CN-370000-HW552-DC031BCO.pdf

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

7DC031B

Professional Service Industries, Inc. (PSI)

Nana Westmark

850-245-8928Killian Talley

Plant City Laundry

ERIC_4722

This Task Assignment Change Order extends the final deliverable due date and task completion date to allow additional time for ongoing discussions between contractor and the Department.

There is no change in the total cost related to this change order.

Site Assessment Report; GIS/ADaPT; Waste Manifests 01/22/2021

$ 95,357.46 $ 0.00 $ 0.00 $ 0.00

$ 267,325.48 $ 0.00 $ 0.00 $ 0.00 $ 267,325.48

$ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00

$ 267,325.48

12/28/2018

12/18/2020

10 weeks

02/26/2021

Killian Talley Digitally signed by Killian Talley Date: 2020.12.17 10:34:36 -05'00'

Killian Talley Digitally signed by Killian Talley Date: 2020.12.17 10:34:55 -05'00'

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2020.12.17 15:28:52 -05'00'

Nana G Westmark Digitally signed by Nana G Westmark Date: 2020.12.17 16:09:33 -05'00'

$ 267,325.48 $ 0.00 $ 0.00 $ 0.00

$ 95,357.46

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

DC031B

$ 267,325.48

Subtasks 2-5: Submittal of Documentation of field work completion, including passive soil gas data, direct push soil and groundwater sampling, lithologic boring installation, and monitoring well installation and sampling, and Documentation of monitoring well sampling (Complete) Subtasks 7-8: Submittal of documentation of additional assessment work completion, including direct push soil and groundwater sampling, and monitoring well installation and sampling (Complete)

Subtask 9: Submittal of Documentation of additional soil assessment completion (Complete)

Subtask 10: Submittal of Documentation of additional soil assessment completion (Complete)

Subtask 11: Submittal of Documentation of additional soil assessment completion (Complete)

Subtasks 1 & 6: Site Assessment Report; GIS/ADaPT; Waste Manifests

Subtasks 2-5: FDEP receipt and approval of Documentation of field work completion, including passive soil gas data, direct push soil and groundwater sampling, lithologic boring installation, and monitoring well installation and sampling, and Documentation of monitoring well sampling (Previously Invoiced)

Subtask 9: FDEP receipt and approval of Documentation of additional soil assessment completion (Previously Invoiced)

Subtask 10: FDEP receipt and approval of Documentation of additional soil assessment completion

Subtasks 1 & 6: FDEP receipt and approval of Site Assessment Report; GIS/ADaPT;

Waste Manifests

Subtask 11: FDEP receipt and approval of Documentation of additional soil assessment completion

Subtask 7&8: FDEP receipt and approval of documentation of additional assessment work completion, including direct push soil and groundwater sampling, and monitoring well installation and sampling (Previously Invoiced)

11/30/2018

02/28/2019

07/31/2019

02/21/2020

01/22/2021

08/28/2020

$ 65,332.69

$ 91,766.89

$ 28,008.51

$ 26,344.87

$ 19,726.88

$ 36,145.64

Florida Department of Memorandum Environmental Protection

Printed on recycled paper.

To: HW552 Contract Negotiation File

Plant City Laundry Plant City, Hillsborough County

ERIC_4722

From: Killian Talley, Project Manager Date: December 17, 2020 Subject: Negotiation Summary

HW552 DC031B-7

This Task Assignment Change Order extends the period of performance and final deliverable date for assignment to allow additional time for communications between the Department and contractor. Recommendations for additional soil data relating to upcoming excavation are under review.

There is no cost change related to this change order.

The FDEP project manager agrees to the scope of work and final cost associated with this Task Assignment Change Order. The final cost for this Task Assignment Change Order is $267,325.48 with 1568 labor hours.

PSI may invoice following the schedule established in the Deliverables and Invoice Schedule Attachment, which accompanies the Task Assignment Change Order Notification Form.