Backup Documents 09/27/2016 Item #16D19 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO6 09
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU 19
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.
Routed by Procurement Services to the Office Initials Date
Following Addressee(s) (In routing order)
1. County Attorney Office County Attorney Office
Mb—
jO,]J'I2. BCC Office Board of County 1Y
Commissioners \rq /� '� 1�\ ue)
3. Minutes and Records Clerk of Court's Office COfr`fry (`3optpt
4. Return to Procurement Services Procurement Services
Division Contact: Lissett De La Rosa
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 Lissett De La Rosa for Leandro Phone Number 239-252-6020
Procurement Staff Goicoechea, 10/19/16
Contact and Date
Agenda Date Item was 9/27/16 V Agenda Item Number 16.D.19
Approved by the BCC
Type of Document Change Order,' Number of Original -1—
Attached Documents Attached
PO number or account N/A Solicitation/Contract 13-6164 Q. ady
number if document is Number/Company Minor& soc.
to be recorded Name
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? �} �B- 01 (',
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A `
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 J
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 N/A
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 N/A
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 LD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip ^
should be provided to the County Attorney Office at the time the item is input into SIRE. 1\)1,4-
Some
4.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 the date above and all changes made XXX
during the 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 the11
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: October 21, 2016
To: Lissett De La Rosa
Procurement Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Change Order for Contract #13-6164 "Professional Services for
Engineers and Architects"
Contractor: Q. Grady Minor & Associates, P.A.
Attached is an original of the document referenced above, (Item #16D19) approved by
the Board of County Commissioners on Tuesday, September 27, 2016.
The second original has been held by 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
IS
i 6 13 .1 �;i;a
Procurement Services ey Change Order Form
❑Contract Modification ®Work Order Modification ❑Amendment
Contract#: 13-6164 Change#: 1 Purchase Order#: 4500166179 - Project#: 90093
Contractor/Firm Name: Q.Grady Minor&Associates,P.A. Contract/Project: Tigertail Beach Restroom Addition
Leandro A.Goicoechea Parks&Recreation
Project Manager Name: Division Name:
Original Contract/Work Order Amount $ „19; 214
263.00 4/16�'f6,D i Original BC( Approval Date;Agenda Item#
Current BCC Appro ed Amount $ 19,263,Od` X4112/16,161)Z Last BCC Approval Date; Agenda Item # ••
Current Contract/Work Order Amount . :$ _;..19,263:b0 3/8/2019: SAP Contract Expiration Date(Master)
Dollar Amount of this Change ::•.$ ` -_ 5 683'00' 29.50% Total Change from Original Amount
Revised Contract/Work Order Total $ ; 24,946.00 29.50% Change from Current BCC Approved Amount :.
Cumulatnne Changes $ 5,683.00 29.50% Change from Current Amount T J j
T
4,� -'9nz' Comfi a 1 ij'Date De tjptcroh•of••tPrw, asks Hange andRatIonale,13 tlr C}ta ige TG.
Notice to Proceed 06/21/2016 Original 8/20/2017 Last Approved 4/12/2016 Revised Date 8/20/2017
Date Completion Date Date i- (includes this change)
#of Days Added 0 Select Tasks; ®Add new task(s) 0 Delete task(s) ❑Change task(s) 0 Other(see
below) •
Provide a response to the following:1.)detailed and specific explanation/rationale of the requested change(s)to the task(s)and 1 or
the additional days added(if requested);2.)why this change was not included in the original contract;and,3.) describe the impact
if this change Is not processed. Attach additional information from the Design Professional and/or Contractor if needed.
1) After a meeting with Marco Island city officials it was determined that the Tigertait Beach Restroom addition will be constructed
seaward of the Coastal Construction Control Line (CCCL) so a new Florida Department of:Environmental Protection Coastal •
Construction Control Line(FDEP CCCL)permit for major structures will be necessary. Also be+rause of its location seaward of the
CCCL,a new Marco island CCCL variance and Flood Variance(FV)will be necessary. To acquire the permit and variance a total
of$5,683.00 is being added to the work order for additional work as described in the attachedquote. The following modifications
are being executed.
Action to Task Description Amount New Task Total
Increase 1 Project Commencement and Survey $ 228.00 $1,999.00
Add Task 1A Building Coordination $4,452.00 $4,452.00
Decrease 2A Variance Application -$ 246.00 $2,744.04,
Increase 2C Public Hearings $ 294.00 $1,883.00
Increase 4A Bidding $ 615.00 $1,691.04
increase 4B Construction $ 340.00 $3,640.00
2) This change was not included in the original contract because it was assumed that a previousiy;acqu€red permit and variance was
able to be used for this project,and has since been proved otherwise by Marco Island officials.
•
3) If this change is not processed,the resulting construction to the Tigertail Beach Restrooms will be non-compliant With Marco •
Island code and could require additional funds,at a later date,to bring this structure up to compliance: •
.411111" !eby:Leandro A.Goicoechea, Facilities Mina.ement Division i• // I I-te: C� / /(P
Prepared ni 1 L� /�/
(Project Manager Name and Division) / ea , ,.-
Acceptance of this Change Order shall constitute a modification to c.- ract/work order i' ntified abov4 and will be subject to all the same
terms and conditions as contained in the contract/work order indicated above,as fully as if the same were stated In this acceptance. The
adjustment,if any,to the Contract shall constitute a full and final settlement of any and all claims of the'Contractor/Vender i Consultant/
Design Professional/arising out of or related to the change set forth herein,including claims for impact and delay costs:
Accepted by: �/4 Date:
(Contractor I V- :. Consultant I Design Professional and Name of Firm,if project applicable)
Approved by: • .* e /4� k. ....\ 'flty kt Q.Cao•" JA:v•. Date: O its-I r to j
(Design Pr-40 na€=nd Nal e i if project applicable)
f
Approved by: '< _,./ Date: V/S-7/ 6
(Mai -ment Professional)
Revised:10/28/2014 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin BCC ES •
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IN WITNESS WHEREOF, Q Grady Minor and Associates, P.A., and the County, have each,
respectively, by an authorized person or agent, hereunder set their hands and seals on the date and year
first above written.
BOARD OF COUNTYCOMMISSIONERS
ATTEST: COLLI ' COUNTY, FLORIDA
Dwigh E. Brock;CI of Courts ,
Donn• Fiala,Chairman
Dated 10l 1 h
(S AL)�A est as to Chairman's
Q GRADY MINOR& ASSOCIATES,P.A.
signature only.
iifriasit
By: '6/k.Firs Witness C:121 --
Signature
'Type/print vyitne name' TType/print signature and title'
c' IA)kr
Second Witness
bo-,...\t; S..:,k.,,.)
!'Type/print witness name'
Approved as to Form and Legality:
1111 t71qii / item# ! to
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ssant County Attorney
Ageneda q f alp`�
Dat
Date 'f\'a `I 1 k
Rec'd
I 1
LLep ty Clerk
.
Change Order#1
16-6164—Work Order 450 0168179
Tigertail Beach Restroom Addition 16