CN-370000-HW682-DC04BCO1.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.

DC004B 01 HW682

This Task Assignment Change Order authorizes a date extension due to delays in obtaining site access and the need to conduct additional sampling.

Ginger Shirah 850-245-8899 Contractor Contractor

Contractor Contractor

Contractor

Environmental Consulting and Technology, Inc. (ECT) Mark A. Culbreth 813-289-9338

ERIC_4775

Victorian Cleaners

$ 0.00 $ 0.00 Completion

Completion✔ 06/23/2023 10/23/2023 122

1 1

Mark A. Culbreth

Vice President

6/20/2023

Digitally signed by Mark Culbreth Date: 2023.06.20 10:51:25-04'00'Mark Culbreth

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2023.06.20 10:29:35 -04'00'

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

HW685

DC012B

$ 71,711.66

GPR Survey and Field notes (Subtask 2)

DPT Soil and Groundwater Sampling Field Notes (Subtask 3)

Well Installation and Groundwater Sampling Field Notes (Subtask 4)

MAGS Field Notes (Subtask 5)

IDW Manifests and PLS (Subtask 6 and 7)

Site Assessment Report and PM (Subtask 8 and 1)

Approval of GPR Survey and Field notes (Subtask 2)

Approval of Well Installation and Groundwater Sampling Field Notes (Subtask 4)

Approval of MAGS Field Notes (Subtask 5)

Approval of Site Assessment Report and PM (Subtask 8 and 1)

Approval of IDW Manifests and PLS (Subtask 6 and 7)

Approval of DPT Soil and Groundwater Sampling Field Notes (Subtask 3)

12/30/2022

06/30/2023

07/14/2023

07/31/2023

09/29/2023

08/31/2023

$ 30,957.79

$ 3,242.13

$ 19,642.07

$ 4,840.91

$ 6,625.85

$ 6,402.91

Printed on recycled paper.

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

From:

Date:

To: HW682 Contract Negotiation File Victorian Cleaners Tampa, Hillsborough County

ERIC_4775

Ginger Shirah, Project Manager June 19, 2023

Subject: Negotiation Summary

HW682 DC004B-01

This Task Assignment Change Order provides a time extension that is necessary due to a delay in obtaining site access as well as additional sampling that needed to be performed.

The task assignment completion date has been extended to October 23, 2023.

There is no change in cost associated with this change order. The FDEP project manager agrees to the scope of work and final cost associated with this Task Assignment that was previously approved. The final cost for this Task Assignment is $71,711.66 with 238 total labor hours.

Shirah, Ginger K

From: Mark Culbreth <mculbreth@ectinc.com> Sent: Monday, June 19, 2023 11:16 AM To: Shirah, Ginger K Subject: Victorian Cleaners: TACO - Extension of Time to Complete Task Assignment

EXTERNAL MESSAGE

This email originated outside of DEP. Please use caution when opening attachments, clicking links, or responding to this email.

Ginger, ECT was issued Task Assignment DC004B to conduct the site assessment at Victorian Cleaners. The Task Assignment is June 23, 2023. ECT would like to request an extension of the CompleƟon date to October 23, 2023. The need for the CompleƟon date extension was due to difficulƟes in obtaining access to the site and the need to conduct addiƟonal sampling.

Please let me know if you have any quesƟons regarding this request.

Thank you

Mark A. Culbreth, P.G. (Florida) Vice President | Site Assessment & Remediation

Environmental Consulting & Technology, Inc.

1408 North Westshore Blvd. Suite 115 | Tampa, Florida 33607 813-725-5950 (Direct) | 813-382-8953 (Mobile) mculbreth@ectinc.com | www.ectinc.com

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.

HW682

DC004B Completion June 23, 2023

This Task Assignment authorizes ECT to to conduct site assessment activities at the Victorian Cleaners site located in Tampa, Florida. All work will be conducted in accordance with the scope of work and cost proposal submitted on October 13, 2022.

Kelly Crain 850-245-8953 Contractor Environmental Consulting and Technology, Inc. (ECT) Contractor

Contractor Mark A. Culbreth Contractor 813-289-9338

ERIC_4775

4920 NEWKIRK DR #10, Tampa, Hillsborough County

VICTORIAN CLEANERS

Contractor Contractor

✔ $ 71,711.66

$ 71,711.66

Select One

Environmental Consulting and Technology, Inc. (ECT Contractor Mark A. Culbreth

Contract Manager Digitally signed by Mark Culbreth DN: CN=Mark Culbreth, E=mculbreth@ectinc.com Reason: I am approving this document Location: your signing location here Date: 2022.11.02 14:57:17-04'00' Foxit PhantomPDF Version: 10.1.6

Mark Culbreth

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2022.11.02 14:48:07 -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

GPR Survey and Field notes (Subtask 2) 12/30/2022

DPT Soil and Groundwater Sampling Field Notes (Subtask 3) 03/01/2023

Well Installation and Groundwater Sampling Field Notes (Subtask 4) 04/01/2023

MAGS Field Notes (Subtask 5) 04/30/2023

IDW Manifests and PLS (Subtask 6 and 7) 05/10/2023

Site Assessment Report and PM (Subtask 8 and 1) 05/30/2023

Approval of GPR Survey and Field notes (Subtask 2) $ 3,242.13

Approval of DPT Soil and Groundwater Sampling Field Notes (Subtask 3) $ 30,957.79

Approval of Well Installation and Groundwater Sampling Field Notes (Subtask 4) $ 19,642.07

Approval of MAGS Field Notes (Subtask 5) $ 4,840.91

Approval of IDW Manifests and PLS (Subtask 6 and 7) $ 6,625.85

Approval of Site Assessment Report and PM (Subtask 8 and 1) $ 6,402.91

$ 71,711.66

HW682

DC004B