CN-370000-HW683-DC01ACO2.pdf

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Attached to
Master Agreement FL|HW683|90e8124b5a65e607dedb86d39c72016e
Contract number
HW683
Issued by
Florida

About this file

This document set comprises a Task Assignment (TA) and related Task Assignment Change Orders (TACOs) between the State of Florida Department of Environmental Protection (FDEP) and Geosyntec Consultants for environmental response and assessment services under Contract Number HW683. The contract authorizes Geosyntec to address critical issues at Waste Site Cleanup Section sites on an as-needed basis, with work performed across multiple project locations in Florida, including sites in Tampa Bay and Paines Prairie State Park. The contract is managed by FDEP Project Manager Brittany Plyler (later Evan Miller) and Geosyntec Contract Manager Todd K. Kafka.

The initial Task Assignment (DC001A) established a fixed unit rate compensation structure with a total value of $2,500.00 for documentation of completed site activities. Two subsequent TACOs increased the compensation: TACO 1 (dated March 1, 2022) increased the total TA value to $12,677.66 to reconcile Work Change Directive 1 for soil sample analysis, and TACO 2 (dated October 26, 2023) increased the value to $16,530.02 to reconcile Work Change Directive 2 for multiple site visits following Hurricane Idalia in August 2023. The work involved 27 labor hours and included soil analytical data, sampling summaries, project management, and post-hurricane photo documentation of six Tampa Bay sites and Paines Prairie State Park. Deliverables were scheduled through December 22, 2026, with invoicing contingent upon FDEP receipt and approval of analytical data and photographic documentation.

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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.

DC001A 2 HW683

This Task Assignment Change Order reconciles WCD 2 for multiple site visits to determine if any impacts had occurred following the passage of Hurricane Idalia in late August 2023.

Brittany Plyler 850-245-8851 Contractor Contractor

Contractor Contractor

Contractor

Geosyntec Todd Kafka 813-379-4396

Multiple

Critical Response

✔ $ 16,530.02 $ 12,677.66

$ 16,530.02 $ 12,677.66 ✔ Completion

Completion 0

✔ 1 1 2

Geosytec

Todd Kafka

Contract Manager

Todd Kafka, P.G. Digitally signed by Todd Kafka, P.G.

Date: 2023.10.26 16:54:56 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.10.26 16:43:50 -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

HW683

DC001A

$ 16,530.02

Documentation of completed site activities

Subtask 1,2- Soil Analytical Data and Soil Sampling Summary; Project Management

Subtask 3: Post Hurricane Idalia Photo Documentation

Documentation of completed site activities

Subtask 3: Post Hurricane Idalia Photo Documentation

Subtask 1,2- Soil Analytical Data and Soil Sampling Summary; Project Management

12/22/2026

03/22/2022

09/01/2023

$ 10,177.66

$ 2,500.00

$ 3,852.36

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

To: HW683 Contract Negotiation File Critical Response Multiple ERIC_Mutiple

From: Brittany Plyler, Project Manager Date: October 26, 2023 Subject: Negotiation Summary

HW683_DC01A-2

This Task Assignment Change Order reconciles WCD 2 for multiple site visits to determine if any impacts had occurred following the passage of Hurricane Idalia in late August 2023.The total increase is $3,852.36, with 27 labor hours.

Geosyntec confirmed on October 26, 2023, that Subtask 1 consists of the calculated project management labor, based upon 13% of the direct labor costs in this proposal, and includes fringe, overhead, other direct costs (ODCs) and completion fees.

Subtask 3: WCD 2 was used for Geosyntec to visit 6 sites in Tampa Bay, and a site in Micanopy following Hurricane Idalia. The site visits included an inspection of the property, any IDW containers, remediation systems, or monitoring equipment.

The FDEP Project Manager agrees to the scope of work and final cost associated with this TACO. The final cost is for this TACO is $16,530.02.

FDEP COST ESTIMATEContractor: Geosyntec Consultants

Date: 10/16/2023

Task #: DC001A SubTask 1 Project Management SubTask 6

Site: multiple SubTask 2 Hurricane Idalia storm visits SubTask 7

Activity/Phase: SubTask 3 SubTask 8

Project Manager: Cain SubTask 4 SubTask 9

SubTask 5 SubTask 10

Totals 1 2 3 4 5 6 7 8 9 10 Labor Rate Category

$49.04 Project Manager O.Cain 3 2.8 $86.54 Principal T. Kafka 3 3 0 0 0 0 0 0 0 0 $49.76 Senior Professional B. Dawson 2 2 0 0 0 0 0 0 0 0 $49.04 Project Professional O. Cain 1 1 0 0 0 0 0 0 0 0 $45.19 Professional F. Fortes 1 1 0 0 0 0 0 0 0 0 $37.02 Senior Staff Professiona K. Pierce 8 8 0 0 0 0 0 0 0 0 $33.41 Staff Professional D. McGill 7 7 0 0 0 0 0 0 0 0 $29.35 Administrative Assistant T. Hampton 2 2 0 0 0 0 0 0 0 0

Total Hours 27 3 24 0 0 0 0 0 0 0 0

Direct Labor $1,177.57 $135.47 $1,042.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Overhead 172.70% $2,033.67 $233.96 $1,799.71 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Gen & Admin 0.00% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fringe 0.00% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Labor $3,211.24 $369.43 $2,841.81 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Travel Vehicle Rental $240.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Mileage Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Air Fare $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Per diem + Hotel $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Travel $240.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor (Equipment Procurement) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor Subtotal $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Procurement Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Subcontractor Cost $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TACO-1 Page 1 of 3 TACO-1

FDEP COST ESTIMATEContractor: Geosyntec Consultants

Date: 10/16/2023

Task #: DC001A SubTask 1 Project Management SubTask 6

Site: multiple SubTask 2 Hurricane Idalia storm visits SubTask 7

Activity/Phase: SubTask 3 SubTask 8

Project Manager: Cain SubTask 4 SubTask 9

SubTask 5 SubTask 10

Totals 1 2 3 4 5 6 7 8 9 10 Subcontractor (Services Procurement)

Drilling (Conventional) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Drilling (Non-conventional) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Mobile Laboratory $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Surveying $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

IDW $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Utilities $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor Subtotal $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Handling Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Subcontractor Cost $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Laboratory Analytical Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fast Turnaround Charges $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Sample Shipping $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Laboratory $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Field Expenses Personal Protection $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Expendables $80.00 $80.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Drilling related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Analytical related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (IDW related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Other) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Field Expenses $80.00 $80.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subtotal $3,531.24 $369.43 $3,161.81 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Completion Fee $321.12 $36.94 $284.18 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Total Estimated Cost $3,852.36 $406.37 $3,445.99 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TACO-1 Page 2 of 3 TACO-1

LEVEL OF EFFORT/EXPENSE WORKSHEET

SITE : multiple SUBTASK: Hurricane Idalia storm visits

DATE: ########

LABOR CATEGORY

STAFF-TITLE HOURS

Principal T. Kafka 3

Senior B. Dawson 2

Project Prof O. Cain 1

Professional 1 F. Fortes

Senior Staff Professional K. Pierce 8

Staff Professional D. McGill 7

Drafter/CADD Operator

Administrative Assistant T. Hampton 2

TOTAL LABOR 24

VEHICLE TYPE RATE UNIT USEAGE

Car $80.00 Day $0.00 Truck $120.00 Day 2 $240.00 Van $120.00 Day 0 $0.00

Subtotal $240.00

Mileage $0.59 Mile 0 $0.00 Subtotal $0.00

Air Fare $0.00 Round Trip 0 $0.00 Subtotal $0.00

TOTAL VEHICLE $240.00

PER DIEM STAFF RATE UNIT USEAGE

TOTAL PER DIEM $0.00

SUBCONTRACTOR COSTS

TOTAL SUB $0.00

LABORATORY COSTS

TOTAL LAB $0.00

EQUIPMENT ITEM RATE COSTING UNIT USEAGE TOTALS

Expendables

$40.00 Day 2 $80.00 Subtotal $80.00

TOTAL EQUIPMENT $80.00

*PROVIDE TIME REQUIRED FOR EACH PERSON

WORK DESCRIPTION

review/submit final deliverables for all site visits field notification and review photo logs for PPSP field notification for 3 of TB sites field notification for 3 of TB sites

Visit 6 TB sites and photo log

PPPSP site visit and photo log compile pdfs for sites

10/23/2023 Page 3 of 3 CO ST 2

Site Name: Site ID #:

Contract #: Contractor:

• Reason for Work Change Directive :

• Description of Work Change Directive :

• Attachments (if applicable, list documents supporting change):

• Costs (if negotiated unit costs, provide information below):

WCP WCD 07-2018

Authorized Contractor Signature:

Authorized FDEP Signature:

WORK CHANGE DIRECTIVE FORM

FDEP Supervisor Approval:

(if applicable)

Additional work is not authorized without prior FDEP approval as indicated by an approved Work Change Directive Form or Task Assignment Change Order Form. It is the Contractor's responsibility to ensure that additional costs associated with this WCD are resolved by a Task Assignment Change Order (TACO) prior to the completion date of the original Task Assignment or subsequent TACOs completed prior to the execution date of this WCD. Failure to do so will result in a loss of reimbursement for work associated with this WCD.

Task Assignment #: Work Change Directive #:

Maximum Estimated Increase in Task Amount:

Critical Reponse

HW683 Geosyntec

DC001A

visit 6 Tampa Bay sites and Paines Prairie SP to document if flooding has affected sites labor to visit sites and prepare photo logs for FDEP

$ 4,000.00

Todd Kafka, P.G.

Digitally signed by Todd Kafka, P.G.

Date: 2023.09.01 12:24:37 -04'00'

Kelly Crain Digitally signed by Kelly Crain Date: 2023.09.01 13:04:02 -04'00'

Kelly Crain Digitally signed by Kelly Crain Date: 2023.09.01 13:04:10 -04'00'

12802 Tampa Oaks Boulevard, Suite 151 Tampa, Florida 33637

PH 813.558.0990

www.geosyntec.com

25 October 2023

Ms. Brittany Plyler Florida Department of Environmental Protection 2600 Blair Stone Road Tallahassee, FL 32399-2400

Subject: Scope of Work/Level of Effort Hurricane Idalia Site Visits

DC001A – TACO #1

Dear Ms. Plyler, As requested by FDEP, Geosyntec conducted multiple site visits to determine if any impacts had occurred following the passage of Hurricane Idalia in late August 2023. Geosyntec received an approved Work Change Directive from FDEP on September 1, 2023 in the amount of $4,000 to conduct these tasks

A summary of the scope of work and costs associated with TACO #1 is provided below in red text.

Subtask 1 – Project Management

Subtask 2 – Post Storm Visits

Geosyntec personnel visited 6 sites in Tampa Bay following the passage of Idalia: Musselman Steel (ERIC_3898), Gentle Touch Cleaners (ERIC_4712), Former Peacock Dry Cleaners (ERIC_5330), Former Scott’s Northwoods Cleaners (ERIC_5307), Former Pelican Dry Cleaners (ERIC_5292), and Former Trophy Cleaners (ERIC_5301). The site visits included an inspection of the property, any IDW containers, remediation systems, or monitoring equipment. Geosyntec personnel also visited Paines Prairie State Park (Micanopy, FL) to inspect and photodocument site conditions related to backfill material and runoff of a recent soil excavation. Our labor included field notifications to owners and tenants, mobilization, on-site inspection, photodocumentation, and preparing a photolog for FDEP as a deliverable submitted on 9/5/23.

Ms. Brittany Plyler 25 October 2023

Deliverable and Invoicing Schedule:

The WCD #1 total is $3,852.36, below the approved total of $4,000. The TACO #1 increase is $3,852.36.

Subtask Deliverable Deliverable Due Date Invoice Amount

1, 2 Hurricane Idalia Photo log 9/5/23 $3,852.36

Period of Performance 29 December 2023

Total: $3,852.36

As always, it is a pleasure to work with the FDEP. If you require any additional information or have any questions, please contact me at 813.379.4396.

Sincerely, Todd K. Kafka, P.G.

Sr. Principal Hydrogeologist

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.

DC001A 1 HW683

This task assignment change order reconciles work change directive 1 for soil sample analysis.

Evan Miller 850-245-8928 Contractor Geosyntec Contractor

Contractor Todd Kafka Contractor 813-379-4396 Multiple

Multiple

✔ $ 10,177.66 $ 2,500.00

$ 10,177.66 $ 2,500.00 ✔ Completion

Completion 0

✔ 1 1 1

Contractor Todd Kafka

Contract Manager

3-1-22

Todd Kafka, P.G. Digitally signed by Todd Kafka, P.G.

Date: 2022.03.01 15:00:18 -05'00'

William E. Burns, Jr.

William E. Burns, Jr. Digitally signed by William E. Burns, Jr.

Date: 2022.03.01 14:42:44 -05'00'

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW683

DC001A

$ 12,677.66

Subtask 1,2- Soil Analytical Data and Soil Sampling Summary/Project Management

Documentation of completed site activities

Subtask 1,2- FDEP receipt and approval of Soil Analytical Data and Soil Sampling Summary/Project Management

Receipt and approval of documentation of completed site activities

03/31/2022

12/22/2026

$ 2,500.00

$ 10,177.66

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.

HW683

DC001A December 22, 2026

This Task Assignment authorizes Geosyntec Consultants (GEO) to address critical issues at Waste Site Cleanup Section sites on an as needed basis in accordance with a request from the Waste Site Cleanup Section.

Evan Miller 850-245-8928 Geosyntec Consultants

Todd K. Kafka 813-379-4396

Multiple

Multiple

Multiple

$ 0.00

$ 2,500.00

$ 0.00

$ 2,500.00

Scope of Work

Geosyntec Consultants

Todd K. Kafka

Contract Manager

Todd Kafka, P.G. Digitally signed by Todd Kafka, P.G.

Date: 2022.01.04 08:47:04 -05'00'

William E. Burns Jr.

William E. Burns, Jr. Digitally signed by William E. Burns, Jr.

Date: 2022.01.03 12:04:46 -05'00'

WC TAFORM

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

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