CN-370000-HW686-DC03DCO1.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:

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.

DC003D 1 HW686

Nicole Knutson 850-245-8763 Professional Service Industries, Inc. (PSI)

Nana Westmark 813-886-1075

ERIC_4814

Pugh's Dry Cleaners

$ 13,797.67 $ 13,797.67

$ 13,797.67 $ 13,797.67

08/30/2024 01/30/2025 153

1 1 1

Mubeen Darji

Mubeen Darji, P.E. Digitally signed by Mubeen Darji, P.E.

Date: 2024.08.16 10:29:02 -04'00'

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

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:

FROM:

Site # ERIC_ File

Project Manager

SUBJECT: Negotiation Summary

HW68

DATE:

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

DC003D Completion August 30, 2024

This Task Assignment authorizes Professional Service Industries, Inc. (PSI) to develop an Interim Source Removal Plan (ISRP) at Pugh's Dry Cleaners at 215 South Bay Street Eustis, Lake County, Florida.

Jennifer Farrell (850) 245-8705 Contractor Professional Service Industries, Inc. (PSI) Contractor

Contractor Nana Westmark Contractor 813-886-1075

ERIC_4814

215 South Bay Street Eustis, Lake County, Florida

Pugh's Dry Cleaners

Contractor Contractor

$ 13,797.67

$ 13,797.67

Scope of Work

Professional Service Industries, Inc. (PSI) Contractor

Nana Westmark

PSI Contract Manager

Nana G Westmark Digitally signed by Nana G Westmark Date: 2024.02.22 11:25:51 -05'00'

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2024.02.20 16:13:55 -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

Subtask 1, 2: Interim Source Removal Plan and Project Management 06/28/2024

Subtask 1, 2: Submittal and FDEP Approval of Interim Source Removal Plan and Project Management $ 13,797.67

$ 13,797.67

HW686

DC003D