CN-370000-GW387-PRP1.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. 8/26/2020

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

PRP-1 Expiration June 30, 2024

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

✔ $ 148,250.00 ✔ $ 132,502.10

$ 280,752.10

Scope of Work

Michael Berry

Natural Sciences Manager

5/22/2023

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 am approving this document Location: your signing location here Date: 2023-05-22 14:48:29 Foxit PhantomPDF Version: 10.0.0

Michael Berry

Tim Bahr

Tim J. Bahr Digitally signed by Tim J. Bahr Date: 2023.06.16 10:09:23 -04'00'

3745040455 JC 131545 37450300 104132 GW387 00 $ 280,752.10

ATTACHMENT A