CN-370000-GW387-CO WC-02.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:

Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

☐ Additional signatures attached on separate page.

WC-02 1 GW387

Funding Reduction

Brian Dougherty 850-245-7503 Contractor Contractor

Contractor Contractor

Contractor

Florida Department of Health Mike Berry 850-901-6486

Department of Health Potable Well Survey and Sampling

✔ $ 97,360.00 $ 231,027.00

$ 97,360.00 $ 231,027.00 ✔ Expiration

Expiration 0

Michael Berry

OMC Manager

05/11/2021

Digitally signed by Michael Berry DN: OU=Bureau of Environmental Health, O=Department of Health, CN=Michael Berry, E=michael.berry@flhealth.gov Reason: I am approving this document Location: your signing location here Date: 2021-05-11 09:26:04 Foxit PhantomPDF Version: 10.0.0

Michael Berry

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.04.19 13:34:07 -04'00'

04/19/21

450102000 ZB 131545 37450300 101492 GW387 00 $ 97,360.00