CN-370000-HW682-DC20ACO1.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.

DC020A 1 HW682

Karlee Fowler 850-245-8944 Contractor Contractor

Contractor Contractor

Contractor

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

ERIC_4545

Koretizing Cleaners I

✔ $ 7,009.98 $ 7,009.98

$ 7,009.98 $ 7,009.98 Completion

Completion✔ 06/14/2024 10/25/2024 133

✔ 1 1 1

Environmental Consulting & Technology, Inc.

Mark A. Culbreth

Contract Manager

6/13/2024

Digitally signed by Mark Culbreth Date: 2024.06.13 12:03:50-04'00'Mark Culbreth

Mubeen Darji

Mubeen Darji, P.E. Digitally signed by Mubeen Darji, P.E.

Date: 2024.06.13 08:47:30 -04'00'

This change order authorizes a no cost time extension to allow time for additional sampling to occur.

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

DC020A

$ 7,009.98

Annual NAM Report

IDW Manifest; Project Management

Upon Submittal and FDEP Approval of Annual NAM Report

Upon Submittal and FDEP Approval of IDW Manifest; Project Management

08/30/2024

08/30/2024

$ 886.56

$ 6,123.42

Fowler_K Cross-Out

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

To:

From:

Date:

HW682 Contract Negotiation File Koretizing Cleaners I Jacksonville, Duval County

ERIC_4545

Karlee Fowler, Project Manager June 11, 2024

Subject: Negotiation Summary

HW682 DC020A-1

This Task Assignment Change Order authorizes a no cost time extension to allow for additional sampling to occur.

The FDEP Project Manager agrees to the scope of work and final cost associated with this Task Assignment. The final cost for this Task Assignment is $7,009.98 with 39 labor hours.

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

DC020A June 14, 2024

This Task Assignment authorizes ECT to perform annual groundwater monitoring in accordance with the attached Scope of Work and Cost Estimate.

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

Mark A. Culbreth 813-289-9338

ERIC_4545

1438 Edgewood Avenue West, Jacksonville, Duval County

Koretizing Cleaners I

$ 7,009.98

$ 7,009.98

Scope of Work

Environmental Consulting and Technology, Inc. (ECT)

Gregory L. Sattler

Contract Manager

Kelly Crain Digitally signed by Kelly Crain Date: 2023.09.08 16:51:38 -04'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WC TAFORM

Contract Number:

Task Assignment #:

Deliverables:

Invoice Schedule:

TOTAL COST