CN-370000-HW686-DC19BCO2.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.

DC019B 2 HW686

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

Contractor Joshua Newell Contractor 863-712-4342

ERIC_4266

Rene Cleaners

✔ $ 26,395.23 $ 26,395.23

$ 26,395.23 $ 26,395.23 Completion

Completion 10/31/2025 01/30/2026 91

1 1

Contractor Douglas Coleman PMP, CHMM, REM

Contract Manager

Douglas Coleman Digitally signed by Douglas Coleman Date: 2025.10.28 15:34:36 -04'00'

Mubeen Darji

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

Date: 2025.10.28 14:00:53 -04'00'

Time Extension Only

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

HW686

DC019B

$ 26,395.23

Subtask 1: Project Management Subtask 2 & 3: Supplemental Site Assessment Report

Subtask 1, 2, & 3: Submittal and DEP approval of the SSAR w/ IDW manifests.

08/29/2025

$ 26,395.23

FFLORIDA DEPARTMENT OF

EEnvironmental Protection

Bob Martinez Center 2600 Blair Stone Road

Tallahassee, FL 32399-2400

Ron DeSantis Governor

Jay Collins Lt. Governor

Alexis Lambert Secretary

Memorandum

TO:

FROM:

SUBJECT:

DATE:

ERIC_

Cleaners

Mary Uribe, Project Manager

Negotiation Summary

HW686 DC0

Total task amount is $ . PSI’s time, labor, and subcontractor costs for these activities have been reviewed and are appropriate. The level-of-effort and cost estimate are reasonable for the scope of services. Final deliverable due date is . Task completion 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. 8/17/2020

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.

DC019B 1 HW686

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

Joshua Newell 863-712-4342

ERIC_4266

Rene Cleaners

$ 26,395.23 $ 27,764.23

$ 26,395.23 $ 27,764.23

10/31/2025 10/31/2025 0

1 1

Douglas Coleman PMP, CHMM, REM

Contract Manager

Douglas Coleman Digitally signed by Douglas Coleman Date: 2025.09.09 09:10:28 -04'00'

Mubeen Darji

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

Date: 2025.09.08 14:34:16 -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