CN-370000-HW687-DC01ACO2.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.

DC001A 2 HW687

This TACO adds costs for two contractor staff travel and attendance at the two day FDEP WSCS Pollution Response Action Contractor (PRAC) Meeting to be held at the Bob Martinez Center July 12th & 13th, 2022.

Dean Cox (850) 245-8969 Contractor Contractor

Contractor Contractor

Contractor

Terracon Consultants, Inc.

Donna Cline (813) 321-0340 multiple multiple

✔ $ 29,280.41 $ 24,780.41

$ 29,280.41 $ 24,780.41 ✔ Completion

Completion 0

✔ 1 1 2

William E. Burns, Jr.

William E. Burns, Jr. Digitally signed by William E. Burns, Jr.

Date: 2022.06.20 08:20:31 -04'00'

N/A dlcline Typewriter Donna Cline dlcline Typewriter Senior Remediation Engineer dlcline Typewriter 06/23/22

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

HW687

DC001A

$ 29,280.41

Sites Status Table update, along with any new owner or property information related to any need for site access authorization or offsite notification.

Two signatures each by two contractor staff - one signature each on the daily PRAC meeting sign-in & sign-out sheet(s) for each of the two meeting days.

Documentation of as-needed critical response site activities requested by the Waste Site Cleanup Section.

FDEP approval of Sites Status Table update, along with any new owner or property information related to any need for site access authorization or offsite notification.

FDEP approval of documentation of as-needed critical response site activities requested by the Waste Site Cleanup Section.

FDEP approval of two signatures each by two contractor staff - one signature each on the daily PRAC meeting sign-in & sign-out sheet(s) for each of the two meeting days.

04/15/2022

08/31/2022

01/04/2027

$ 4,500.00

$ 22,280.41

$ 2,500.00