CN-370000-GC904-223A.pdf

Funding Information:

Org. Code E.O. Object Code Budget Entity Appropriation

Category Grant # Project # Year Amount

Rev. 8/26/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment This Task Assignment (TA) is entered into between the Parties named below, pursuant to Contract Number: .

1. TA Number: TA Completion Date:

TA Description:

2. Parties State of Florida Department of Environmental Protection (Department)

Department Project Manager: Department Project Manager Phone:

Contractor Name: (Contractor ) ntractor’st ’s Project Manager: ontractor’s t’s Project Manager Phone:

3. Project Number:

(If different from TA Number)

Project Location(s):

Project Name:

4. As consideration for the services rendered by Contractor under the terms of this TA, the Department shall pay the Contractor on the following bases, up to the Total TA Value as indicated below:

☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. The Parties agree to comply with the terms and conditions of the underlying the Contract, and the following attachments which are hereby incorporated by reference:

Attachment 1:

☐ Additional Attachments (if necessary):

IN WITNESS WHEREOF, this TA shall be effective on the last date signed below.

State of Florida Department of Environmental Protection

CONTRACTOR Department Name:

Title: Program Administrator or Designee

(Authorized Signature) (Authorized Signature)

☐ Additional signatures attached on separate page.

GC904

GC904-223A Completion August 15, 2023

Task Assignment description and deliverable information are specified in the Scope of Work (SOW), Attachment A with costs and invoice information attached as Scheduled Pay Items (SPI) Attachment B. The following attachments and or documents are hereby added to the contract.

Melissa Brock 850-245-8922 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Geosyntec Consultants

Geosyntec Consultants

Joe Applegate 850-556-8419

GC904-223A-068732818

3130 SW 19th Street, Pembrooke Park ,Broward Co. FL

Petroleum Products Corp

✔ $ 4,601.19

$ 4,601.19

Scope of Work

Schedule of Pay Items Attachment B

Joe Applegate

Project Manager

Joseph Applegate Digitally signed by Joseph Applegate Date: 2023.04.17 22:39:26 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.04.18 12:35:25 -04'00'

450202000 JG 139900 37450300 087889 NA NA 23 $ 4,601.19

9-Digit Facility ID Number: 068732818 STCM Facility Name: Petroleum Product Corp

TSS/SSA

Prepare and submit a site specific Health and Safety Plan (HASP). Perform a file review and submit a Historical Summary Worksheet (HSW).

After approval of the HASP and HSW, mobilize to site to meet with owners and to obtain offsite property access. Then if site access is secured, conduct a site recon. Prepare and submit Site Recon documents including area survey table, location map, area map, site map, photo documentation and field notes.

Contingent Funding in this Task is only to be used to offset the cost for pay items associated with a Field Request for Change for any open task.

HASP, HSW, Site Recon Docs, Copy of executed access agreement Thursday, June 15, 2023 Tuesday, August 15, 2023

Attachment A Division of Waste Management

Scope of Work

Task 1 Description:

Task 1 Deliverable Due Date:

Task 1 Deliverable:

Specifications All work must be performed in accordance with this Scope of Work (SOW) and any attachments, Chapters 62-160, 62-532, 62-777 and 62-780, F.A.C., all applicable FDEP and Water Management District guidance memoranda, standard industry procedures and as described in the Agency Term Contract (ATC).

Copies of all referenced guidelines are available at:

http://www.dep.state.fl.us/waste/categories/pcp/default.htm Reports must be submitted using the appropriate FDEP forms found at:

http://www.dep.state.fl.us/waste/categories/pcp/pages/pg_documents.htm All work must be conducted in accordance with PRP Standard Specification Details found at:

http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm

The following tables are included as attachments to this SOW and further represent the details of the scope of work.

Any change which results in an extension of the due dates, PO end date, or a change in quantities or costs, requires that a PO Change Order be formally issued prior to performance of the revised SOW.

The FDEP/LP Task Manager will review the work and/or deliverables within the timeframes established in FDEP guidance documents. The Contractor will respond to any comments to complete the work and/or deliverables within the timeframe established in the comment letter or email correspondence.

http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm

Schedule of Pay Items (SPI) All unit rates and extended prices for all line item costs associated with this project are provided in the SPI [Attachment B to this Purchase Order (PO)] and shall not exceed the rates established in the ATC.

Requests for Change (RFC) All requests for changes to the SOW must be submitted in writing and be approved in writing by the FDEP/LP using the RFC form in accordance with paragraphs 2.A and 26 of the ATC and can be found at:

Performance Measures The FDEP/LP Site Manager will review the submitted documentation to confirm that all work was performed in accordance with the Specifications referenced above. The FDEP/LP Task Manager will notify the Contractor of acceptance or any deficiencies in the work and/or deliverables. The Contractor will be given an opportunity to remedy deficiencies at no additional cost to the FDEP.

SubPhase(s):

PO End Date:

Attachment A (SOW Template) F&TS 4-21-17 http://www.dep.state.fl.us/waste/categories/pcp/default.htm http://www.dep.state.fl.us/waste/categories/pcp/default.htm http://www.dep.state.fl.us/waste/categories/pcp/default.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/pg_documents.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/pg_documents.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/pg_documents.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/default.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/pg_documents.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm http://www.dep.state.fl.us/waste/categories/pcp/pages/templates.htm

9-Digit Facility ID Number: 068732818 STCM Facility Name: Petroleum Product Corp

Attachment A Division of Waste Management

Scope of Work

Failure to provide all deliverables, failure to provide deliverables which are satisfactory or failure to meet the specified deliverable timetables, shall result in non-payment, loss of retainage, or other financial consequences, and/or termination of the PO, as specified in the ATC. If the deliverable due day occurs on a weekend, state holiday, or federal holiday the deliverable will be due the following business day.

Retainage shall be withheld in the amount of 10%, unless otherwise noted in the SPI, from each payment by the FDEP/LP until completion and approval of all Tasks. The Contractor shall submit a Release of Claims and request for retainage payment with the final invoice. Payment of retainage will be reduced by the amount of any assessed financial consequences.

Notice of Field Activities The Contractor must provide written notification (emails are acceptable) of field activities at least seven (7) calendar days prior to the commencement of work to all applicable parties including the FDEP/LP task manager, Inspector (PRP_Inspector@dep.state.fl.us), site operator, site owner, RP and affected off-site property owners.

Invoicing, Payments and Financial Consequences The Contractor may submit an invoice for a Task upon written notification of acceptance of the work/deliverables by the FDEP/LP Task Manager. Upon receipt of FDEP/LP written approval of the required documentation for completed portions of each task, the Contractor must submit an invoice. Invoices for completed work may be submitted no more frequently than every thirty (30) days, or upon completion of the individual tasks as specified. Each invoice request must contain all documentation of performance as specified in the ATC, this Purchase Order (PO), and its attachments.

Attachment A (SOW Template) F&TS 4-21-17

Environmental Forensics Site Investigation and Other Technical Support Services Attachment B, SCHEDULE OF PAY ITEMS WORKSHEET

Petroleum Product Corp Contract #:

8732818 CID #:

06 Contractor:

Brittany.Anding Contract Term: Year 2

(850) 245-8856 Brittany.Anding@floridadep.gov

PAY

ITEM

UNIT OF

MEASURE PAY ITEM PRICE TOTAL

QUANTITIES TASK 1

QUANT.

TASK 2

QUANT.

TASK 3

QUANT.

TASK 4

QUANT.

TASK 5

QUANT.

TASK 6

QUANT.

TASK 7

QUANT.

TASK 8

QUANT.

TASK 9

QUANT.

TASK 10

QUANT.

1-1. Per Review 753.93$ 1 1 1-2. Per Site 441.80$ 1 1 1-5. Per Agreement 643.34$ 1 1 2-1. Per Visit 1,074.64$ 1 1 3-1. Per Round Trip 687.48$ 1 1

23-1. NOT BILLABLE 1.00$ 1000 1000

Version: 2.1

Geosyntec Consultants

Contingent Funding - Allowance only to be used as offset for field change orders

*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.

DESCRIPTION

Facility Name:

Off-Site Property Access Agreement Site Reconnaissance/Field Measurement Visit Mobilization, Light Duty Vehicle (car or 1/2 ton truck) - ≤ 100 miles each way

7-Digit Facility ID #:

County:

Task Manager Name:

Task Manager Phone:

Task Manager Email:

File Review Site Health & Safety Plan

GC904

00360

Original Renewal

Page 1 of 1 4/17/2023F&TS Schedule of Pay Items 10-06-22

Environmental Forensics Site Investigation and Other Technical Support Services

SCHEDULE OF PAY ITEMS WORKSHEET

DETAIL INVOICE, Page 2 of 2

Petroleum Product Corp Contractor: Purchase Order:

8732818 CID #: 360 Retainage %: 10% Program Area: PRP

County: 06 Contract #: GC904 FDEP Cost Share %: 100.00% Total Extended Cost: 4,601.19$ Brittany.Anding Contract Term: Renewal - Year 2 Without Handling Fee: 4,601.19$ 8502458856 Brittany.Anding@floridadep.gov

PAY

ITEM

UNIT OF

MEASURE UNITS PAY ITEM PRICE TOTAL EXTENDED

PRICE UNITS UNITS EXTENDED

PRICE UNITS

Task 1 1-1. Per Review 1 753.93$ 753.93$ 0 0 -$ 1 1-2. Per Site 1 441.80$ 441.80$ 0 0 -$ 1 1-5. Per Agreement 1 643.34$ 643.34$ 0 0 -$ 1 2-1. Per Visit 1 1,074.64$ 1,074.64$ 0 -$ 1 3-1. Per Round Trip 1 687.48$ 687.48$ 0 0 -$ 1 23-1. NOT BILLABLE 1000 1.00$ 1,000.00$ n/a n/a n/a 1000

RETAINAGE 460.12$ -$ -$ 460.12$

SUBTOTAL 4,601.19$ -$ -$ 4,601.19$

TOTAL COST 4,601.19$ -$ -$ 4,601.19$

Version: 2.1 Owner Cost Share: -$ -$ -$ -$

FDEP Cost Share: 4,601.19$ -$ -$ 4,601.19$ Retainage: 460.12$ -$ -$ 460.12$

FDEP Less Retainage: 4,141.07$ -$ -$ 4,141.07$

Task Manager Approval:

Print Name

Signature

Date of Review Letter

This Invoice

Mobilization, Light Duty Vehicle (car or 1/2 ton truck) - ≤ 100 miles each way

Balance Previously Invoiced

DESCRIPTION

File Review Site Health & Safety Plan Off-Site Property Access Agreement Site Reconnaissance/Field Measurement Visit

Facility Name:

7-Digit Facility ID #:

Task Manager Name:

Task Manager Phone:

Task Manager Email:

PO Rate Sheet

Geosyntec Consultants

Contingent Funding - Allowance only to be used as offset for field change orders

4/17/2023F&TS Schedule of Pay Items 10-06-22