CN-370000-HW552-DC04RCO2.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

2DC004R

Professional Service Industries (PSI)

Nana Westmark

850-245-8928Killian Talley

Tempo Cleaners

ERIC_5476

This Task Assignment Change Order extends the task completion date to allow adequate time for final invoicing.

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

Revised Remedial Action Plan Modification 09/27/2019

$ 11,555.26 $ 0.00 $ 0.00 $ 0.00

$ 11,555.26 $ 0.00 $ 0.00 $ 0.00 $ 11,555.26

$ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00

$ 11,555.26

01/31/2020

05/29/2020

1 month

06/30/2020

Killian Talley Digitally signed by Killian Talley Date: 2020.05.28 11:56:12 -04'00'

Killian Talley Digitally signed by Killian Talley Date: 2020.05.28 11:56:24 -04'00'

Digitally signed by Jennifer Farrell Date: 2020.05.28 14:57:12 -04'00'

Nana G Westmark Digitally signed by Nana G Westmark Date: 2020.05.29 08:40:23 -04'00'

$ 11,555.26 $ 0.00 $ 0.00 $ 0.00

$ 11,555.26

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 01_18

Contract Number:

Task Assignment #:

Change Order #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW552

DC004R

$ 11,555.26

Subtasks 1-3: Submittal of Revised Remedial Action Plan Modification; GIS/ADaPT (Complete)

Subtasks 1-3: FDEP receipt and approval of Revised Remedial Action Plan Modification; GIS/ADaPT

09/27/2019

$ 11,555.26

Florida Department of Memorandum Environmental Protection

To: HW552 Contract Negotiation File

Tempo Cleaners Fern Park, Seminole County

ERIC_5476

From: Killian Talley, Project Manager Date: May 28, 2020 Subject: Negotiation Summary

HW552 DC004R-2

This Task Assignment Change Order extends the period of performance for assignment DC004R to allow additional time for completion of final invoicing. The Remedial Action Plan Modification was submitted on its original due date, has undergone multiple review comments, and responses to review comments prior to agreement between Department and contractor. This time extension is to allow for the completion of final invoicing.

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 $11,555.26 with 86 labor hours.

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