager, FDEP Signature Date

Contract Manager, FDEP Signature Date

Consultant Signature Date

Contract Authority, FDEP Signature Date

Project # Grant # Org Code Cat/Year Fund Module Object Code EO Amount

29 Digit FLAIR Code: Total:

CN220 16 3 61206C

Gilchrist Blue Springs State Park Ranger Residence

Dewberry Engineers Inc.

Deji Ajose-Adeogun 850-523-0062 Ajose-Adeogun@Dewberry.com

Alyssa Skehan 85-245-2781 Alyssa.Skehan@FloridaDEP.gov

This Change Order would have the consultant prepare the energy forms that are needed for county building permits per proposal dated 3/1/2021.

$ 1,100.00 $ 59,754.13 $ 60,854.13 $ 1,100.00 $ 77,035.06 $ 78,135.06

$ 0.00 $ 1,609.71 $ 1,609.71 $ 1,100.00 $ 78,644.77 $ 79,744.77

8/20/2019

12/31/2020

12/31/2021

7/1/2022

Greg Turral Gregory Turral Digitally signed by Gregory Turral Date: 2021.03.01 15:14:02 -05'00'

Laura Ross Laura S. Ross Digitally signed by Laura S. Ross Date: 2021.03.02 11:26:27 -05'00'

Alyssa Skehan Alyssa Skehan Digitally signed by Alyssa Skehan Date: 2021.03.02 11:46:45 -05'00'

Deji Ajose-Adeogun Digitally signed by Ayodeji Ajose-Adeogun DN: C=US, E=aajose-adeogun@dewberry.com, O=Dewberry|Preble Rish, CN=Ayodeji Ajose-Adeogun Date: 2021.03.02 15:38:38-05'00'

Michael W. Foster Jr. PE Michael W. Foster Jr., P.E.

Digitally signed by Michael W.

Foster Jr., P.E.

Date: 2021.03.08 13:39:44 -05'00'

61206C 37502000175 080039/19 675002 U3200 131500 XR $ 1,609.71

$ 1,609.71

March 1, 2021

Ms. Laura S. Ross, RA Senior Architect Bureau of Design and Construction Florida Department of Environmental Protection 3900 Commonwealth Boulevard, MS 520 Tallahassee, FL 32399

RE: FDEP Project Number: CN220 – TA16 CO3 Additional Services for Gilchrist Blue Springs Ranger Residence

Dear Ms. Ross, This proposal is additional services for the Gilchrist Blue Springs Ranger Residence located in Gilchrist County, Florida. This scope of work is to complete the Energy Forms for the residence to be in compliance with Gilchrist County Building Department.

Please review the attached Proposal Summary and deliverables.

Sincerely, Dewberry

Deji Ajose-Adeogun, P.E.

Senior Project Manager

Ms. Ross, RA Gilchrist Blue Springs Ranger Residence March 1, 2021

Subtask 16: Energy forms

Description: Prepare and complete energy forms for above referenced project in compliance with Gilchrist County Building Department by a licensed professional

Deliverable:

Completed energy forms to be delivered to BDC via email in a PDF format.

Performance Measure: Deliverables will be reviewed by the Department to confirm they are complete, accurate, and timely.

Fixed Price Cost:

Subtask 16 Firm Name Position Classification Hourly Rate Hours Total Fixed

Price Cost Dewberry Senior Project Manager $131.01 2.00 $ 262.02 Dewberry Administrative $38.49 3.00 $ 115.47 Pinnacle Principle Sr. Engineer $190.40 1.00 $ 190.40 Pinnacle Snr. Engineer $143.01 6.00 $ 858.06 Pinnacle Admin. Assistant $45.94 4.00 $ 183.76

Total Subtask 4 $1,609.71

Reimbursable Cost: NA

Total for Subtask: $1,609.71

March 1, 2021

Project Schedule:

Activity Duration (Calendar Days) Dates Subtask 16: Energy Forms 14 days after

* Tentative execution date

Summary of Fees:

Subtask Subtask Fixed Price Cost

Subtask Reimbursable

Subtask 1:Project Initiation & Project Documentation $1,609.71

Total Reimbursable Cost: $0.00 Overall Total Cost: $1,609.71

Payment will be made upon approval of deliverables for each subtask by the FDEP in the amount specified.

Exclusions: The following items are excluded from our scope of work.

• Identification of or testing for hazardous materials. It is our understanding that DEP will be procuring this information separately.

• An Abatement plan for any hazardous materials is excluded. It is our understanding that should the testing performed by DEP reveal any hazardous materials, they will arrange for its abatement prior to the start of the project.

• Design of any existing plumbing line extensions or modifications (unless specifically listed in the proposal otherwise} is not included. If testing indicates any deficiencies or need for modifications; or if the permitting agencies requires changes, additional fees will be required.

• Architectural Services, Value Engineering is excluded.

I. ADDITIONAL SERVICES

Services authorized by the Client other than those specifically listed above shall be considered Additional Services for which the Client shall compensate DEWBERRY when a revised scope of work is agreed and approved. Additional services may include, but not limited to the following:

A. Local Site Plan permitting B. Specifications, or other documents when such revisions are inconsistent with written approval or instructions previously given or are due to causes beyond the control of Dewberry.

C. Design of roadway improvements beyond typical driveway connection points.

D. Traffic Analysis.

E. Stormwater Design F. Preparation of off-site utility adjustment and/or utility services plans or permits beyond connections to existing utilities in adjacent parcels or rights-of-way.

March 1, 2021

G. Completion of any additional offsite stormwater modeling that may be required by the County or other agencies to evaluate upstream or downstream impacts.

H. Any work associated with establishing 100-year floodplain elevation and any work associated with establishing drainage tailwater conditions.

I. Any work associated with evaluating and determining wetland limits.

J. Off-site survey necessary outside of the scope of work to revise and/or adjust ROW easements.

K. Completion of any design variances.

L. Preparation of any traffic analysis for this project. Such analyses could include, but are not limited to, on-site trip generation, off-site distribution, turn lane analyses, and intersection analyses.

M. Rezoning of property.

N. Variance request.

O. FDOT Drainage Connection Permit and/or Utility Connection Permit applications and calculations.

P. Off-site survey necessary to revise and/or adjust any existing limited partition boundaries.

Q. Landscape Plans.

R. The design of alternates in the contract documents or evaluation of substitutions proposed by the contractor.

S. Equipment pre-purchase specifications for the project.

T. Field inspections & meetings beyond those specified herein.

U. Prepare record drawings based on information as provided by the contractors.

V. Construction cost estimates, other than engineering estimates of probable construction cost.

W. Hidden or concealed conditions requiring additional design or consulting services.

X. Revisions to the plans that require additional MEP work.

Y. Providing services to verify the accuracy of drawings or other information furnished by the Client.

Z. Life Cycle cost analysis.

AA. Value Analysis.

BB. Post Occupancy Inspection/Evaluation.