CN-370000-HW681-DC06BCO3.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.

DC006B 3 HW681

This Task Assignment Change Order is for a time extension to complete the Interim Source Removal Plan (ISRP) pending DEP comments on the Supplemental Soil Assessment Report (SSAR) that are needed to inform the ISRP.

Aaron Cohen 850-245-8974 Contractor CDM Smith Inc. Contractor

Contractor Shayne Wood Contractor 904-527-6703

ERIC_4671

Jasper Laundry & Cleaners

✔ $ 0.00 $ 0.00

$ 0.00 $ 0.00 ✔ Completion

Completion 11/30/2023 03/29/2024 120

✔ 1 1 2

CDM Smith Inc.

Contractor Shayne Wood

Vice President

11/27/2023

Shayne Wood Digitally signed by Shayne Wood DN: C=US, E=woodsh@cdmsmith.com, O=CDM Smith, OU=NAU, CN=Shayne Wood Date: 2023.11.27 17:21:32-05'00'

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.11.27 15:15:30 -05'00'

11/27/2023

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW681

DC006B

$ 157,367.97

Supplemental Soil Assessment Report (SSAR)

Groundwater Sampling - Updated Tables, Field Notes, and Laboratory Analytical Report

Revised ISRP

Subtasks 1 and 2: FDEP Review and approval of Supplemental Soil Assessment Report, and Project Management

Subtask 4: FDEP Review and approval of Revised ISRP

Subtask 3: FDEP Review and approval of Groundwater Sampling - Updated Tables, Field Notes, and Laboratory Analytical Report

08/30/2023

08/30/2023

01/31/2024

$ 35,293.91

$ 104,658.16

$ 17,415.90

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.

DC006B 2 HW681

This Task Assignment Change Order is to reduce subcontractor costs.

Kyle McMurray 850-245-8973 CDM Smith Inc.

Shayne Wood 904-527-6703

ERIC 4671

Jasper Laundry & Dry Cleaners

$ 157,367.97 $ 159,908.97

$ 157,367.97 $ 159,908.97

1 1 1

CDM Smith Inc.

Shayne Wood

CDM Contract Manager

10/16/2023

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.10.12 15:36:04 -04'00'

10/12/23

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

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.

DC006B 1 HW681

This Task Assignment Change Order tasks CDM with sourcing the soil and groundwater PFAS analyses to a private lab (AEL).

Kyle McMurray 850-245-8973 Contractor CDM Smith Inc. Contractor

Contractor Shayne Wood Contractor 904-527-6703

ERIC 4671

Jasper Laundry & Dry Cleaners

$ 159,908.97 $ 128,734.39

$ 159,908.97 $ 128,734.39 Completion

Completion 0

1 1 1

CDM Smith Inc.

Contractor Shayne Wood

CDM Contract Manager

6/27/2023

Shayne Wood Digitally signed by Shayne Wood DN: C=US, E=woodsh@cdmsmith.com, CN=Shayne Wood Date: 2023.06.27 15:49:24-04'00'

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.06.27 13:57:00 -04'00'

6/27/2023

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW681

DC006B

$ 159,908.97

Supplemental Soil Assessment Report

Groundwater Sampling - Updated Tables, Field Notes, and Laboratory Analytical Report

Revised ISRP

Subtasks 1 and 2: FDEP Review and approval of Supplemental Soil Assessment Report, and Project Management

Subtask 4: FDEP Review and approval of Revised ISRP

Subtask 3: FDEP Review and approval of Groundwater Sampling - Updated Tables, Field Notes, and Laboratory Analytical Report

08/30/2023

08/30/2023

09/30/2023

$ 35,293.91

$ 107,199.16

$ 17,415.90

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.

HW681

DC006B November 30, 2023

CDM Smith Inc. will conduct supplemental soil sampling, groundwater sampling, and prepare a revised ISRP for the Jasper Laundry & Dry Cleaning site located in Jasper, Florida. All work will be conducted in accordance with the scope of work and cost proposal submitted on March 15, 2023.

Kyle McMurray 850-245-8973 CDM Smith Inc.

Shayne Wood 904-527-6703

ERIC_4671

214 1st Ave SW, Jasper, Hamiltion County, Florida

Jasper Laundry & Dry Cleaners

$ 128,734.39

$ 128,734.39

Scope of Work

CDM Smith Inc.

Shayne Wood

Vice President

6/5/2023

Teresa Booeshaghi

Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2023.06.05 11:01:57 -04'00'

6/5/23

WC TAFORM

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST