CN-370000-HW685-DC001A.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.

HW685

DC001A Completion December 27, 2026

This Task Assignment authorizes Golder 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.

Ben Grubbs 850-245-8992 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Golder Associates USA Inc.

Golder Associates USA Inc.

Matt Crews 904-363-3430 Multiple

Multiple

Multiple

$ 0.00 ✔ $ 2,500.00

$ 0.00

$ 2,500.00

Scope of Work

Donald Miller

Principal

January 7, 2022

Donald Miller Digitally signed by Donald Miller Date: 2022.01.07 13:12:07 -05'00' William E. Burns, Jr. Digitally signed by William E. Burns, Jr.

Date: 2022.01.07 10:54:10 -05'00'

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

Documentation of Completed Site Activities 12/27/2026

Submittal and FDEP approval of Documentation of Completed Site Activities $ 2,500.00

$ 2,500.00

HW685

DC001A

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: HW685 Contract Negotiation File Critical Response, Multiple Sites From: Ben Grubbs, Project Manager Date: January 7, 2022 Subject: Negotiation Summary

HW685 DC001A

This Task Assignment authorizes Golder to perform critical tasks at sites on an as needed basis in accordance with a request from the Waste Site Cleanup Section. The Section will request the services in writing and will identify the site or sites to be addressed.

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 $2,500.00.

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