TASK ASSIGNMENT NOTIFICATION CHANGE ORDER FORM

DEP CONTRACT NO. HW553

Task Assignment #:

Contractor Name;

BF005B Change Order No.;

Ecology and Environment, Inc.

Contractor Representative; Richard Stephens

DEP Contract Manager; Justin Cross Site Name: Corner of Spring and Garden Street (Escambia County School District) Site ID/Facility ID:: COM 334397

Phone#; 850/245-8968

Description ofChange [use additional pages if necessary];

This change order will extend the deliverable due dates for Subtasks 2and 3due to issues discovered during the original removal. This change order will not extend the task assignment due date.

The Deliverable and Invoice Schedule is attached.

Final Deliverable: ISR - Limited Scope Source Removal (LSSR) Final Deliverable Due Date: 8/4/2017

TASK ASSIGNMENT TYPEAND NOTTO EXCEED AMOUNTS:

ITEM FIXED PRICE FEE SCHEDULE

COST PLUS FIXED FEE

TOTAL

Cost Reimbursement Fixed Fee

Original Task Amount $73,223.75 $0.00 $0.00 $0.00 $73,223.75 Task Amount Prior to this

Chanae Order $73,223.75 $0.00 $0.00 $0.00 $73,223.75 Net Incrcase/dccrease in task amount $0.00 $0.00 $0.00 $0.00 $0.00

Task amount with all change orders $73,223.75 $0.00 $0.00 $0.00 $73,223.75

CHANGE IN TASK TIME

Original Task Completion Date:

Completion Date Prior to this Change;

Net Increase/Decrease in Task Period:

Completion Date wl^aj^hange Orders:

DEP Task Manager:

DEP Contract Manager: ^ Contractual Authority:

Contractor Representative: /jj

CO ProcurementSection (MS 93) Section Representative

9/30/2017

9/30/2017

N/A

9/30/2017

Date: ^/^^J'7 Date: 7/^//'7 Date: Tf j C?

Date:

WCP TAFORM 04/14

Deliverables:

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

Contract Number:

Task Assignment #;

Change Order #:

HW553

BF005B

Field notes, photo log, daily status reports to evidence oversight of source removal 9-Jun-17 Backfilland waste profile sample laboratory tinal report(s), final waste manifests, backfillweigh tickets, compaction test results, 4-Aug-17

Limited Scope Source Removal Report 4-Aug-17 ice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

FDEP approval of the Limited Scope Source Removal Letter Report (Subtasks 1 &4) $3,196.21

FDEP approval of field notes, photo log, daily status reports to evidence oversight of source removal $8,398.04

FDEPapproval of backfill and waste profilesample laboratory final report(s), final waste manifests, backfill weigh tickets, compaction test results, permits (if required), confirmation sample

$61,629.50

TOTAL COST $73,223.75

BWC TAFORM 2/03