CN-370000-HW680-DC13DC01.pdf

Funding Information:

Org. Code E.O. Object Code Budget Entity Appropriation

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 8/17/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment Change Order This Change Order is entered into between the Parties named below and amends the Task Assignment (TA) and any previous TA Change Orders (TACO) as follows:

1. TA Number: TACO Number: Contract Number:

TACO Description:

2. Parties State of Florida Department of Environmental Protection

(Department)

Department’s Project Manager: Department’s Project Manager Phone:

Contractor Name: (Contractor ) ntractor’st ’s Project Manager: ontractor’s t’s Project Manager Phone:

3. Project Number:

(If different from TA Number)

Project Name:

4. ☐ There are no changes to the TA compensation.

☐ The compensation of the TA is changed to the amounts indicated below:

Amended Price Price Prior to TACO ☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. ☐ There are no changes to the TA Expiration Date.

☐ The TA Completion Date is changed from ______________ to ______________ (a total of ______ days).

6. ☐ There are no changes to the Attachments.

☐ Attachment ___ is replaced with Attachment -____.

7. ☐ No Additional Changes.

☐ Additional Changes:

8. All other terms and conditions of the TA remain in effect. If and to the extent that any inconsistencies may appear between the TA and this TACO, the provisions of this TACO shall control.

IN WITNESS WHEREOF, this TACO shall be effective on the last date signed below.

State of Florida Department of Environmental Protection CONTRACTOR Department Name:

Title:

Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

☐ Additional signatures attached on separate page.

DC013D 1 HW680

This change order authorizes a time extension of sixty days for review and approval.

Theresa Pepe 850-245-8966 Contractor Contractor

Contractor Contractor

Contractor

Arcadis U.S. Inc.

Gus Suarez 813-205-4703

ERIC_4824

Donna's Cleaners

$ 0.00 $ 0.00 Completion

Completion✔ 01/26/2024 03/26/2024 60

✔ 1 1 1

Arcadis U.S. Inc.

Gus Suarez

Contract Manager

Gus Suarez, P.E. Digitally signed by Gus Suarez, P.E.

Date: 2024.01.26 09:51:18 -05'00'

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2024.01.26 09:38:15 -05'00'

N/A

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

HW680

DC013D

$ 20,423.02

Groundwater Monitoring Event

Annual Monitoring Report/IDW manifest/Project Management

FDEP approval of Groundwater Monitoring Event

FDEP approval of Annual Monitoring Report/IDW manifest/Project Management

10/06/2023

01/19/2024

$ 8,373.62

$ 12,049.40

FLORIDA DEPARTMENT OF

Environmental Protection

Bob Martinez Center

2600 Blair Stone Road Tallahassee, FL 32399-2400

Ron DeSantis Governor

Jeanette Nuñez

Lt. Governor

Shawn Hamilton Secretary

Memorandum

TO: Negotiation File Donna’s Cleaners Facility ID No. 35-9502053; ERIC_4824 Leesburg, Lake County FROM: Theresa C. Pepe, Project Manager SUBJECT: Task Assignment Change Order DC013D-1 (HW680) DATE: January 24, 2024

Arcadis has submitted the final deliverable. A time extension of sixty days will allow for review and approval of the deliverable. It will also allow time for a teleconference between FDEP and Arcadis to discuss a path forward for remediation at the site.

This change order adds sixty days to the completion date. There is no cost change to the task assignment. Arcadis may invoice according to the attached schedule.

Funding Information:

Org. Code E.O. Object Code Budget Entity Appropriation

Category Grant # Project # Year Amount

Additional Funding Information attached on separate page.

Rev. 8/26/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment This Task Assignment (TA) is entered into between the Parties named below, pursuant to Contract Number: .

1. TA Number: TA Completion Date:

TA Description:

2. Parties State of Florida Department of Environmental Protection (Department)

Department Project Manager: Department Project Manager Phone:

Contractor Name: (Contractor ) ntractor’st ’s Project Manager: ontractor’s t’s Project Manager Phone:

3. Project Number:

(If different from TA Number)

Project Location(s):

Project Name:

4. As consideration for the services rendered by Contractor under the terms of this TA, the Department shall pay the Contractor on the following bases, up to the Total TA Value as indicated below:

Fixed Price:

Fixed Unit Rate: (Extended Price)

Cost Reimbursement:

Total TA Value:

5. The Parties agree to comply with the terms and conditions of the underlying the Contract, and the following attachments which are hereby incorporated by reference:

Attachment 1:

Additional Attachments (if necessary):

IN WITNESS WHEREOF, this TA shall be effective on the last date signed below.

State of Florida Department of Environmental Protection

CONTRACTOR Department Name:

Title: Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

Additional signatures attached on separate page.

HW680

DC013D Completion January 26, 2024

Arcadis will conduct annual groundwater monitoring from select wells at the site. All activities will be performed according to the September 8, 2023, Work Plan submitted by Arcadis.

Theresa Pepe 850-245-8966 Contractor Arcadis U.S. Inc. Contractor

Contractor Gus Suarez Contractor 813-205-4703

ERIC_4824

1421 W. Main Street, Leesburg, Lake County

Donna's Cleaners

Contractor Contractor

✔ $ 20,423.02

$ 20,423.02

Scope of Work

Arcadis U.S. Inc.

Contractor Gus Suarez

Contract Manager

Gus Suarez, P.E. Digitally signed by Gus Suarez, P.E.

Date: 2023.09.14 15:27:50 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.09.14 13:59:33 -04'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WC TAFORM

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

Groundwater Monitoring Event 10/06/2023

Annual Monitoring Report/IDW manifest/Project Management 12/08/2023

FDEP approval of Groundwater Monitoring Event $ 12,049.40

FDEP approval of Annual Monitoring Report/IDW manifest/Project Management $ 8,373.62

$ 20,423.02

HW680

DC013D