CN-370000-HW686-DC02ACO1.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.

DC002A 1 HW686

This Task Assignment Change Order modifies the deliverable and invoice schedule to change the names of the quarterly deliverables to reflect the calendar year schedule.

Skylar Schwed (850)245-8795 Contractor Contractor

Contractor Contractor

Contractor

Professional Service Industries, Inc. (Intertek-PSI) Nana G. Westmark 813-886-1075

N/A

Lakeland Storage Facility

$ 0.00 $ 0.00 ✔ Completion

Completion 0

✔ 1 1 1

Professional Service Industries, Inc. (Intertek-PSI)

Nana Westmark

Senior Geologist / Principal Consultant

Nana G Westmark Digitally signed by Nana G Westmark Date: 2022.11.16 07:09:55 -05'00'

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2022.11.15 15:41:40 -05'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 01_18

Contract Number:

Task Assignment #:

Change Order #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

HW686

DC002A

$ 50,428.57

Quarter 2 Equipment Storage Status Report - Subtasks 2 and 3

Quarter 3 Equipment Storage Status Report - Subtask 4

Quarter 4 Equipment Storage Status Report - Subtask 5

Quarter 1 2023 Equipment Storage Status Report and Project Management - Subtasks 1 and 6

FDEP approval of Quarter 2 Equipment Storage Status Report - Subtasks 2 and 3

FDEP approval of Quarter 4 Equipment Storage Status Report - Subtask 5

FDEP approval of Quarter 1 2023 Equipment Storage Status Report and Project Management - Subtasks 1 and 6

FDEP approval of Quarter 3 Equipment Storage Status Report - Subtask 4

07/20/2022

10/20/2022

01/20/2023

04/20/2023

$ 11,336.28

$ 13,634.68

$ 11,336.28

$ 14,121.33

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: HW686 Contract Negotiation File Lakeland Storage Facility

From: Skylar Schwed, Project Manager Date: November 15, 2022 Subject: Negotiation Summary

HW686 DC002A-1

This Task Assignment Change Order modifies the deliverable and invoice schedule to change the names of the quarterly deliverables to reflect the calendar year schedule.

There is no cost increase related to this change order. There is no change in the TA completion date.

The FDEP project manager agrees to the scope of work and final cost associated with this Task Assignment Change Order. The final cost for this Task Assignment Change Order is $50,428.57

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

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 bas s, 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

DC002A Completion June 30, 2023

This Task Assignment authorizes Professional Service Industries, Inc. (PSI) to manage remedial equipment used by the Drycleaning Solvent Cleanup Program currently housed at the Lakeland storage facility including coordination of delivery and pick up of equipment and monthly maintenance of equipment in accordance with the PSI Scope of Work, cost estimate, and schedule received on February 8, 2022.

Walsta Jean-Baptiste 850-245-8973 Contractor PSI Contractor

Contractor Nana G. Westmark Contractor 813-886-1075

NA

NA

NA

Contractor Contractor

$ 0.00 ✔ $ 50,428.57

$ 0.00

$ 50,428.57

Scope of Work

PSI

Contractor Nana Westmark

Contract Manager

Nana G Westmark Digitally signed by Nana G Westmark Date: 2022.02.14 09:45:32 -05'00'

Jennifer A. Farrell

Digitally signed by Jennifer Farrell Date: 2022.02.11 13:14:48 -05'00'

N/A

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

Quarter 1 Equipment Storage Status Report - Subtasks 2 and 3 07/20/2022

Quarter 2 Equipment Storage Status Report - Subtask 4 10/20/2022

Quarter 3 Equipment Storage Status Report - Subtask 5 01/20/2023

Quarter 4 Equipment Storage Status Report and Project Management - Subtasks 1 and 6 04/20/2023

FDEP approval of Quarter 1 Equipment Storage Status Report - Subtasks 2 and 3 $ 13,634.68

FDEP approval of Quarter 2 Equipment Storage Status Report - Subtask 4 $ 11,336.28

FDEP approval of Quarter 3 Equipment Storage Status Report - Subtask 5 $ 11,336.28

FDEP approval of Quarter 4 Equipment Storage Status Report and Project Management - Subtasks 1 and 6 $ 14,121.33

$ 50,428.57

HW686

DC002A