CN-370000-HW556-BF561A.pdf

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

HW556

SRPPM SRP18BF561A

Cardno

Bruce Moore, P.G. Phone#: (850) 385-8232

(850) 245-8765Carrie K. Kruchell, P.G.

Folio#s 035741-0000 and 35742-0000

UACDC - Group B Sites 4 & 5

13612 & 13608 N. 20th Street Tampa, Hillsborough County

Phase 1 Environmental Site Assessments (ESAs)

The Department approves this Task Assignment (TA) based upon the Cost Proposal and Level of Effort (CP/LOE) submitted to the Department on 12/13/18, with revisions through 12/19/18, by Cardno. Two Phase I ESAs will be conducted by Cardno in accordance with ASTM Standards for UACDC Group B parcel Sites 4 & 5. The final deliverable will be the Phase I ESA Reports.

Phase I ESA Report

02/20/2019

04/30/2019

$ 3,193.04 $ 0.00 $ 0.00 $ 0.00

$ 0.00

Jim Mccarthy Digitally signed by Jim Mccarthy Date: 2018.12.21 09:58:17 -05'00'

Carrie Kruchell Digitally signed by Carrie Kruchell Date: 2018.12.21 10:02:37 -05'00'

Jennifer Farrell Digitally signed by Jennifer Farrell Date: 2018.12.21 12:43:33 -05'00'

W. Bruce Moore, P.G. Digitally signed by W. Bruce Moore, P.G.

Date: 2019.01.02 09:55:55 -05'00'

$ 3,193.04

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 04-2017

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

Site Visit field notes and copy of EDR Radius Report 02/01/2019

Final Phase I ESA Reports for Group B, Sites 4 & 5 02/20/2019

Department approval of field notes and EDR Radius Report, Subtask 2 $ 633.88

Department approval Final Phase I ESA Report for Group B, Sites 4 & 5 $ 2,559.16

$ 3,193.04

HW556

BF561A