CN-370000-HW552-DC01KCO1.pdf
PDF 175 KB Posted
- Contract number
- HW552
- Issued by
- Florida
About this file
This document is a Task Assignment Notification Change Order Form issued by the Florida Department of Environmental Protection (DEP) for contract HW552. The contractor is Professional Service Industries, Inc. (PSI), represented by Nana Westmark. The DEP contract manager is Walsta Jean-Baptiste, and the contractual authority is William E. Burns, Jr. The task assignment applies to multiple Hazardous Waste Cleanup Section sites across multiple locations in Florida.
Change Order No. 1 extends the task assignment completion date by three months, from December 9, 2021 to March 9, 2022, to allow PSI to continue addressing critical issues at waste site cleanup section sites on an as-needed basis. The task assignment type is Fixed Price with no changes to the financial terms. The original task amount of $2,500.00 remains unchanged, with no net increase or decrease in task amount. The deliverable is documentation of completed site activities, due on March 9, 2022, with invoice submission contingent upon FDEP approval of the documentation. The total task assignment value is $2,500.00, with payment due upon FDEP receipt and approval of completed site activities. All parties signed the change order on December 9, 2021.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DEP CONTRACT NO.
Task Assignment #: Change Order No.:
Contractor Name:
Contractor Representative:
DEP Contract Manager: Phone #:
Site Name:
Site ID / Facility ID::
Description of Change [use additional pages if necessary]:
The Deliverable and Invoice Schedule is attached.
Final Deliverable:
TASK ASSIGNMENT TYPE AND NOT TO EXCEED AMOUNTS:
Cost Reimbursement Fixed Fee
Original Task Amount
Task Amount Prior to this Change Order Net Increase/decrease in task amount Task amount with all change orders $0.00 $0.00 $0.00 $0.00
Original Task Completion Date:
Completion Date Prior to this Change:
Net Increase/Decrease in Task Period:
Completion Date with all Change Orders:
DEP Task Manager:
DEP Contract Manager:
Contractual Authority:
Contractor Representative:
CC: Procurement Section (MS 93) Section Representative ________
FIXED PRICE
TASK ASSIGNMENT NOTIFICATION CHANGE ORDER FORM
ITEM
$0.00
$0.00
DEP will review the deliverables to verify that they meet the specifications of this contract and task description. DEP’s Contract Manager shall notify the Contractor of any deficiencies in the deliverable(s) and shall give the Contractor reasonable opportunity to correct noted deficiencies and provide a revised deliverable(s).
Final Deliverable Due Date:
$0.00
$0.00
CHANGE IN TASK TIME
FEE SCHEDULE
COST PLUS FIXED FEE
TOTAL
WCP TAFORM 01_18
HW552
1DC001K
Professional Service Industries, Inc. (PSI)
Nana Westmark
850-245-8705Walsta Jean-Baptiste
Multiple
Multiple
This Task Assignment Change Order extends the Task Assignment completion date to allow PSI to continue to address critical issues at Waste Site Cleanup Section sites on an as needed basis.
Completed Site Activities 03/09/2022
$ 2,500.00 $ 0.00 $ 0.00 $ 0.00
$ 2,500.00 $ 0.00 $ 0.00 $ 0.00 $ 2,500.00
$ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
$ 2,500.00
12/09/2021
12/09/2021
3 Months
03/09/2022
Walsta Jean-Baptiste Digitally signed by Walsta Jean-Baptiste Date: 2021.12.09 09:03:12 -05'00'
Walsta Jean-Baptiste Digitally signed by Walsta Jean-Baptiste Date: 2021.12.09 09:03:19 -05'00'
William E. Burns, Jr. Digitally signed by William E. Burns, Jr.
Date: 2021.12.09 09:29:57 -05'00'
Nana G Westmark Digitally signed by Nana G Westmark Date: 2021.12.09 09:41:36 -05'00'
$ 2,500.00 $ 0.00 $ 0.00 $ 0.00
$ 2,500.00
Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment
BWC TAFORM 2/03
Contract Number:
Task Assignment #:
Change Order #:
Deliverables:
Deliverable Deliverable Due Date
Invoice Schedule:
Requirements for Invoice Submittal Amount to be Invoiced
TOTAL COST
HW552
DC001K
$ 2,500.00
Documentation of completed site activities
FDEP approval of documentation of completed site activities
03/09/2022
DEP CONTRACT NO.
Task Assignment #: Module #: Grant #:
Contractor Name:
Contractor Representative:
DEP Contract Manager: Phone #:
DEP Site #:
Site Name:
Address(Street, City, County):
Phase:
Task Description [use additional pages if necessary]:
The Deliverable and Invoice Schedule is attached.
Final Deliverables:
Final Deliverable Due Date:
TASK ASSIGNMENT TYPE AND NOT TO EXCEED AMOUNTS:
FIXED FEE
RETAINAGE:
TOTAL TASK ASSIGNMENT VALUE: $0.00
DEP Task Manager:
DEP Contract Manager:
Contractual Authority:
Contractor Representative:
CC: Procurement Section (MS 93) Section Representative ________
TASK ASSIGNMENT NOTIFICATION FORM
COST PLUS FIXED FEE
COST REIMBURSEMENT
FIXED PRICE FEE SCHEDULE
Period of Performance:
Execution of Task Assignment through:
DEP will review the deliverables to verify that they meet the specifications of this contract and task description. DEP’s Contract Manager shall notify the Contractor of any deficiencies in the deliverable(s) and shall give the Contractor reasonable opportunity to correct noted deficiencies and provide a revised deliverable(s).
WCP TAFORM 01_18
HW552
D000 N/ADC001K
Professional Service INdustires, Inc. (PSI) Nana Westmark
850-245-8928Killian Talley Multiple Multiple Multiple Critical Response
Task Assignment authorizes PSI to address critical issues at Hazardous Waste Cleanup Section sites on an as-needed basis.
Completed Site Activities
12/09/2021
12/09/2021
$ 2,500.00 $ 0.00 $ 0.00 $ 0.00
$ 0.00
Killian Talley Digitally signed by Killian Talley Date: 2021.06.03 11:39:26 -04'00'
Killian Talley Digitally signed by Killian Talley Date: 2021.06.03 11:39:32 -04'00'
William E. Burns, Jr. Digitally signed by William E. Burns, Jr.
Date: 2021.06.03 13:17:50 -04'00'
Nana Westmark Digitally signed by Nana Westmark Date: 2021.06.03 15:22:18 -04'00'
Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment
WC TAFORM
Contract Number:
Task Assignment #:
Deliverables:
Deliverable Deliverable Due Date
Invoice Schedule:
Requirements for Invoice Submittal Amount to be Invoiced
TOTAL COST
Documentation of completed site activities 12/09/2021
FDEP receipt and approval of completed site activities $ 2,500.00
$ 2,500.00
HW552
DC001K
| Task Assignment CHANGE ORDER |
| BWC Task Assignment Change Order Form (Rev 02-17).pdf |
| Task Assignment CHANGE ORDER |
| BWC Task Assignment Form - Page 2 (Rev 08_10) - Rev 1.pdf |
| Deliverable & Invoice Schedule |
File details come from the government source that posted it. Updated .