Backup Documents 12/08/2015 Item #16C2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1R6 c
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT
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 12/8/15
4. BCC Office Board of County 114t
Commissioners \(�73/ VZ-V \�c
5. Minutes and Records Clerk of Court's Office `
PIT czlc I IS Cf"3
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 Tom Sivert V��� `eSx�o� 252-5376
Contact/ Department
Agenda Date Item was 12/8/15 Agenda Item Number 16-C-2
Approved by the BCC
Type of Document Work Order— 14-6213-48 Number of Original One
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 12/8/15 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 th SZ
BCC,all changes directed by the BCC have been made,and the document is ready f r the
Chairman's signature. V N'e-
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
16 C 2
MEMORANDUM
Date: December 11, 2015
To: Tom Sivert, P.E. Senior project Manager
Utilities Engineering
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Work Order to Contract #14-6213-48 for the
activation of North Reverse Osmosis Well 109
Contractor: Quality Enterprises USA, Inc.
Attached for your records is a copy of the document referenced above, (Item #16C2)
approved by the Board of County Commissioners on Tuesday, December 8, 2015.
The original has been held by the Minutes and Records Department for the Board's
Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachment
1602
WORK ORDER/PURCHASE ORDER
Contract 14-6213-48 "Annual Underground Utility Contractors"
Contract Expiration Date: July 7, 2016
This Work Order is for utility contractor services for work known as:
Project Name: NRO Well 109
Project No: 70085.16.6
The work is specified in the proposal dated October 15, 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: Quality Enterprises USA, Inc.
Scope of Work: As detailed in the attached proposal and the following:
* Task I Perform all work as described in the RFQ and as listed on the quote form
* Task II Allowance
Schedule of Work: Complete work within 90 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 # 14-6213 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): NNegotiated Lump Sum (NLS) ❑Lump Sum Plus
Reimbursable Costs (LS+RC) /1 Time & 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 $271,355.34 NLS
Task II $ 25000.00 TM
TOTAL FEE $296,355.34
4,4116
Prepared by: / 7
c Sivert, PE Senior Project Manager, PPMD Date
Page 1 of 3
16C2
S /° / Hozz/
APPROVED BY: &j ! yl
Oscar Martinez,P.-.,PPM I4'rine 'al Project Manager Date
APPROVED BY: Oev✓✓i /./ /0k--2 //5--
Pam '.iy,Distributi•• f a 1 ger Date
APPROVED BYE )01Z3 1 i c
Steve ,i ssner, - -t i t./ ate
APPROVED BY: 0 4 16711110 --
Tom
TZ h1 --Tom I0 I,- k,P. P I Director Date
APPROVED BY: //6,, .. tO/2141 S
Swai,Purchasing Procurement Strategist Date
APPROVED BY: po kSko/S--
Joe Be ne, ti rm ities Operations Support Director Date
APPROVED BY: �� l0/2H/t
George Yilmaz,Public Utilities Administrator Date
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.
(Remainder of page intentionally left blank)
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1 6 C 2
IN WITNESS WHEREOF,the parties hereto, have each, respectively, by an authorized person or
agent, have executed this Work Order on the date and year first written below.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Dwight E. Brock, Clerk of Courts COLLIER COUNTY, FLORIDA
By: 1; . 46 ot, O� By: / ewailte.e..
_ Tim Nance, Chairman \Z,,���\S
Dated: 1 i'-i 1�4 -s
(SMCISI aS 140• (n18n'S Quality Enterprises USA Inc.
signature miry.
. . „1„
first Witn4; ignature
Louis J. Gaudio, Vice President
Susan J. Schultz TType/print signature and titleT
TType/print witness nameT
2,/),,,,,illA efipi,„ 1
Second Witness
Marcie Cohen
TType/print witness nameT
Appra 7FriL gality:
1
Aat•County Attorney
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Print Name
Item# I (tiC-2- I
Agenda fZ_p_lr
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