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. 2 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 81 facilities storage tank systems within Indian River County, identified in Exhibit #1, by May 31, 2018.

Perform all re-inspections per Guidance Document A to confirm compliance within Indian River 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 2 06/26/2017 Roger Ruiz

GC916-2

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

$51,678.00

Judy Dolan Judy Dolan Digitally signed by Judy Dolan Date: 2017.06.28 15:54:51 -04'00' 06/28/2017

Roger Ruiz Roger Ruiz Digitally signed by Roger Ruiz Date: 2017.06.29 08:13:18 -04'00' 06/29/2017

Jennifer Vickers Jennifer Vickers Digitally signed by Jennifer Vickers Date: 2017.06.29 14:06:07 -04'00'

Douglas Divers Douglas Divers Digitally signed by Douglas Divers Date: 2017.06.28 15:10:53 -04'00'

Fletcher Herrald Fletch Herrald Digitally signed by Fletch Herrald Date: 2017.06.29 14:41:41 -04'00'

37450300 GC916 37450104000 00 212001 100029 132500 JD $51,678.00

NaN

FACILITY_ID NAME ADDRESS1 CITY SC1_STATE_ID ZIP5 DISTRICT COUNTY FACSTAT FACTYPE DEPCONOW LAST_ANNUAL_INSP_DATE MIN_TANK_INSTALL_INSP_DATE FAC_TOTAL_AST FAC_TOTAL_UST

9815110

WAWA

FOOD

MARKET#

1180 S US

HIGHWAY

VERO

BEACH FL 32962 SED 31 OPEN A P 12/14/2016 0 4

9815433

WAWA

FOOD

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9050 20TH

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VERO

BEACH FL 32966 SED 31 OPEN A P 0 4

9200341

LOGGERH

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MARINA‐

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BEACH

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VILLAGE

CIRCLE

VERO

BEACH FL 32967 SED 31 OPEN V P 9/15/2015 0 1

9800360

EXXON‐

SEBASTIA

N

FELLSMERE

RD

SEBASTIA

N FL 32958 SED 31 OPEN A P 10/26/2015 8/25/2006 0 2

8509299

ROLLINS

BLUE

CYPRESS

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4701 S

KENANSVIL

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OKEECH

OBEE FL 34972 SED 31 OPEN C P 11/3/2015 0 2

9812189

RACEWAY

#6861

108TH AVE

VERO

BEACH FL 32967 SED 31 OPEN C P 11/5/2015 12/1/2010 0 3

8736130

GIANT

#212

617 US

HWY 1

SEBASTIA

N FL 32958 SED 31 OPEN A P 11/13/2015 4/15/2010 0 3

9815065

FELLSMER

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MANAGE

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RE FL 32948 SED 31 OPEN G P 1 0

9815252

DAVIS

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BEACH FL 32960 SED 31 OPEN C P 11/1/2016 1 0

9815312

INDIAN

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BIOENER

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925 74TH

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BEACH FL 32968 SED 31 OPEN C P 1 0

9815506

RENAISSA

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SENIOR

LIVING

2100 10TH

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BEACH FL 32960 SED 31 OPEN C P 1 0

8509333

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BEACH

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CHEROKEE

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BEACH FL 32960 SED 31 OPEN A P 9/18/2014 9/29/2008 5 0

Exhibit 1

9809968

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BATCH

PLT ‐

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BEACH

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BEACH FL 32967 SED 31 OPEN C P 9/19/2014 5/13/2010 1 0

8945168

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4055 41ST

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8945550

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BEACH FL 32963 SED 31 OPEN C P 10/7/2014 2 0

9103255

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BEACH FL 32963 SED 31 OPEN C P 10/7/2014 2 0

8629982

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BEACH FL 32963 SED 31 OPEN C P 10/23/2014 1/18/2007 3 0

8520206

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BEACH FL 32966 SED 31 OPEN M P 10/27/2014 5 0

8520271

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PUBLIC

WORKS

DEPT

VETERANS

MEMORIAL

WAY

SEBASTIA

N FL 32958 SED 31 OPEN H P 10/27/2014 12/17/2014 2 0

8731901

CAMPBEL

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450 118TH

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VERO

BEACH FL 32960 SED 31 OPEN M P 10/27/2014 2 0

9812230

SEBASTIA

N POLICE

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1201 MAIN

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SEBASTIA

N FL 32958 SED 31 OPEN H P 10/27/2014 8/4/2011 1 0

9813527

MAGIC

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1565 9TH

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VERO

BEACH FL 32962 SED 31 OPEN C P 10/27/2014 10/2/2013 1 0

8520281

RUSSELL

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1400 10TH

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BEACH FL 32960 SED 31 OPEN C P 10/28/2014 1 0

9813998

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RADIOLO

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3725 11TH

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BEACH FL 32960 SED 31 OPEN C P 10/28/2014 4/9/2014 1 0

8509231

SEBASTIA

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N FL 32958 SED 31 OPEN C P 10/30/2014 1 0

8509274

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9202132

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9202133

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9046331

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9808069

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8734356

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9046796

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BEACH FL 32960 SED 31 OPEN I P 1/27/2015 1 0

9600729

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BEACH FL 32967 SED 31 OPEN I P 1/27/2015 9/23/2008 6 0

9602274

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9801840

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9801843

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BEACH FL 32962 SED 31 OPEN I P 1/27/2015 12/26/2007 1 0

9808598

UTILITIES

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4350 41ST

ST

BEACH FL 32967 SED 31 OPEN H P 1/27/2015 12/27/2006 1 0

9811956

INDIAN

RIVER

CNTY

BIOSOLID

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1355 SW

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VERO

BEACH FL 32968 SED 31 OPEN I P 1/27/2015 3/22/2010 1 0

8520287

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VERO

BEACH FL 32960 SED 31 OPEN H P 2/5/2015 9/30/2009 3 0

8734786

INDIAN

RIVER

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1325 SW

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VERO

BEACH FL 32968 SED 31 OPEN I P 3/5/2015 10/14/2009 3 0

9101058

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OF

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3905 9TH

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BEACH FL 32968 SED 31 OPEN C P 3/5/2015 1 0

9809496

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4225 43RD

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BEACH FL 32967 SED 31 OPEN I P 3/6/2015 8/22/2007 1 0

8945170

INDIAN

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4055 41ST

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BEACH FL 32967 SED 31 OPEN I P 3/17/2015 1/23/2008 1 0

8944032

SEBASTIA

N

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HWY 1

SEBASTIA

N FL 32958 SED 31 OPEN C P 5/19/2015 8/27/2010 2 0

9806007

VERO

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BEACH FL 32960 SED 31 OPEN F P 5/20/2015 1 0

9808537

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8736762

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925 SW

122ND AVE

VERO

BEACH FL 32968 SED 31 OPEN G P 6/19/2015 20 0

8624200

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11825 8TH

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BEACH FL 33880 SED 31 OPEN M P 7/31/2015 1 0

8944729

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4705 82ND

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BEACH FL 32967 SED 31 OPEN C P 8/4/2015 8/4/2015 1 0

9046710

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154TH AVE

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BEACH FL 32966 SED 31 OPEN M P 8/5/2015 12/28/2011 1 0

8520254

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8595 4TH

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VERO

BEACH FL 32968 SED 31 OPEN M P 8/12/2015 3 0

8626039

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FARMS

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150TH AVE

OFF RT 60

VERO

BEACH FL 32961 SED 31 OPEN M P 8/17/2015 1 0

8736617

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FARMS

LLC‐

SECTION

15410 9TH

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VERO

BEACH FL 32966 SED 31 OPEN M P 8/17/2015 4 0

8945022

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VERO

BEACH FL 32960 SED 31 OPEN M P 8/17/2015 2 0

9102272

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DISTRICT

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VERO

BEACH FL 32960 SED 31 OPEN M P 8/17/2015 3 0

9202292

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150 102ND

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BEACH FL 32968 SED 31 OPEN M P 8/17/2015 1/29/2015 3 0

8520282

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BEACH FL 32966 SED 31 OPEN C P 8/20/2015 1 0

8735530

QUALITY

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ROUTE 60

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VERO

BEACH FL 32961 SED 31 OPEN C P 8/20/2015 1 0

9047527

UNITED

PARCEL

SERVICE

4555 41ST

ST

VERO

BEACH FL 32967 SED 31 OPEN C P 8/27/2015 1 0

8943692

LAMBETH

GROVE

#19

130TH AVE

VERO

BEACH FL 32966 SED 31 OPEN M P 9/8/2015 1 0

9808268

PUBLIX

SUPER

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#240

1255 US

HWY 1

VERO

BEACH FL 32960 SED 31 OPEN C P 9/16/2015 1 0

9808283

PUBLIX

SUPER

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9621 N US

HWY 1

SEBASTIA

N FL 32958 SED 31 OPEN C P 9/16/2015 1 0

9810584

PUBLIX

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SEBASTIA

N FL 32958 SED 31 OPEN C P 9/16/2015 12/29/2008 1 0

9813540

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SUPER

MARKET

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5230 US

HWY 1

VERO

BEACH FL 32967 SED 31 OPEN C P 9/16/2015 6/26/2013 1 0

8629911

BENT

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GOLF

CLUB

CLUBHOUS

E DR

VERO

BEACH FL 32967 SED 31 OPEN C P 9/24/2015 2 0

9809974

INDIAN

RIVER

SCHOOL

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TREASUR

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ELEM

8955 85TH

ST

SEBASTIA

N FL 32958 SED 31 OPEN G P 9/29/2015 2/5/2008 1 0

9814717

INDIAN

RIVER

CNTY

SCHOOL

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SCH

6850 81ST

ST

BEACH FL 32967 SED 31 OPEN H P 10/7/2015 1 0

9802613

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4850 77TH

ST

VERO

BEACH FL 32967 SED 31 OPEN C P 10/14/2015 1 0

8509294

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2345 US

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BEACH FL 32963 SED 31 OPEN V P 10/15/2015 2 0

8736923

INDIAN

RIVER

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PACKERS

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BEACH FL 32968 SED 31 OPEN C P 10/20/2015 1 0

9813219

VERO

BEACH

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VERO

BEACH FL 32963 SED 31 OPEN C P 10/22/2015 7/5/2012 1 0

9801595

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BEACH FL 32962 SED 31 OPEN C P 10/23/2015 1 0

8622655

ROLLINS

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MI N

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8520283

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BEACH FL 32967 SED 31 OPEN M P 11/9/2015 11/18/2015 3 0

9808576

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3150 52RD

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BEACH FL 32967 SED 31 OPEN C P 11/13/2015 1/18/2007 1 0

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

8943899

CUMBERL

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SEBASTIA

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SEBASTIA

N FL 32958 SED 31 OPEN A P 1/15/2016 8/9/2006 0 2

9814178

CUMBERL

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4490 US

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VERO

BEACH FL 32967 SED 31 OPEN A P 1/15/2016 ######## 0 2

9814240

CUMBERL

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FARMS

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27TH ST

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BEACH FL 32968 SED 31 OPEN A P 1/19/2016 ######## 0 2

8509325 STEIL #1

1031 S US

#1

VERO

BEACH FL 32860 SED 31 OPEN A P 1/20/2016 ######## 0 2

8943328

EVANS

GROVE

LAND LLC‐

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OKEECHO

BEE FL 34972 SED 31 OPEN M P 1/26/2016 1 0

8509285

PRESSLEY

RANCH

INC

BLUE

CYPRESS

LAKE RD

VERO

BEACH FL 32966 SED 31 OPEN M P 1/28/2016 3 0

9811752

FL DEPT

OF TRANS

PUMP STA‐

RETENTIO

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4A

SR 60 &

CR 12 (.48

MI N OF

SR 60)

VERO

BEACH FL 32948 SED 31 OPEN G P 2/8/2016 ######## 1 0

9805185

SHELL‐

27TH AVE

927 SW

27TH AVE

VERO

BEACH FL 32968 SED 31 OPEN A P 2/24/2016 ######## 1 3

8509238

EXXON‐

SIFFORDS

1550 US

HWY 1

VERO

BEACH FL 32960 SED 31 OPEN A P 2/25/2016 0 4

8736587

S N

KNIGHT &

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KENANSVI

LLE FL 87 SED 31 OPEN M P 2/29/2016 1 0

8520290

SHELL‐

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VERO

BEACH FL 32960 SED 31 OPEN A P 3/9/2016 ######## 0 2

9802488

GRAND

HARBOR

SHELL

5325 US

HWY 1

VERO

BEACH FL 32967 SED 31 OPEN A P 3/15/2016 0 3

9805670

CHEVRON‐

WABASSO

8650 US

HIGHWAY

SEBASTIA

N FL 32976 SED 31 OPEN A P 3/15/2016 ######## 0 3

9806125

INDIAN

RIVER

CNTY‐

FLEET

MAINT

COMPLEX

5235 41ST

ST

VERO

BEACH FL 32967 SED 31 OPEN H P 3/28/2016 ######## 3 0

8520278

ROCKET 5

CORP

1940 S US

HWY 1

VERO

BEACH FL 32962 SED 31 OPEN A P 4/5/2016 ######## 0 2

9812926

SCHOOL

DIST OF

INDIAN

RIVER CO‐

SUPPT

SRV

CMPLX

62ND AVE

VERO

BEACH FL 32967 SED 31 OPEN I P 4/13/2016 ######## 3 0

9803106

OLD DIXIE

SUNOCO

755 4TH

ST

VERO

BEACH FL 32962 SED 31 OPEN A P 4/15/2016 0 1

9047526

SIMS

CRANE &

EQUIP

936 OLD

DIXIE

HWY

VERO

BEACH FL 32960 SED 31 OPEN C P 4/19/2016 1 0

9810607

JOHNS

ISLAND

BCH CLUB

BEACH RD VERO BCH FL 32963 SED 31 OPEN C P 4/19/2016 ######## 1 0

8509199

VERO

BEACH

TRAVEL

CENTER

20TH ST

VERO

BEACH FL 32966 SED 31 OPEN A P 4/21/2016 8/6/2008 0 6

Alternative

8944195

TWENTY

MILE

BEND

GROVES

LLC

22200 SR

VERO

BEACH FL 32966 SED 31 OPEN M P 4/28/2016 3 0

9811798

FL DEPT

OF

TRANSPO

RTATION‐

NC3 GEN

LOC 8

I‐95 AT

FELLSMER

E RD‐MI

PST 155.9

SE CRN

VERO

BEACH FL 32967 SED 31 OPEN G P 4/29/2016 ######## 1 0

9811799

NC3

GENERAT

OR

LOCATION

I‐95 AT SR

60/OSCEO

LA BLVD

MI POST

146.6

VERO

BEACH FL 32966 SED 31 OPEN G P 4/29/2016 ######## 1 0

9812780

CVS VERO

BCH

DISTRIBUT

ION LLC

98TH AVE

VERO

BEACH FL 32966 SED 31 OPEN Z P 4/29/2016 ######## 4 0

8509245

SUNSHINE

FOOD

MART

#316

20TH ST

VERO

BEACH FL 32966 SED 31 OPEN A P 5/19/2016 0 3

9600066

SUTHERLI

N NISSAN

OF VERO

BEACH

910 US

HWY 1

VERO

BEACH FL 32962 SED 31 OPEN C P 5/19/2016 1 0

8509358

SUNSHINE

FOOD

MART

#384

20TH ST

VERO

BEACH FL 32966 SED 31 OPEN A P 5/25/2016 ######## 0 3

8509230

SUNRIVER

SERVICES

INC

7300 4TH

ST

VERO

BEACH FL 32968 SED 31 OPEN M P 5/26/2016 2 0

8520249

COMMUN

ITY

ASPHALT

CORP

INDUSTRI

AL BLVD

BEACH FL 32967 SED 31 OPEN C P 5/27/2016 2 0

8945225

BEACH

SPORTS

VILLAGE

26TH ST

VERO

BEACH FL 32961 SED 31 OPEN I P 6/1/2016 1 0

9809612

SEBASTIA

N

MUNICIPA

L AIRPORT

AIRPORT

DRIVE

EAST

SEBASTIA

N FL 32958 SED 31 OPEN H P 6/6/2016 ######## 1 0

8509234

SOUTHER

N

FULFILLM

ENT

SERVICES

90TH AVE

VERO

BEACH FL 32966 SED 31 OPEN M P 6/8/2016 2 0

8736843

SEXTON

GROVE

SERVICE

17TH ST

SW

VERO

BEACH FL 32968 SED 31 OPEN M P 6/13/2016 2 0

8842129

INDIAN

RIVER

ESTATES‐

EAST

2250 W

INDIAN

CREEK

BLVD

VERO

BEACH FL 32966 SED 31 OPEN C P 6/13/2016 2 0

9046067

INDIAN

RIVER

ESTATES‐

WEST

INDIAN

OAKS DR

VERO

BEACH FL 32966 SED 31 OPEN C P 6/13/2016 1 0

9602140

SUNSHINE

FOOD

MART

#383

108TH

AVE

VERO

BEACH FL 32967 SED 31 OPEN A P 6/13/2016 ######## 0 3

9801934

OSLO

PETROLEU

M INC

OSLO RD‐

9TH ST

SW

VERO

BEACH FL 32968 SED 31 OPEN A P 6/13/2016 0 1

8945169

THE

TRADING

POST

175 43RD

AVE

BEACH FL 32968 SED 31 OPEN A P 6/15/2016 3/1/2007 0 1

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