CN-370000-HW684-DC057ACO.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.

DC057A 1 HW684

Mackenzie Childs 850-245-8929 Contractor GHD Services, Inc Contractor

Contractor Brian Moore Contractor 813-971-3882

ERIC_4106

Imperial Cleaners

✔ $ 5,223.46 $ 5,223.46

$ 5,223.46 $ 5,223.46 Completion

✔ Completion 12/11/2024 02/09/2025 60

✔ 1 1 1

GHD Services, Inc Contractor

Brian Moore Digitally signed by Brian Moore Date: 2024.12.10 09:58:38 -05'00'

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2024.12.10 09:14:11 -05'00'

N/A

This Task Assignment Change Order authorizes a time extension for review of Subtask 2.

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

Contract Number:

Task Assignment #:

Change Order #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

BWC TAFORM 01/18

HW684

DC057A

Subtask 2 & 1: Interim Source Removal Plan (ISRP) Review + Project Management (Review documentation and comments) 10/11/2024

Subtask 2 & 1: Upon submission of Interim Source Removal Plan (ISRP) Review + Project Management $ 5,223.46

$ 5,223.46

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

Memorandum

TO:

FROM:

ERIC_

, Project Manager

SUBJECT: Negotiation Summary

HW684_

DATE: , 2024

Completion

Contractor Contractor Contractor Contractor

Contractor Contractor

Contractor

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 2 & 1: Interim Source Removal Plan (ISRP) Review + Project Management (Review documentation and comments) 10/11/2024

Subtask 2 & 1: Upon submission of Interim Source Removal Plan (ISRP) Review + Project Management $ 5,223.46

$ 5,223.46

HW684

DC057A