Funding Information:

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

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 1/6/2021

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 CompletionCompletion Date: December 31, 2024

TA Description:

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

Department Project Manager: Department Project Manager Phone:

(Contractor) Contractor's Name: Florida Department of Health

Conntractor’st ’s Project Manager: Michael Berry Contractor’s Project Manager Phone: 904-363-3430

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 Contractoron 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 Florida Department of Health

Contractor Department Name:

Title: Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

☐ Additional signatures attached on separate page.

DB2

GW387

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

Robert Perlowski 850-245-8917

N/A

Tallahassee, FL

Potable Well Survey and Sampling

$133,090.00

$90,779.00

Scope of Work

Michael Berry Teresa Booeshaghi

OMC Manager

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: 2024-06-21 10:17:21 Foxit PhantomPDF Version: 10.0.0

Michael Berry Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2024.06.24 08:46:31 -04'00'

37450102000 ZB 131545 37450300 101492 GW387 00 $183,169.00

37450202000 ZJ 131545 37450300 088502 GW387 25 $40,700.00

$223,869.00

BerryMS Typewriter 6/21/2024

PROPOSED DOH COSTS PROPOSED DEP EXPENSES FIELD COSTS BREAKDOWN

BY PROGRAM

DOH Program Office Petroleum Petroleum units $/unit Petroleum 18.7% $62,411 Surveys 250 $225 $56,250 Toxics 54.1% $180,557 Program Office $62,411 Samples 350 $95 $33,250 Drycleaning 0.0% $0 Field Costs $91,500 Out of County 80 $25 $2,000 District Support 27.2% $90,779 Total $153,911 Total $91,500

Total 100% $333,746 Water Restoration Program (Toxics) Toxics units $/unit Surveys 25 $225 $5,625

Field Costs units $/unit Program Office $180,557 Samples 2400 $95 $228,000 Surveys 475 $225 $106,875 Field Costs $265,575 Multiple Samples 75 $110 $8,250 Surveys (1/2-1 mile) 10 $420 $4,200 Total $446,132 Out of County 602 $25 $15,050 Surveys (1-2 mile) 5 $630 $3,150 Field Assistance 8 $50 $400.00 Surveys (>2 mile) 2 $1,120 $2,240 Drycleaning GPS Well Points 550 $15.00 $8,250.00 Samples 3550 $95 $337,250 Total $265,575 Mult Samples 75 $110 $8,250 Program Office $0 out of county 782 $25 $19,550 Field Costs $0 Drycleaning units $/unit GPS 550 $15.00 $8,250 Total $0 Surveys 0 $225 $0 Assistance 8 $50 $400 Samples 0 $95 $0 Total $490,165 Out of County 0 $25 $0

District Support Total $0

Program Office $90,779 District Support units $/unit Field Costs $133,090 Surveys 200 $225 $45,000 Total $223,869 Surveys (1/2-1 mile) 10 $420 $4,200

Surveys (1-2 mile) 5 $630 $3,150 Surveys (>2 mile) 2 $1,120 $2,240 Samples 800 $95 $76,000 Out of County 100 $25 $2,500

FY24 (6 MONTHS) TOTAL $823,911 $823,911 Total $133,090