Funding Information:

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

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 8/26/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment This Task Assignment (TA) is entered into between the Parties named below, pursuant to Contract Number: .

1. TA Number: TA Completion Date:

TA Description:

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

Department Project Manager: Department 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 Location(s):

Project Name:

4. As consideration for the services rendered by Contractor under the terms of this TA, the Department shall pay the Contractor on the following bases, up to the Total TA Value as indicated below:

☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. The Parties agree to comply with the terms and conditions of the underlying the Contract, and the following attachments which are hereby incorporated by reference:

Attachment 1:

☐ Additional Attachments (if necessary):

IN WITNESS WHEREOF, this TA 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.

GW387

DB1 Completion June 30, 2024

The Contractor will provide administrative staff and potable well identification and sampling services to the Office of District and Business Support according to Contract GW387. Please see the attached pages for itemized Tasks.

Robert Perlowski 850-245-8917 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Florida Department of Health

Florida Department of Health

Michael Berry 904-363-3430 N/A

Tallahassee Florida

Potable Well Survey and Sampling

✔ $ 85,715.00 ✔ $ 71,866.47

$ 157,581.47

Scope of Work

Michael Berry

OMC Manager

5/26/2023

Digitally signed by Michael Berry DN: C=US, OU=Bureau of Environmental Health, O=Florida Department of Heallth, CN=Michael Berry, E=michael.berry@flhealth.gov Reason: I agree to the terms defined by the placement of my signature in this document Location: your signing location here Date: 2023-05-26 14:25:07 Foxit PhantomPDF Version: 10.0.0

Michael Berry

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.05.30 08:31:50 -04'00'

5/30/2023

Funding Information

Office of District and Business Support (ODBS)

Org. Code EO Object Code

Budget Entity

Appropriation Category

Grant# Project# Year Amount

37450102000 ZJ 131545 37450300 088502 GC130 23 $157,581.47

Funding Information

DOH OFFICE EXPENSES PROGRAM EXPENSES FIELD & LAB COSTS BREAKDOWN

BY PROGRAM

DOH Program Office Petroleum Restoration Program (PRP) PRP units $/unit Petroleum 20.4% $124,298.00 surveys 350 $225 $78,750.00 Toxics 36.5% $222,667.40 $124,298.00 program office samples 600 $95 $57,000.00 Drycleaning 12.6% $76,716.81 $148,250.00 field costs ooc 500 $25 $12,500.00 ODBS 11.8% $71,866.47 $272,548.00 total total $148,250.00 DSCP & State - PFAS 18.8% $114,488.31 total 100% $610,037.00 Toxics units $/unit Water Restoration Program (Toxics) surveys 25 $225 $5,625.00 samples 2400 $95 $228,000.00 field costs units $/unit $222,667.40 program office Multiple Samples 75 $110 $8,250.00 surveys 930 $225 $209,250.00 $265,575.00 field costs ooc 602 $25 $15,050.00 surveys (1/2-1 mile) 30 $420 $12,600.00 $488,242.40 total Field Assistance 8 $50 $400.00 surveys (1-2 mile) 20 $630 $12,600.00 GPS Well Points 550 $15.00 $8,250.00 surveys (>2 mile) 12 $1,120 $13,440.00 total $265,575.00 samples 4500 $95 $427,500.00 Drycleaning Solvent Cleanup Program (DSCP) Mult samples 75 $110 $8,250.00 DSCP units $/unit out of county 1412 $25 $35,300.00 $76,716.81 program office surveys 250 $225 $56,250.00 GPS 550 $15.00 $8,250.00 $91,500.00 field costs samples 350 $95 $33,250.00 Assistance 8 $50 $400.00 $168,216.81 total ooc 80 $25 $2,000.00 total $727,590.00 total $91,500.00

Office of District and Busness Support (ODBS) ODBS units $/unit surveys 5 $225 $1,125.00

$71,866.47 program office surveys (1/2-1 mile) 10 $420 $4,200.00 $85,715.00 field costs surveys (1-2 mile) 5 $630 $3,150.00

$157,581.47 total surveys (>2 mile) 2 $1,120 $2,240.00 samples 750 $95 $71,250.00 ooc 150 $25 $3,750.00

DSCP & State - PFAS total $85,715.00

$114,488.31 program office DSCP & State - PFAS units $/unit $136,550.00 field costs surveys 300 $225 $67,500.00 $251,038.31 total surveys (1/2-1 mile) 20 $420 $8,400.00 surveys (1-2 mile) 15 $630 $9,450.00 Fixed Unit Rate (Field Costs): $85,715.00 surveys (>2 mile) 10 $1,120 $11,200.00

Cost Reimbursement (Program Office): $71,866.47 samples 400 $95 $38,000.00 Task Assignment (DBSP) Total: $157,581.47 ooc 80 $25 $2,000.00 total $136,550.00

ATTACHMENT A