CN-370000-HW683-DC07BCo1.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:

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.

DC007B 1 HW683

Sarah Aduwa 850-245-8973 Contractor Geosyntec Contractor

Contractor Melissa Shook Contractor 321-747-1909

ERIC_5500

Lipham Cleaners

✔ $ 14,117.03 $ 14,117.03

$ 14,117.03 $ 14,117.03 Completion

✔ Completion 11/29/2024 03/14/2025 105

1 1

Geosyntec Contractor Todd Kafka

Contract Manager

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

Date: 2024.11.20 13:50:18 -05'00'

Mubeen Darji

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

Date: 2024.11.20 11:03:45 -05'00'

This Task Assignment Change Order authorizes Geosyntec a no-cost 105-day extension on all deliverables and TA completion date.

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW683

DC007B

$ 14,117.03

Subtask 5 - PFAS Deliverable

Subtasks 1, 2, 3, 4 - Submittal of GWMR

Subtask 5 - PFAS Deliverable

Subtasks 1, 2, 3, 4 - Submittal of GWMR

01/31/2025

01/31/2025

$ 12,798.78

$ 1,318.25

Printed on recycled paper.

FFLORIDAA DEPARTMENTT OF

EEnvironmentall Protection

Bob Martinez Center

2600 Blair Stone Road Tallahassee, FL 32399-2400

Ronn DeSantis Governor

Jeanette Nuñez

Lt. Governor

Shawnn Hamilton Secretary

To: HW683 Contract Negotiation File Lipham Cleaners Longwood, Seminole County, Florida

ERIC 5500

From: Sarah Aduwa, Project Manager Date: November 18, 2024 Subject: Negotiation Summary

HW683 DC007B-1

This Task Assignment Change Order authorizes Geosyntec a no-cost 105-day extension on all deliverables and TA completion date. The new end date is March 14, 2025.

Site access issues with Publix caused a delay in sampling.

Aduwa, Sarah

From: Melissa Shook <Melissa.shook@Geosyntec.com> Sent: Friday, November 15, 2024 1:08 PM To: Aduwa, Sarah Cc: Todd Kafka Subject: TA Extension for Lipham Cleaners (ERIC_5500)

EXTERNAL MESSAGE

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

Hi Sarah, The TA end date for Lipham Cleaners TA DC007B is November 29, 2024.

Can we please push this back to February 28, 2025?

We pushed back the sampling for Lipham Cleaners due to Site access agreement issues with Publix.

We completed the sampling, received the results yesterday, and are working on the deliverables.

Thanks, Melissa Shook, EI Senior Staff Engineer Geosyntec Consultants, Inc.

6770 South Washington Ave., Suite 3 Titusville, FL 32780 NEW Phone: 321.451.5480

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

DC007B Completion November 29, 2024

This Task Assignment authorizes Geosyntec to conduct Groundwater Monitoring and PFAs sampling at Lipham Cleaners, located at Longwood, Orange County in accordance with Geosyntec scope of work, cost estimate and schedule received on April 1, 2024.

Sarah Aduwa 850-245-8973 Contractor Geosyntec Contractor

Contractor Melissa Shook Contractor 321-747-1909

ERIC 5500

2492 W State Road 434, Longwood, Seminole County, Florida

Lipham Cleaners

Contractor Contractor

✔ $ 14,117.03

$ 14,117.03

Scope of Work

Geosyntec Contractor Todd Kafka

Contract Manager

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

Date: 2024.05.08 15:15:20 -04'00'

Mubeen Darji

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

Date: 2024.05.08 14:22:41 -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

Subtask 5 - PFAS Deliverable 08/30/2024

Subtasks 1, 2, 3, 4 - Submittal of GWMR 09/27/2024

Subtask 5 - PFAS Deliverable $ 1,318.25

Subtasks 1, 2, 3, 4 - Submittal of GWMR $ 12,798.78

$ 14,117.03

HW683

DC007B