CN-370000-HW686-DC001C.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

DC001C Completion August 16, 2022

This Task Assignment authorizes Professional Service Industries, Inc. (PSI) staff members (2) travel and attendance at the WSCS 2 day contractor workshop at FDEP Bob Martinez Center on July 12 and 13 2022.

Skylar Murphy 850-245-8795 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Professional Service Industries, Inc. (Intertek-PSI)

Professional Service Industries, Inc. (Intertek-PSI)

Nana G. Westmark 813-886-1075 Multiple

Multiple

Multiple

✔ $ 4,500.00

$ 4,500.00

Scope of Work

Nana Westmark

Senior Geologist / Principal Consultant

5/12/2022

Nana G Westmark Digitally signed by Nana G Westmark Date: 2022.05.12 10:01:30 -04'00'

William E. Burns, Jr.

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

Date: 2022.05.11 14:15:17 -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

The signature of the 2 staff members in attendance on workshop sign in and sign out sheets. 07/14/2022

FDEP approval of the of completed attendance and signature by the 2 staff members in attendance on the workshop sign in and sign out sheets. Subtasks 1 & 2. $ 4,500.00

$ 4,500.00

HW686

DC001C