CN-370000-HW683-DC023A.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. 8/26/2020

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

DC023A Completion November 30, 2022

This Task Assignment authorizes Geosyntec to prepare a Site Rehabilitation Completion Report (SRCR) for the Fulmers Cleaners site in accordance with the Geosyntec scope of work, cost estimate, and schedule received on 12 September 2022.

Evan Miller 850-245-8928 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Geosyntec

Geosyntec

Ann Sava 727-330-9956

ERIC_4818

716 North 14th Street, Leesburg, Florida

Fulmers Cleaners

✔ $ 2,252.02

$ 2,252.02

Scope of Work

Todd Kafka

Contract Manager

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

Date: 2022.09.22 08:41:15 -04'00'

Jennifer farrell

Digitally signed by Jennifer Farrell Date: 2022.09.21 12:16:56 -04'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 04-2017

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

Subtask 1, 2- Submittal of SRCR; Project Management 10/15/2022

Subtask 1, 2- FDEP receipt and approval of SRCR; Project Management $ 2,252.02

$ 2,252.02

HW683

DC023A

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 Fulmers Cleaners Leesburg, Lake County

ERIC_4818

From: Evan Miller, Project Manager Date: September 13, 2022 Subject: Negotiation Summary

HW683 DC023A

This Task Assignment authorizes Geosyntec to prepare a Site Rehabilitation Completion Report (SRCR) for the Fulmers Cleaners site.

Subtask 1: Project Management An automatic calculation based upon total direct labor hours determines the labor hours within this subtask.

Subtask 2 – Site Rehabilitation Completion Report Geosyntec will prepare a Site Rehabilitation Completion Report documenting that the Site has met the No Further Action Conditions as defined in Chapter 62-780.680, Risk Management Option #1.

The content provided will be consistent with that recommended in Bill Linn’s memorandum dated July 24, 2013 and will include a brief site narrative, conclusion, and recommendation for SRCO.

Figures will include a site map with the designated boundaries of the source area property, maps of sampling locations (soil and groundwater), a groundwater elevation map of relevant aquifers, and a contaminant plume maps. Geosyntec will include the most recent tables containing soil analytical results (and post-remediation confirmatory samples, if relevant) and SCTLs, SPLP results, groundwater results (with GCTL screening), other analytical data (if relevant), monitoring well construction information, and groundwater level data. The analytical laboratory report and chain of custody for the most recent groundwater monitoring event will be attached. The report will be signed and sealed by a Florida-licensed professional engineer or geologist.

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 $2,252.02 with 18 labor hours.

Geosyntec may invoice following the schedule established in the Deliverables and Invoice Schedule Attachment, which accompanies the Task Assignment Notification Form.

Prior to field work, Geosyntec will obtain an updated Access Agreement from the current real property owner of the Fulmers Cleaners (ERIC_4818) site.

FDEP COST ESTIMATEContractor: Geosyntec Consultants

Date: 10/8/2022

Task #: DC015M (pending) SubTask 1 Project Management SubTask 6

Site: Fulmers Cleaners SubTask 2 SRCR SubTask 7

Activity/Phase: HW683 SubTask 3 SubTask 8

Project Manager: A. Sava SubTask 4 SubTask 9

SubTask 5 SubTask 10

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

$38.94 Project Manager A. Sava 2 2.2 $76.92 Principal T. Kafka 1 1 0 0 0 0 0 0 0 0 $46.15 Project Professional M. Hensley 2 2 0 0 0 0 0 0 0 0 $38.94 Professional A Sava 12 12 0 0 0 0 0 0 0 0 $27.88 Administrative Assistant A. Acosta 1 1 0 0 0 0 0 0 0 0

Total Hours 18 2 16 0 0 0 0 0 0 0 0

Direct Labor $750.75 $86.37 $664.38 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Overhead 172.70% $1,296.54 $149.16 $1,147.38 $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 $2,047.29 $235.53 $1,811.76 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Cost Estimate Page 1 of 2 Cost Estimate

FDEP COST ESTIMATEContractor: Geosyntec Consultants

Date: 10/8/2022

Task #: DC015M (pending) SubTask 1 Project Management SubTask 6

Site: Fulmers Cleaners SubTask 2 SRCR SubTask 7

Activity/Phase: HW683 SubTask 3 SubTask 8

Project Manager: A. Sava SubTask 4 SubTask 9

SubTask 5 SubTask 10

Totals 1 2 3 4 5 6 7 8 9 10 Travel

Vehicle Rental $0.00 $0.00 $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 $0.00 $0.00 $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

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

Subtotal $2,047.29 $235.53 $1,811.76 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Completion Fee $204.73 $23.55 $181.18 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Total Estimated Cost $2,252.02 $259.08 $1,992.94 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Cost Estimate Page 2 of 2 Cost Estimate

LEVEL OF EFFORT/EXPENSE WORKSHEET

SITE : Fulmers Cleaners

SUBTASK: SRCR

DATE: 10/8/2022

LABOR CATEGORY *PROVIDE TIME REQUIRED FOR EACH PERSON

STAFF-TITLE WORK DESCRIPTION HOURS

Principal T. Kafka 1

Project Professional M. Hensley 2

Professional A. Sava 12

Administrative Assistant A. Acosta 1

TOTAL LABOR 16

VEHICLE TYPE RATE UNIT USEAGE

TOTAL VEHICLE $0.00

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

TOTAL EQUIPMENT $0.00

report formatting and PDF compilation

Prepare SRCR

Figure Preparation

Preparation of Site Rehabilitation Completion Report

9/13/2022 Page 1 of 1 Subtask 2

12802 Tampa Oaks Blvd., Ste. 151 Temple Terrace, Florida 33637

PH 813.558.0990

www.geosyntec.com

12 September 2022

Mr. Evan Miller Florida Department of Environmental Protection Waste Cleanup Program 2600 Blair Stone Road, MS 4520 Tallahassee, FL 32399-2400

Subject: Scope of Work and Level of Effort Site Rehabilitation Completion Report Fulmers Cleaners 716 North 14th Street, Leesburg, Florida FDEP Facility ID No. ERIC_4818

Dear Mr. Miller:

Geosyntec has prepared this Scope of Work (SOW) and proposed Cost Estimate Form/Level of Effort (CEF/LOE) for preparation of a Site Rehabilitation Completion Report (SRCR) for the Fulmers Cleaners site (Site) located in Leesburg, Florida. A detailed explanation of the proposed report preparation is provided below.

Subtask 1 – Project Management

This subtask covers the general management of the project as specified in Contract No. HW683.

Subtask 2 – Site Rehabilitation Completion Report

Geosyntec will prepare a Site Rehabilitation Completion Report documenting that the Site has met the No Further Action Conditions as defined in Chapter 62-780.680, Risk Management Option #1. The content provided will be consistent with that recommended in Bill Linn’s memorandum dated July 24, 2013 and will include a brief site narrative, conclusion, and recommendation for SRCO. Figures will include a site map with the designated boundaries of the source area property, maps of sampling locations (soil and groundwater), a groundwater elevation map of relevant aquifers, and a contaminant plume maps. Geosyntec will include the most recent tables containing soil analytical results (and post-remediation confirmatory samples, if relevant) and SCTLs, SPLP results, groundwater results (with GCTL screening), other analytical data (if relevant), monitoring well construction information, and groundwater level data. The analytical laboratory report and chain of custody for the most recent groundwater monitoring event will be attached. The report will be signed and sealed by a Florida-licensed professional engineer or geologist.

Mr. Evan Miller 12 September 2022

Fulmers Cleaners_SRCR_SOW_2022

Invoice and Deliverable Schedule:

Subtask Deliverable Deliverable Due Date Invoice Amount

1 & 2 SRCR 15 October 2022 $2,252.02

Period of Performance 30 November 2022

Total: $2,252.02

We appreciate the opportunity to work with FDEP on this project. Feel free to call me if you have questions or require additional information.

Sincerely, Geosyntec Consultants

Ann Sava, P.G.

Project Manager

Todd Kafka, P.G.

Senior Principal