CN-370000-HW682-DC13ACO1.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.

DC013A 1 HW682

This Task Assignment Change Order will change the Project Name and Project Number only.

Ginger Shirah 850-245-8899 Contractor Contractor

Contractor Contractor

Contractor

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

ERIC_5377

Southside Cleaners-Launderers

$ 0.00 $ 0.00 ✔ Completion

Completion 0

1 1

Mark A. Culbreth

Vice President

3/31/2023

Digitally signed by Mark Culbreth DN: CN=Mark Culbreth, E=mculbreth@ectinc.com Reason: I am approving this document with my legally binding signature Location: your signing location here Date: 2023.03.31 14:47:18-04'00' Foxit PhantomPDF Version: 10.1.6

Mark Culbreth

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2023.03.30 14:38:34 -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

HW682

DC013A

$ 5,000.00

Site Assessment Work Plan; Project Management

Subtasks 1 & 2: Upon submittal and FDEP approval of the Site Assessment Work Plan; Project Management

04/10/2023

$ 5,000.00

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 Southside Cleaners-Launderers Lakeland, Polk County

ERIC_5377

Ginger Shirah, Project Manager March 17, 2023

Subject: Negotiation Summary

HW685 DC013A-01

This Task Assignment Change Order changes the Project Name and Project Number only. Previously, the name was Miramar Cleaners and the number was ERIC_4517. This change order changes the Project Name to Southside Cleaners- Launderers and the Project Number to ERIC_5377.

There is no cost change associated with this change order.

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

DC013A Completion May 15, 2023

This Task Assignment authorizes Environmental Consulting and Technology, Inc. to generate a Site Assessment Work Plan for the Cleaners site located in

, FL in accordance with the attached Site Assessment Work Plan Task List.

Ginger Shirah (850) 245-8899 Contractor Environmental Consulting and Technology, Inc. (ECT) Contractor

Contractor Mark A. Culbreth Contractor 813-289-9338

ERIC_4517

4448 Hendricks Ave, Jacksonville, Duval County, Florida

Miramar Cleaners

Contractor Contractor

✔ $ 5,000.00

$ 5,000.00

Scope of Work

Environmental Consulting and Technology, Inc. (ECT Contractor

Contract Manager

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.03.07 10:06:58 -05'00'

N/A

Digitally signed by Mark Culbreth DN: CN=Mark Culbreth, E=mculbreth@ectinc.com Reason: I am the author of this document Location: your signing location here Date: 2023.03.07 16:39:31-05'00' Foxit PhantomPDF Version: 10.1.6

Mark Culbreth

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

Site Assessment Work Plan; Project Management 04/10/2023

Subtasks 1 & 2: Upon submittal and FDEP approval of the Site Assessment Work Plan; Project Management $ 5,000.00

$ 5,000.00

HW682

DC013A