CN-370000-HW686-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.

HW686

DC001A Completion December 21, 2026

This Task Assignment authorizes Professional Service Industries, Inc. (PSI) 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.

Walsta Jean-Baptiste 850-245-8973 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

PSI

PSI

Nana Westmark 813-886-1075 Multiple

Multiple

Multiple

$ 0.00 ✔ $ 2,500.00

$ 0.00

$ 2,500.00

Scope of Work

Nana G. Westmark

PSI Contract Manager

Nana G Westmark Digitally signed by Nana G Westmark Date: 2022.01.03 09:22:18 -05'00'

William E. Burns Jr.

William E. Burns, Jr. Digitally signed by William E. Burns, Jr.

Date: 2021.12.28 12:19:34 -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 12/21/2026

Documentation of completed site activities $ 2,500.00

$ 2,500.00

HW686

DC001A

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

Memorandum

TO: HW686 Contract File

FROM: Walsta Jean-Baptiste, Contract Manager

SUBJECT: Critical Response

DC001A

DATE: December 28, 2021

This Task Assignment authorizes PSI 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.

The Waste Site Cleanup Section will request the services in writing with the site or sites identified in the written request.

The total cost related to this Task Assignment is $2,500.