DEP Contract No. GC916, Attachment C, Page 1 of 4

Attachment C

Florida Department of Environmental Protection Task Assignment Notification Form for BREVARD COUNTY

Contract No. GC916 Task No. 1 Amendment No. ____ Date June 26, 2017

Performance Period: Effective the date of execution of this Task Assignment or July 1, 2017, whichever is later, and shall remain in effect until June 30, 2018.

Description:

The Contractor shall complete the following services in accordance with the requirements in DEP Contract No. GC916:

Conduct routine compliance inspections at the 269 facilities storage tank systems within Brevard County, identified in Exhibit #1, by May 31, 2018.

Perform all re-inspections per Guidance Document A to confirm compliance within Brevard County.

Comply with the Revised Invoice Procedure (Page 2)

Utilize the new Contractual Services Invoice Form for all monthly invoices (Guidance Document E)

Compensation will only occur for routine annual compliance inspections conducted at the facilities explicitly identified in the revised Payment Calculation Sheet (Guidance Document H)

The Enforcement County Contractors must perform all Enforcement Actions in accordance with Guidance Document F (Level of Effort). Guidance Document F available online at:

http://www.dep.state.fl.us/waste/categories/tanks/pages/compliance.htm.

All Guidance documents referenced in the Contract’s Scope of Work are available online at:

http://www.dep.state.fl.us/waste/categories/tanks/pages/compliance.htm.

Order of Inspection and Substitutions of facilities on Exhibit #1:

Contractor is to conduct routine inspection in order provided in Exhibit #1. Substitutions of facilities are authorized with sites listed on the substitution list on Exhibit #1. The Contractor wishing to substitute a facility shall email department at STR_Invoices@dep.state.fl.us stating the facility and reason for the substitution. The Department will notify via email authorizing the substitution. Copies of authorizations shall be retained by the Contractor for the remainder of the Contract.

Payment Schedule:

Compensation will occur on a monthly basis, per the fee schedule listed in Guidance Document H. Invoices are due no later than the 15th day of the month proceeding work activity. The twelfth month invoice will be due to the DEP District Office on the first business day of July. The Contractor must submit a signed ‘Contractual Services Invoice’ noting the quantity and location of inspections.

FDEP will determine levels of performance based on routine inspections completed before March 15, 2018 to allow for the ninety-day return to compliance rate to be determined by June 30, 2018. The DEP Contract Manager will advise the Contractor of the amount of retainage to be requested in its FINAL Invoice #13 by June 27, 2018 so the Contractor can submit its FINAL Invoice to the DEP Contract Manager by July 6, 2018.

http://www.dep.state.fl.us/waste/categories/tanks/pages/compliance.htm http://www.dep.state.fl.us/waste/categories/tanks/pages/compliance.htm mailto:STR_Invoices@dep.state.fl.us

DEP Contract No. GC916, Attachment C, Page 2 of 4

Retainage Criteria:

1. Number of days to return to compliance for facilities receiving routine inspections

2. Percent of facilities returned to compliance for facilities receiving routine inspections.

Retainage reimbursement criteria for the amount retained per Paragraph 21 of the contract:

- Fifty percent (50%) of the amount retained will be returned to Contractor having an average return to compliance in less than 45 days for facilities receiving routine inspections

- Fifty percent (50%) of the amount retained will be returned to Contractor having an average return to compliance rate of 95% or higher for facilities receiving routine inspections

- Forty percent (40%) of the amount retained will be returned to Contractor having an average return to compliance rate between 45 and 60 days for facilities receiving routine inspections.

- Forty percent (40%) of the amount retained will be returned to Contractor having an average return to compliance rate of between 90% and up to 95% for facilities receiving routine inspections

- Thirty percent (30%) of the amount retained will be returned to Contractor having an average return to compliance rate between 61 days and 75 days for facilities receiving routine inspections.

- Thirty percent (30%) of the amount retained will be returned to Contractor having an average return to compliance rate of between 85% and up to 90% for facilities receiving routine inspections

- Twenty percent (20%) of the amount retained will be returned to Contractor having an average return to compliance rate between 76 days and 90 days for facilities receiving routine inspections.

- Twenty percent (20%) of the amount retained will be returned to Contractor having an average return to compliance rate of between 80% and up to 85% for facilities receiving routine inspections

NO retainage will be returned to Contractor having either: more than ninety (90) days as average time to return to compliance for facilities receiving routine inspections; or having an average of less than 80% of facilities receiving routine inspections returned to compliance.

Invoice Procedure

Review of Inspections: The Payment Calculation Sheet shall be submitted by the Contractor to the appropriate DEP District Office. The District will review in Florida Inspection Reporting of Storage Tanks (FIRST) each variable inspection listed on the Payment Calculation Sheet to ensure that the inspection is correctly invoiced. The District will ensure that each routine compliance inspection on the Payment Calculation Sheet is also listed on the task assignment facilities list. Upon completion of the review, the District shall report via email to the Permitting and Compliance Assistance Program’s Contract Manager and the Contractor that the review of the inspections has been completed and of any known contractual obligations that have not been met.

Invoice Submission: All invoices with verified and approved Payment Calculation Sheet by the appropriate DEP District Office will be directly submitted by the Contractor to the Permitting and Compliance Assistance Program’s Contract Manager in accordance with the Payment Schedule.

Submission of invoice shall be via email to: STR_Invoices@dep.state.fl.us.The email shall consist of a single PDF package. The order of documents in the complete PDF package shall be as follows:

1) Contractual Services Invoice

2) Verified Payment Calculation Sheet (please make sure the month of services rendered appears below the “Invoice Period”)

3) FIRST Report (Compliance and Activity by Date Range)

4) Tracking Form (Monthly percentage of Routine Inspections Completed) mailto:STR_Invoices@dep.state.fl.us

DEP Contract No. GC916, Attachment C, Page 3 of 4

TASK ASSIGNMENT FORM

Required Signatures: Adobe Signature

FDEP Contract No: Task Assignment No: Date: DEP Task Manager:

Project:

Contractor Name:

Contractor Representative: Phone: Email:

FDEP Contract Manager: Phone: Email:

Task Description:

Deliverables:

Performance Measures:

Financial Consequences:

GC916 1 06/26/2017 Roger Ruiz

GC916-1

Brevard County Natural Resources Management Department

Douglas Divers (321) 633-2017 Doug.Divers@brevardfl.gov

Roger Ruiz 850-245-8854 roger.ruiz@dep.state.fl.us

Conduct routine compliance inspections at the facilities identified in Exhibit #1 (provided electronically).

Perform inspections for all reported complaints, discharges, installations and closures involving storage tank systems within the county or counties on Page 1.

Submit Contractual Services Invoice with verified Payment Calculation Sheet, along with FIRST Report (Compliance and Activity by Date Range) and Tracking Form (Monthly percentage of Routine Inspections Completed) Compensation will only occur for routine annual compliance inspections conducted at the facilities explicitly identified Exhibit 1 and variable inspections identified in supporting documentation.

The CONTRACTOR shall complete the following percentage of the required routine compliance inspections unless otherwise indicated in the Task Assignment:

(1) After four (4) months, thirty-three percent (33%) of inspections shall be completed.

(2) After eight (8) months, sixty-six (66%) of inspections shall be completed.

(3) After (12) months, one hundred percent (100%) of inspections shall be completed.

No payment will be made for deliverables deemed unsatisfactory by the Department. In the event that a deliverable is deemed unsatisfactory by the Department, the Contractor shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to Department, within thirty (30) days of being notified of the unsatisfactory deliverable.

If a satisfactory deliverable is not submitted within the specified time frame, the Department may, in its sole discretion: 1) assess liquidated damages if specified in the Contract or its attachments; 2) request from the Contractor agreement to a reduction in the amount payable; 3) suspend all Work until satisfactory performance is achieved, or 4) terminate the Contract for failure to perform.

DEP Contract No. GC916, Attachment C, Page 4 of 4

TASK ASSIGNMENT FORM

Schedule:

Start Date: Completion Date:

Fixed Price Cost: Cost Reimbursement not to exceed:

Total Task Value:

Signatures and Date:

1._________________________________ __________________________________ __________________ Task Manager, FDEP Signature Date

2._________________________________ __________________________________ __________________ Contract Manager, FDEP Signature Date

3. _________________________________ __________________________________ __________________ Budget Representative, FDEP Signature Date

4. _________________________________ __________________________________ __________________ Contractor, Contract Manager Signature Date

5. _________________________________ __________________________________ __________________ Contract Authority, FDEP Signature Date

Encumbrance Information:

Budget Entity

Project

Grant

Org Code Category & Year

Fund Special Category

Object Code

EO Amount

Total:

07/01/2017 06/30/2018

$171,622.00

Charles “CJ” Johnson Charles D. Johnson Digitally signed by Charles D.

Johnson Date: 2017.06.29 08:41:42 -04'00'

06/29/2017

Roger Ruiz Roger Ruiz Digitally signed by Roger Ruiz Date: 2017.06.29 08:55:50 -04'00' 06/29/2017

Jennifer Vickers Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2017.06.29 14:08:36 -04'00'

Douglas Divers Douglas Divers Digitally signed by Douglas Divers Date: 2017.06.28 15:02:21 -04'00'

Tim Bahr Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2017.06.29 17:31:41 -04'00'

37450300 GC916 37450104000 00 212001 100029 132500 JD $171,622.00

NaN

FACILITY_ID NAME ADDRESS1 CITY C1_STATE_I ZIP5 DISTRICT COUNTY FACSTAT FACTYPE DEPCONOW LAST_ANNUAL_INSP_DATE MIN_TANK_INSTALL_INSP_DATE C_TOTAL_AC_TOTAL_UST

9815134

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PALM BAY

RD NE PALM BAY FL 32905 CD 5 OPEN A P 8/8/2016 0 2

9815185

RACETRA

C#2431

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WICKHAM

RD

MELBOUR

NE FL 32940 CD 5 OPEN A P 12/20/2016 0 3

9815305

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#1426

KING ST COCOA FL 32922 CD 5 OPEN A P 3/21/2017 0 3

9815432

SUNRISE

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#166

JUPITER

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9815467

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8622709

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8622706

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9804720

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BLVD COCOA FL 32922 CD 5 OPEN A P 8/21/2015 0 1

8521307

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8518431

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8622715

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8500821

7‐ELEVEN

FOOD

STORE

#21872

4539 EAU

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MELBOUR

NE FL 32901 CD 5 OPEN A P 10/14/2015 10/24/2007 0 3

8500824

7‐ELEVEN

FOOD

STORE

#25181

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8500826

7‐ELEVEN

FOOD

STORE

#25191

3177 N

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BEACH FL 32931 CD 5 OPEN A P 10/14/2015 6/3/2008 0 2

8500827

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#22388

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8500828

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#22407

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8518387

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FOOD

STORE

#25396

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8622716

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#26300

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8627804

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STORE

#26858

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#29951

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9601171

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STORE

#32144

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MELBOUR

NE FL 32940 CD 5 OPEN A P 10/15/2015 10/12/2006 0 2

9700218

7‐ELEVEN

FOOD

STORE

#32165

MURRELL

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ROCKLED

GE FL 32955 CD 5 OPEN A P 10/15/2015 9/27/2006 0 3

9800886

7‐ELEVEN

FOOD

STORE

#32372

605 S

WICKHAM

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MELBOUR

NE FL 32904 CD 5 OPEN A P 10/15/2015 11/30/2006 0 4

9801644

7‐ELEVEN

FOOD

STORE

#32232

BARNES

BLVD

ROCKLED

GE FL 32955 CD 5 OPEN A P 10/15/2015 9/27/2006 0 3

9601394

7‐ELEVEN

FOOD

STORE

#32142

3100 N

WICKHAM

RD

MELBOUR

NE FL 32955 CD 5 OPEN A P 10/20/2015 8/17/2006 0 3

9804418

7‐ELEVEN

STORE

#37235

2201 HWY

524 COCOA FL 32926 CD 5 OPEN A P 10/20/2015 5/19/2015 0 3

9806427

FOOD

STORE

#33357

3986 N

HARBOR

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MELBOUR

NE FL 32935 CD 5 OPEN A P 10/20/2015 3/27/2009 0 2

8943130

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5807 N US

HWY 1 COCOA FL 32927 CD 5 OPEN A P 10/21/2015 12/2/2009 0 1

8518401 SUN7 INC

1530 N US

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8518403

TIME

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#54

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MELBOUR

NE BEACH FL 32951 CD 5 OPEN A P 10/28/2015 0 1

8501113

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#148

2750 S

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TITUSVILL

E FL 32780 CD 5 OPEN A P 10/29/2015 0 1

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ISLAND FL 32953 CD 5 OPEN A P 10/29/2015 0 1

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9812888

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2455 HWY

1 MIMS FL 32754 CD 5 OPEN A P 10/29/2015 1/31/2012 0 3

8622741 A1A

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BEACH FL 32937 CD 5 OPEN A P 11/5/2015 11/17/2008 0 2

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9812184

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9814514

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8501083

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8518277

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8518490

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8520506

MELBOUR

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NE FL 32904 CD 5 OPEN H P 12/11/2015 1 2

8521068

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MELBOUR

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8518413

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9301060

WICKHAM

MOBIL

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WICKHAM

RD

MELBOUR

NE FL 32934 CD 5 OPEN A P 12/16/2015 3/4/2016 0 3

9801146 G‐1 SHOP

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BABCOCK

ST PALM BAY FL 32905 CD 5 OPEN A P 12/30/2015 2/29/2016 0 3

9804371

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BLVD SE PALM BAY FL 32909 CD 5 OPEN A P 12/30/2015 4/19/2016 0 2

8518381

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MELBOUR

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8501254

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FOOD

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BEACH FL 32937 CD 5 OPEN A P 2/24/2016 2/26/2008 0 1

8518417

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FOOD

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#191

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MELBOUR

NE FL 32901 CD 5 OPEN A P 2/24/2016 0 2

9600090

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FOOD

MART

#175

8020 N

WICKHAM

RD VIERA FL 32940 CD 5 OPEN A P 2/24/2016 0 2

9802931

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FOOD

MART

#251

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WICKHAM

RD

MELBOUR

NE FL 32935 CD 5 OPEN A P 2/24/2016 0 2

9806646

SUNSHINE

FOOD

MART

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RD PALM BAY FL 32907 CD 5 OPEN A P 2/24/2016 5/4/2011 0 2

9810358

SUNSHINE

FOOD

MART

#234

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HIGHWAY

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MELBOUR

NE BEACH FL 32951 CD 5 OPEN A P 2/24/2016 7/10/2008 0 2

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KING ST COCOA FL 32922 CD 5 OPEN A P 3/21/2016 0 4

8841566

SPEEDWA

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9046655

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3095 N

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9200367

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1 COCOA FL 32927 CD 5 OPEN A P 3/21/2016 0 3

9701305

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GE FL 32955 CD 5 OPEN A P 3/21/2016 0 2

8501110

CIRCLE K

#2726142

BABCOCK

ST NE PALM BAY FL 32907 CD 5 OPEN A P 3/23/2016 10/13/2010 0 2

8518407

CIRCLE K

#2726210

EMERSON

DR NE PALM BAY FL 32907 CD 5 OPEN A P 3/23/2016 3/1/2007 0 2

8518487

CIRCLE K

#2726093

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SATELLITE

BEACH FL 32937 CD 5 OPEN A P 3/23/2016 11/2/2012 0 2

8501072

CIRCLE K

#2726156

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520 COCOA FL 32926 CD 5 OPEN A P 3/24/2016 3/2/2012 0 2

8501108

CIRCLE K

#2726145

7175 N US

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8501118

CIRCLE K

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SINGLETO

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TITUSVILL

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8501122

CIRCLE K

#2726128

6155 N

COURTEN

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MERRITT

ISLAND FL 32953 CD 5 OPEN A P 3/24/2016 0 2

8501381

SUNSHINE

FOOD

MART #13

1449 W

KING ST COCOA FL 32922 CD 5 OPEN A P 3/24/2016 4/21/2009 0 1

8501398

SUNSHINE

FOOD

MART #42

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BLVD

ROCKLED

GE FL 32955 CD 5 OPEN A P 3/24/2016 0 1

8518264

SUNSHINE

FOOD

MART

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GE FL 32955 CD 5 OPEN A P 3/24/2016 8/18/2008 0 1

8518397

SUNSHINE

FOOD

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NE FL 32901 CD 5 OPEN D P 1/20/2015 7/31/2009 24 0

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NE FL 32935 CD 5 OPEN C P 7/17/2015 4/28/2015 1 0

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NE FL 32934 CD 5 OPEN C P 7/22/2015 11/13/2014 1 0

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E FL 32796 CD 5 OPEN C P 9/14/2015 12/11/2008 1 0

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CITY OF

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ST NE PALM BAY FL 32905 CD 5 OPEN C P 4/4/2016 1 0

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SPACE

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NE FL 32901 CD 5 OPEN C P 4/5/2016 ######## 2 0

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Invoice No. Contract No. Date Period of Service

7/1/2016 to 6/30/2017

Vendor: Bill To: Florida Department of Environmental Protection

Permitting and Compliance Assistance Program

2600 Blair Stone Road, M.S. 4565

Tallahassee, Florida 32399-2400

FEID No.: Attn.: Tanks Compliance Assistance Accounting

Telephone:

Agent:

Contractor Use:

Month/Yr.

Routine

Inspection

Amount

Less

Retainage

(10%)

Routine

Inspection

Invoiced

Variable

Invoiced

Adjusted Invoice

Total Total Previously

Invoiced

Fixed Price: Cost Plus: N/A Jul 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ -$

Aug 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 1,224.40$

Contract/Task Amount Contract/Task Amount Sep 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 2,448.80$

Less Previously Invoiced Oct 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 3,673.20$

Gross Invoice Amount Less Previously Invoiced Nov 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 4,897.60$

Less/Plus Retainage Dec 2016 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 6,122.00$

Invoice Total Invoice Total Jan 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 7,346.40$

Feb 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 8,570.80$

TOTAL AMOUNT OF INVOICE: Mar 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 9,795.20$

Apr 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 11,019.60$

FDEP Use Only: May 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 12,244.00$

Jun 2017 515.50$ 51.55$ 463.95$ 760.45$ 1,224.40$ 13,468.40$

Total: 6,186.00$ 618.60$ 5,567.40$ 9,125.40$ 14,692.80$ 14,692.80$ NOT Yet Invoiced Amt.: 618.60$ 15,311.40$

STRS Rev. 6/15 WB

GUIDANCE DOCUMENT E

CONTRACTUAL SERVICES INVOICE

Task No.

$150,000.00

$14,692.80

$51.55

$1,224.40

$1,224.40

Less/Plus Retainage (10% routine inspection costs)

$1,275.95

GUIDANCE DOCUMENT H

Date

Value Quantity

510.40$

TOTAL

Signature Date

190.11$

Enforcement

Non-Compliance

190.11$

380.23$

190.11$

190.11$

190.11$

209.12$

570.34$

190.11$

UST System Install

UST Piping Install

Component Install

UST System Closure

UST Piping Closure

Component Closure

AST System Install

AST Piping Install

1,140.68$

380.23$

190.11$

836.50$

418.25$

AST Piping Closure

AST System Closure

Complaint

Discharge

Inspection Type

Routine

List of Facilities (FAC. ID only)

Attach FIRST spreadsheet

CONTRACTUAL SERVICES INVOICE

Payment Calculations

Invoice No. Contract No. Task No. Invoice Period