Backup Documents 06/09/2015 Item #16A14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO ® A 1 (
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office SRT �- 6/10/15
4. BCC Office Board of County 'CN
Commissioners \Asrb \\ k
5. Minutes and Records Clerk of Court's Office
n 1(1(5 32f
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Gary McAlp' ,Natural Resources Phone Number 252-5342
Contact/ Department
Agenda Date Item was 6/9/15 Agenda Item Number 16-A-14
Approved by the BCC
Type of Document Work Orders—Atkins&CB&I Number of Original One of each
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded _
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK SRT
2. Does the document need to be sent to another agency for additional signatures? If yes, SRT
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be SRT
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's SRT
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the SRT
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's SRT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SRT
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 6/9/15 and all changes made during the SRT
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for t -
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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MEMORANDUM
DATE: June 12, 2015
TO: Gary McAlpin, Coastal Programs Manager
Coastal Zone Management
FROM: Teresa Cannon, Deputy Clerk
Minutes and Records Department
RE: Work Order/Purchase Order for Contract #13-6164-CZ
Contractor: Atkins North America, Inc. and
CB&I Coastal Planning & Engineering, Inc.
Attached is a copy of each Work Order referenced above, (Item #16A14)
adopted by the Board of County Commissioners on June 9, 2015.
The original will be held on file in the Minutes and Records Department as part of
the Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
1 6 A 1 4
WORK ORDER/PURCHASE ORDER
Contract 13-6164-CZ Architect& Engineering"
Contract Expiration Date: March 8,2019 .-
This Work Order is for professional Engineering services for work known as: Phase 11-Contingency
FEMA Support
Project Name: FEMA Support
Project No:001-103010 ./
The work is specified in the proposal dated April 20, 2015 which is attached hereto and made a part
of this Work Order. In accordance with Terms and Conditions of the Agreement referenced above.
this Work Order/Purchase Order is assigned to: Atkins North America. Inc.
Scope of Work: As detailed in the attached proposal and the following:
* Task I FEMA Support
Schedule of Work: Complete work within 180 days from the date of the Notice to Proceed which is
accompanying this Work Order. The Consultant agrees that any Work Order that extends beyond the
expiration date of Agreement No. 13-6164-CZ... ill survive and remain subject to the terms and
conditions of that Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenced above, the County will compensate the
Firm in accordance with following method(s): [Negotiated Lump Sum (NLS) [Lump Sum Plus
Reimbursable Costs (LS+RC)®Tjme & Material (T&M)(established hourly rate-Schedule A)[
Cost Plus Fixed Fee (CPFF). (define which method will be used for which tasks)as provided in the
attached proposal.
Task I $5,000.00(T&M) "
TOTAL FEE $5,000.00(T&M)
PREPARED BY: frL4y
1 in. P.t:. !M Manager Date
APPROVED BY: (. 1 7JIJ°—
Am ,Pat on. Division Director Date
� J
APPROVED BY. �V' -�
} Nick Casalan ' i a. -partme t I lead and Date
Deputy C fry anager
APPROVED BY: $ %3.tv-
Mar sackson, Division Director Corp. Date
Finance& Management Services
Page 1 of 2
S
1 6 A14 4 !
By the signature below, the Firm (including employees. officers and/or agents) certifies. and hereby
discloses, that. to the best of their knowledge and belief: all relevant facts concerning past. present. or
currently planned interest or activity (financial, contractual, organizational, or otherwise) which
relates to the proposed work; and bear on whether the Firm has a potential conflict have been fully
disclosed.
Additionally, the Firm agrees to notify the Procurement Director, in writing within 48 hours of
learning of any actual or potential conflict of interest that arises during the Work Order and/or project
duration.
ACCEPTED BY: Atki North Amca, In•.
1147N—_____ /1 1,5"
Bryan . Flynn. Sr. Projec Manager Da e
Attest: BOARD OF COUNTY COMMISSIONERS
Dwight E. Brock, _ erk` Corunty, Florida
e',/,.a..i.,
t ....._. A__ 1 - ..3 • ', ‘ BY:
r 1,it; i as4o, ' i atl'5 Tim Nance,Chairman b1q`‘S
DepufMlIe only.
ATTEST:
BY:
(Print Name/Title)
Approved as to Form and
"/ -
fir; i t
•eputy County Attorney
1
Page 2of2
1 6 A 1 4
WORK ORDER/PURCHASE ORDER
Contract 13-6164-CZY'Architect& Engineering""
Contract Expiration Date: March 8,2019✓
This Work Order is for professional Engineering services for work known as: Phase II Contingency
FEMA Support
Project Name: FEMA Response Assistance ''
Project No:001-103010 /
The work is specified in the proposal dated April 17. 2015 which is attached hereto and made a part
of this Work Order. in accordance with Terms and Conditions of the Agreement referenced above,
this Work Order/Purchase Order is assigned to:CB&I Coastal Planning& Engineering, Inc. f"
Scope of Work: As detailed in the attached proposal and the following:
* Task I FEMA Support
Schedule of Work: Complete work within 180 days from the date of the Notice to Proceed which is
accompanying this Work Order. The Consultant agrees that any Work Order that extends beyond the
expiration date of Agreement # 13-6164-CZ/will survive and remain subject to the terms and
conditions of that Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenced above, the County will compensate the
Firm in accordance with following method(s): ['Negotiated Lump Sum (NLS) []Lump Sum Plus
Reimbursable Costs (LS+RC) ®Tj(ne& Material (T&M)(established hourly rate-Schedule A)❑
Cost Plus Fixed Fee (CPFF), (define which method will be used for which tasks)as provided in the
attached proposal.
Task I $5,000.00(T&M)
TOTAL FEE $5,000.00(T&M)
PREPARED BY: 4,4 374//s
Ciar Alpin. P. .. CZM Manager Date
APPROVED BY: le (`�'N',�i�C�( �-d1�..� 5 7/I J'
4' it`' Amy Pa 17rson. Divi m Director Date
7r APPROVED BY: ��/ .iAr/ �.�de r-/y �-5
Nick Casali • ruin Ott 11� 'Ind Date
Deputy ' u y imager
APPROVED BY:
Mark Isackson.Division Drector Corp. Date
Finance& Management Services
Page 1of2
1
1 6 A14
By the signature below, the Firm (including employees, officers and/or agents) certifies, and hereby
discloses,that, to the best of their knowledge and belief, all relevant facts concerning past,present, or
currently planned interest or activity (financial, contractual, organizational, or otherwise) which
relates to the proposed work; and bear on whether the Firm has a potential conflict have been fully
disclosed.
Additionally, the Firm agrees to notify the Procurement Director, in writing within 48 hours of
learning of any actual or potential conflict of interest that arises during the Work Order and/or project
duration.
ACCEPTED BY: CB&I Coastal Plannin & Engineering, Inc.
eilli/k (12.7"--? 5/14/15
Thomas P. Pierro, P.E., Director Date
Attest BOARD OF COUNTY COMMISSIONERS
y
Dwi. E Brock;, e k Collier County,Florida
1
- .0.1,4t _ ,.
A est as to Chairman's / 4//
BY:
Deputy c1 , lgnature only' Tim Nance,Chairman IG\cA
ATTEST:
BY:
(Print Name/Title)
Approved as to Form and
Legality:
aro /
D eptuty County Atttorney
Page 2 of 2
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