CN-370000-HW553-BF04DCO4.pdf

TASK ASSIGNMENT NOTIFICATION CHANGE ORDER FORM

DEP CONTRACT NO. HW553

Task Assignment#:

Contractor Name:

BF004D Change Order No.:

Ecology and Environment, inc.

Contractor Representative: Richard Stephens

DEP Contract Manager:

Site Name:

Site ID / Facility ID:;

Justin Cross

Old Carrabelle Water Plant Site

Phone#; 850/245-8968

C Street and 4tti Avenue, Carrabelle, Franklin County

Description of Change [use additional pages if necessary]:

At the Department's request, change order includes time extension to allow for completion of reconciliation change order and invoicing to close out task assignment. Additionally the invoice schedule has been adjusted, however, the reconciliation change order is still needed prior to invoicing.

The Deliverable and Invoice Schedule is attached.

Final Deliverable; Limited Scope Source Removal Report Final Deliverable Due Date: 2/7/2017

TASK ASSIGNMENT TYPE AND NOT TO EXCEED AMOUNTS:

ITEM FIXED PRICE FEE SCHEDULE

COST PLUS FIXED FEE

TOTAL

Cost Reimbursement Fixed Fee

Original Task Amoun( $72,083.28 $72,083.28

Task Amount Prior lo this

Change Order $73,610.16 $73,610.16

Net Increase/decrease in task amount $0.00 $0.00

Task amount with all change orden $73,610.16 $0.00 $0.00 $0.00 $73,610.16

CHANGE IN TASK TIME

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; I ^

Contractual Authority;

Contractor Representative:

CC: Procurement Section (MS 93) Section Representative

11/15/2016

2/7/2017

35 days

3/14/2017

Date:2l[zAx Date: J-h /\'7 Date:"^ 0

Date:

WCP TAFORM 0<l/14

Deliverables:

Task Assignment Notification/Change Order Deliverables and Invoice Scliedule Attachment

Contract Number:

Tasic Assignment #:

Change Order #:

Deliverable

HW553

BF004D

Deliverable Due Date

Limited Scope Source Removal/Groundwater Profile 31-Aug-16

Groundwater Sampling Report 7-Oct-16

Limited Scope Source Removal Report 7-Feb-17

>ice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

Completion of limitedscope source removal, groundwater profiling, MWinstallation, IDW sampling, management and disposal; submittalof IDW manifest and MW installation log(s) (Subtasks2.3&6)

$60,581.53

Completion of groundwater sampling; approval of the Groundwater Sampling Report and Limited Scope Source Removal Report (Subtasks 1.4 & 5)

$13,028.63

TOTAL COST $73,610.16

BWCTAFORM2/03