CN-370000-GC904-223ACO1.pdf

Funding Information:

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

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 8/17/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment Change Order This Change Order is entered into between the Parties named below and amends the Task Assignment (TA) and any previous TA Change Orders (TACO) as follows:

1. TA Number: TACO Number: Contract Number:

TACO Description:

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

Department’s Project Manager: Department’s 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 Name:

4. ☐ There are no changes to the TA compensation.

☐ The compensation of the TA is changed to the amounts indicated below:

Amended Price Price Prior to TACO ☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. ☐ There are no changes to the TA Expiration Date.

☐ The TA Completion Date is changed from ______________ to ______________ (a total of ______ days).

6. ☐ There are no changes to the Attachments.

☐ Attachment ___ is replaced with Attachment -____.

7. ☐ No Additional Changes.

☐ Additional Changes:

8. All other terms and conditions of the TA remain in effect. If and to the extent that any inconsistencies may appear between the TA and this TACO, the provisions of this TACO shall control.

IN WITNESS WHEREOF, this TACO 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) Date:

☐ Additional signatures attached on separate page.

GC904-223A 1 GC904

Due date extension only TACO. Waiting on SAA.

Melissa Brock 850-245-8922 Contractor Contractor

Contractor Contractor

Contractor

Geosyntec Consultants 850-556-8419

Joe Applegate

Petroleum Products Corp

✔ $ 4,601.19

$ 0.00 $ 4,601.19 Expiration

Expiration✔ 08/15/2023 09/15/2023 31

TACO 1 Changes Task 1 deliverable due date from 6/15/2023 to 7/17/23 and extends the POS from 8/15/23 to 9/15/23

Geosyntec Consultants

Joe Applegate

Project Manager

Joseph Applegate Digitally signed by Joseph Applegate Date: 2023.06.05 14:29:53 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.06.05 15:18:03 -04'00'

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

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 01_18

Contract Number:

Task Assignment #:

Change Order #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

GC904

GC904-223A

$ 4,601.19

HASP, HSW, Site Recon Docs, Copy of executed access agreement

Task 1 Deliverable, SPI Attachment B details

07/17/2023

$ 4,601.19