CN-370000-GC904-222ACO1.pdf

Florida Department of Environmental Protection-Division of Waste Management-Petroleum Restoration Program

Task Assignment Change Order - Authorization for Change in Scope of Work

ERIC13332 Contract #: GC904 PO #: TA-GC904-222A Coyote Navarre C&D Debris Disposal Facility Contractor:

Brittany Anding Contractor Phone:

TACO #: 1

TACO Type: Rush

850-245-8856 FDEP Cost Share %: 100.00% Ref #:

brittany.anding@floridadep.gov

TASK PAY ITEM UNIT OF MEASURE PAY ITEM PRICE UNITS EXTENDED PRICE

2 3-3. Per Round Trip $817.93 1 $ 817.93

2 12-14. Per Gallon $2.26 750 $ 1,695.00

Task Change Order Subtotals

1 -$ 2 2,512.93$ 3 -$

Period of Service: 2,512.93$ Total Authorized Cost (FDEP Share: 100%)

Contractor Representative: J. Brooks Baldwin 4/6/2023 (Print Name) (Date)

FDEP Task Manager: Brittany Anding

*For reimbursable pay items the cost listed is a "not to exceed" amount. Fees will be reimbursed for the pay item based on the actual invoice. Please note, the unit of measure for these items will be displayed as dollars for invoicing purposes. Please refer to the Scope of Work for additional description of these items.

8/2/2023 No Change

Previous End Date New End Date

(Signature)

Previous Due Date New Due Date

4/7/2023 No Change 4/28/2023 6/2/2023

No Change No Change

Deliverable Name

HASP, field notes and photos Field notes, invoices, photos Tank Abandonment/Site Restoration Report

Description of Change and Justification: Include complete description of who, what, where, when, how and why.

During the site reconnaissance mobilization, Geosyntec noted that the 1,000 gallon AST was approximately 1/4 full of petroleum contact water. Geosyntec is submitting this request for change for 1 heavy duty truck (3-3) and up to 750 gallons (as a maximum contingency amount, actual amount removed only will be invoiced) of transport and disposal of petroleum contact water (12-14) to pump out the petroleum contact water prior to removal of the AST.

Geosyntec Consultants 850.528.2268Task Manager Name:

Heavy Duty/Stakebed Truck (3/4 ton +) - ≤ 100 miles each way

Transport and Disposal of Petroleum Contact Water (bulk)

Facility ID #:

Facility Name:

Task Manager Phone:

Task Manager Email:

This is an authorization for the costs associated with the change in quantities of services being provided and/or deliverable due dates. In order for these costs to be paid, these changes must be processed through a change order to the purchase requisition and a revised Purchase Order issued by MFMP prior to initiating work.

DESCRIPTION

Page 1 of 2F&TS Schedule of Pay Items 10-06-22

904-222A

4/6/2023

Special Category

Florida Department of Environmental Protection-Division of Waste Management-Petroleum Restoration Program

Task Assignment Change Order - Authorization for Change in Scope of Work

570013332 Contract #: GC904 Coyote Navarre C&D Debris Disposal Facility Contractor:

PO #: TA-GC904-222A

TACO #: 1Geosyntec Consultants

9-Digit Facility ID #:

Facility Name:

Administrative Reviewer:

(Print Name) (Date)

Reviewer (optional):

Technical Approval (optional):

Cost Center Approval (optional):

(Signature)

Page 2 of 2F&TS Schedule of Pay Items 10-06-22

Melissa Brock

Natasha Lampkin Digitally signed by Natasha Lampkin Date: 2023.04.06 12:34:41 -04'00'

Melissa Brock Digitally signed by Melissa Brock Date: 2023.04.06 12:40:29 -04'00'

RFC