CN-370000-HW686-DC18CCO1.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.

DC018C 1 HW686

Mary Uribe 8502458990 Professional Service Industries, Inc. (Intertek-PSI)

Joshua Newell 863-712-4342

ERIC_4713

Hampton Cleaners

$ 18,910.61 $ 18,912.81

$ 18,910.61 $ 18,912.81

11/27/2026 11/27/2026 0

1 1

Douglas Coleman PMP, CHMM, REM

Contract Manager

Douglas Coleman Digitally signed by Douglas Coleman Date: 2026.04.22 11:40:28 -04'00'

Mubeen Darji

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

Date: 2026.04.21 12:42:21 -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

Ordered Shipped Qty B/O Product Code Unit Price Ext Price

Order Date Order #

10/15/25 500866

Salesperson Terms

NET 30 16

AccountPurchase Order #

JOHN DAUGHERTY PSIJ118

Date ShippedShip Via

UPS GROUND 10/16/25

SOLD TO: SHIP TO:

P S I - TAMPA

5801 BENJAMIN CENTER DR.,# 112

TAMPA, FL 33634 TAMPA, FL 33634

5801 BENJAMIN CENTER DR.,# 112

P S I - TAMPA

ATLANTIC SUPPLY

800-752-9416

PO BOX 17620

CLEARWATER, FL 33762

INVOICE

Invoice #: 500866

10/16/25Invoice Date:

Page:1 of 1

Description

Due by: 11/15/25

2.00 2.00 T6 LOCKING PLUG, 6" ORANGE S40/80 $41.7500 $83.50

1.00 1.00 T4 LOCKING PLUG, 4" ORANGE SCH40 $10.3500 $10.35

Subtotal: $93.85 Sales Tax: 7.04

Freight: $17.05

TOTAL: $117.94

5400 117.94

GEN

Acct. No 06 0552 Amount Name

Job No.

0552_________

Mgr. Approval VP Approval

APPROVED FOR PAYMENT