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

DWM-1 Expiration June 30, 2022

The Contractor will provide administrative staff and services to the Department according to Contract GW387. Please see the attached pages for itemized Tasks.

Robert Perlowski 8502458917 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Florida Department of Health

Florida Department of Health

Mike Berry 8509016486

Tallahassee Florida

Potable Well Survey and Sampling

✔ $ 737,100.00 ✔ $ 451,668.19

$ 1,188,768.19

Scope of Work

Michael Berry

OMC Manager

6/10/2021

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 agree to the terms defined by the placement of my signature in this document Location: your signing location here Date: 2021-06-10 15:00:45 Foxit PhantomPDF Version: 10.0.0

Michael Berry Leslie Reed Digitally signed by Leslie Reed Date: 2021.06.14 14:28:11 -04'00'

Funding Information

Petroleum Restoration Program (PRP) Funding Information

Org. Code EO Object Code

Budget Entity

Appropriation Category

Grant# Project# Year Amount

37450404555 JC 131545 37450300 104132 GW387 00 $883,794.56

Drycleaning Solvent Cleanup Program (DSCP) DSCP Funding Information

Budget Entity

Appropriation Category

37450202000 ZJ 131300 37450300 080524 GW387 22 $166,735.58

Office of District and Business Support (ODBS) Funding Information

Budget Entity

Appropriation Category

37450102000 ZB 131545 37450300 101492 GW387 00 $138,238.05

PROPOSED DOH COSTS PROPOSED DEP EXPENSES FIELD & LAB COSTS BREAKDOWN

BY PROGRAM

program office petroleum petroleum units $/unit petroleum 57.0% $335,794.56 surveys 1200 $225 $270,000.00 toxics 23.4% $137,629.81 $335,794.56 program office samples 2400 $95 $228,000.00 drycleaning 10.8% $63,350.58 $548,000.00 field costs ooc 2000 $25 $50,000.00 ODBS 8.9% $52,523.05 $883,794.56 total total $548,000.00 total 100% $589,298.00 toxics units $/unit toxics surveys 25 $225 $5,625.00 samples 2000 $95 $190,000.00 field costs units $/unit $137,629.81 program office Multiple Samples 48 $110 $5,280.00 surveys 1578 $225 $355,050.00 $224,605.00 field costs ooc 602 $25 $15,050.00 surveys (1/2-1 mile) 10 $420 $4,200.00 $362,234.81 total Field Assistance 8 $50 $400.00 surveys (1-2 mile) 5 $630 $3,150.00 GPS Well Points 550 $15.00 $8,250.00 surveys (>2 mile) 2 $1,120 $2,240.00 total $224,605.00 samples 5398 $95 $512,810.00 drycleaning Mult samples 48 $110 $5,280.00 drycleaning units $/unit out of county 2813 $25 $70,325.00 $63,350.58 program office surveys 348 $225 $78,300.00 GPS 550 $15.00 $8,250.00 $103,385.00 field costs samples 248 $95 $23,560.00 Assistance 8 $50 $400.00 $166,735.58 total ooc 61 $25 $1,525.00 total $961,705.00 total $103,385.00

Office of District and Business Support waste cleanup units $/unit surveys 5 $225 $1,125.00

$52,523.05 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

$138,238.05 total surveys (>2 mile) 2 $1,120 $2,240.00 samples 750 $95 $71,250.00 ooc 150 $25 $3,750.00 total $85,715.00

Task Assignment Total (Petroleum, Drecleaning, OBDS) $1,188,768.19 NOTE: Toxics Program costs are not included in this Task Assignment.

ATTACHMENT 1