CN-370000-HW686-DC16BCO1.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.

DC016B 1 HW686

This Task Assignment Change Order authorizes a time extension in order for PSI to conduct PFAS sampling.

Skylar Schwed 850-245-8795 Contractor Contractor

Contractor Contractor

Contractor

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

ERIC_4993

Springfield Cleaners

$ 0.00 $ 0.00 Completion

Completion✔ 07/27/2023 10/27/2023 92

1 1

Professional Service Industries, Inc. (Intertek-PSI)

Nana Westmark

Senior Geologist / Principal Consultant

Nana G Westmark Digitally signed by Nana G Westmark Date: 2023.06.12 09:19:11 -04'00'

Kelly Crain

Kelly Crain Digitally signed by Kelly Crain Date: 2023.06.05 14:42:25 -04'00'

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

DC016B

$ 4,307.77

Subtasks 1 & 2: Site rehabilitation Completion report and Project management

Submittal and FDEP approval of the Site rehabilitation Completion Report and Project management Subtasks 1 & 2

10/20/2023

$ 4,307.77

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

From:

Date:

To: HW686 Contract Negotiation File Springfield Cleaners Winter Park, Orange County

ERIC_4993

Ginger Shirah, Project Manager June 2, 2023

Subject: Negotiation Summary

HW686 DC016B-01

This Task Assignment Change Order will extend the Task Assignment Completion Date by three months, from July 27, 2023 to October 27, 2023. This time extension is necessary for PSI to conduct PFAS sampling before submitting the Site Rehabilitation Completion Report.

There is no cost change associated with this change order.

Shirah, Ginger K

From: Schwed, Skylar L <Skylar.Schwed@FloridaDEP.gov> Sent: Wednesday, May 31, 2023 11:34 AM To: Crain, Kelly <Kelly.Crain@dep.state.fl.us> Subject: FW: Request for Time Extension ‐ TA DC016B Springfield ERIC_4993

Best, Skylar Schwed Environmental Specialist III Florida Department of Environmental Protection Division of Waste Management Waste Cleanup Program Skylar.Schwed@FloridaDEP.gov Office: 850-245-8795 Save a tree, please don't print this e-mail unless necessary

From: Nana Westmark <nana.westmark@intertek.com> Sent: Thursday, April 13, 2023 10:08 AM To: Schwed, Skylar L <Skylar.Schwed@FloridaDEP.gov> Subject: Request for Time Extension ‐ TA DC016B Springfield ERIC_4993

EXTERNAL MESSAGE

This email originated outside of DEP. Please use caution when opening attachments, clicking links, or responding to this email.

Good Morning Skylar ‐ PSI is requesƟng a Ɵme extension for TA DC016B for Springfield ERIC_4993. The TA is for a SRCR report which we have actually completed. However, based on the FDEP’s request that we conduct PFAS groundwater monitoring, the report may be premature at this point and my require later revisions.

We would like a 3‐month Ɵme extension to give us Ɵme to develop the PFAS groundwater monitoring TA and perform the work.

Please let me know if this works for you!

Kind Regards, Nana Westmark, PG, CHMM Senior Geologist / Principal Consultant Building & Construction Intertek‐PSI

Direct 813 – 886 – 1075 Ext 219

Mobile 813 ‐ 267 ‐ 2519 Office 813 – 886 – 1075 Email Nana.Westmark@intertek.com Skype Nana.Westmark.Intertek www.intertek.com/building [gcc02.safelinks.protection.outlook.com] [gcc02.safelinks.protection.outlook.com]

Intertek‐PSI 5801 Benjamin Center Drive, Suite 112 Tampa, Florida 33634

Total Quality. Assured.

CONFIDENTIALITY NOTICE

This email may contain confidential or privileged information, if you are not the intended recipient, or the person responsible for delivering the message to the intended recipient then please notify us by return email immediately. Should you have received this email in error then you should not copy this for any purpose nor disclose its contents to any other person.

http://www.intertek.com

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.

gOrg. Code

HW686

DC016B Completion July 27, 2023

This Task Assignment authorizes Professional Service Industries, Inc. (PSI) to develop a Site Rehabilitation Completion Report in accordance with the PSI scope of work, cost estimate, and schedule received on January 12 2023.

Skylar Schwed 850-245-8795 Contractor Professional Service Industries, Inc. (Intertek-PSI) Contractor

Contractor Nana G. Westmark Contractor

ERIC_4993

2335 Temple Trail Winter Park, Orange County, Florida

Springfield Cleaners

Contractor Contractor

✔ $ 4,307.77

$ 4,307.77

Scope of Work

Professional Service Industries, Inc. (Intertek-PSI) Contractor Nana Westmark

Senior Geologist / Principal Consultant

Nana G Westmark Digitally signed by Nana G Westmark Date: 2023.01.25 14:54:29 -05'00' Kelly Crain Digitally signed by Kelly Crain

Date: 2023.01.23 15:48:03 -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

Subtasks 1 & 2: Site rehabilitation Completion report and Project management 04/27/2023

Submittal and FDEP approval of the Site rehabilitation Completion report and Project management Subtasks 1 & 2 $ 4,307.77

$ 4,307.77

HW686

DC016B