REVISED TASK ASSIGNMENT NOTIFICATION FORM

DEP CONTRACT NO. GW283

Task Assignment Number: TOX12 _________ _ Date:_ 4/11/2018_

Contractor: Florida Department of Health

Contractor Contract Coordinator. Michael Bcrrv Phone Number: 1850; 24:�#414 silt.�

DEP Contract Manager: =Ch=a=rles�C=o=u=lta=s _ _ _ _ _________ _ Phone Number: 245-8369

Task Description (Use additional sheets if necessary: In accordance with DEP Contract GW283. Attachment C�Scooe of Services and ttachment D Fee Schedule r W II Surve, · ,Jin� e · es S fo P a• hs A throu •h D. the contractor shall 1rovide administrative services for annual cost reimbursement of, I 04,679.00 for the Certification and Restoration Progran,. The contracto� �l!th_ori_z� !9J•�rt'Q!m �rvices that exceed theJ:.Yl 8/J2 fi�_c.3cl s�l!!" �IDJ,mnt.

Deliverables: • )uarterh invoice with applicable •. backup documentation. See additional deliverables as described in the attached "DOH Contra t W283-To al A mini trati e Services FY Task Assi •mnent Subtasks" t� I'( Task Assignment Performance Period: Execution - '""'7"'"/1=/2=0"""18'---'6"""/3=0"""{2=0"""19'------------------

Task Assignment Type: Amount Not To Exceed:

Fixed Price $ ______ _

Cost Reimbursement $_ 104,679.00 _ ..

Fee Schedule $

Total Task Assignment Value $ 104,679.00 ·- ·---

Funding Information:

Om. Code_ 1..E.Q_IFund ID jOb'ect Code !Module �I Category I. !'.?..rJ!.ntJLI Year l,_A_mo�u�n ..... t _____ !

1�7 352040000 tz!1._ ED � 8249 104qL J)O >40.000. _J 37352040000 _ZB wnA1F � :8249 101492 00 IS55679 IJ7 352040000 __ 1 JC I IPTF I 4399e0- I . j_� I �9.000

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.,�.'. . FLORIDA DEPARTMENT OF EVIRONMENTAL PROTECTION

?#It' �� c;;0t�_ �/,/-z�;-g- Date DEP Contract Manager Date t,..j f\ DEP Contract Coordinator (Only ·for PRP) - Date

APPR�D 'J

J tit )rr �{\)-..1����) Date

�� l'N-!� 4-�. Jl){g Funding Authority � Date

Procurement Section Date

Priest_t Text Box

ATTACHMENT D4

Revised Fee Schedule for Well Survey and Sampling Services

The Contractor shall be compensated In accordance with the following rates as evidenced by an executed Task Assignment Notification Form or Task Assignment Change Order Form.

ITEM .

FEE SCHEDULE

1. Drinking Water Well Surveyl Well Location

Well Survey Request( as outlined In Attachment C Scope of Services) 217.00/survey

GPS Well Location or Well Property Location( or if> 10 wells per request) 12.50/well

11. Drinking Water Sample Collection

Three or Less Water Samples from the same well 93.001well

More than three Water Samples from the same well 103.00twell

Ill. Out of County( additional fee for above services) 23.001surveyfiocaton/sample

IV. Miscellaneous Expenses

A. DEP User Licenses for DOH Lab Sample Manager information 6,684.00 system if requested by DEP( up to 4 at$ 1, 716 each)

B. Nitrate Field Screening Testing 5.001test

C. Request for CHD Assistance( no GPS location or well sampling 41. 00/ visit required)

D. Hands-on training session on water well surveying and sampling 700.001session conducted by CHD staff( one-day session for up to 6 staff)

V. Cost Reimbursement as Authorized by an Executed Task Assignment

A. Administrative Services

Administrative services costs shall be compensated on a cost reimbursement basis in the amount specified in each Task Assignment Notification Form and Change Order as outlined In paragraph S.A. of the Contract and Section VII of the Scope of Services. These costs shall be Invoiced on a quarterly basis.

B. Training and Travel

With the exception of training sessions conducted by CHD staff, the Contractor shall be reimbursed for the actual costs of training and travel up to the amount specified in each Task Assignment Notification Form and Change Order as outlined in Paragraph S.C. of the Contract and Section Vill of the Scope of Services. Ail associated travel expenses will be reimbursed In accordance with Section 112.061, F. S. These costs shall be invoiced on a quarterly basis.

DEP Contract No. GW283, Attachment D• 1, Page 1 of 2

C. Equipment Maintenance and Repair

The Contractor shall be reimbursed for the actual cost of maintenance and repairs of DEP and DOH owned GPS equipment as outlined in Paragraph S.C. of this Contract and Section Vill of the Scope of Services up to the amount specified In each Task Assignment Notification Form and Change Order. These costs shall be Invoiced on a quarterly basis.

D. Equipment Purchase/ Replacement

The Contractor shall be reimbursed for the actual cost of GPS equipment purchased as outlined in Paragraph S.C. of this Contract and Section Bill of the Scope of Services up to the amount specified in each Task Assignment Notification Form and Change Order. Any equipment purchased over$ 1, 000.00 will be the property of DEP and must be pre-authorized by DEP. Other equipment purchase requirements are specified in Paragraph 27, Section A through E of this contract Attachment F( Property Reporting Form) will be*used to list all equipment purchased under this contract

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DEP Contract No. GW283, Attachment D- 1, Page 2 of 2