CN-370000-HW684-DC001D.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.

HW684

DC001D Completion October 20, 2023

This Task Assignment authorizes GHD Services, Inc. to send two staff members to attend the WSCS two-day contractor workshop at the TCC Center for Innovation on May 23 and 24, 2023.

Kevin Kane 850-245-8971 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

GHD Services, Inc.

GHD Services, Inc.

Brian Moore 813-257-0658 Multiple

Multiple

Multiple

✔ $ 4,500.00

$ 4,500.00

Scope of Work

Brian Moore

Project Manager

Brian Moore Digitally signed by Brian Moore Date: 2023.05.11 14:07:27 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.05.11 13:36:03 -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

Signature by two staff members on workshop sign in and sign out sheets 08/18/2023

Upon FDEP approval of completed attendance and signature by two staff members on workshop sign in and sign out sheets $ 4,500.00

$ 4,500.00

HW684

DC001D