#14-6213-77 (Haskins, Inc.) ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 CMG 12-05-16
4. BCC Office Board of County
Commissioners V N 4S lZ`S\k10
5. Minutes and Records Clerk of Court's Office
rat 11(03,153(161
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 Shane Cox 239-252-57 2
Contact/ Department
Agenda Date Item was November 15,2016 Agenda Item Number 16A30
Approved by the BCC
Type of Document Work Order 14-6213-77 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 CMG
2. Does the document need to be sent to another agency for additional signatures? If yes, CMG
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 CMG
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 CMG
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 CMG
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 CMG
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CMG
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 November 15,2016 and all changes CMG
made 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 the rAck
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
WORK ORDER/PURCHASE ORDER
RFQ/WORK ORDER 14-6213-77
Contract 14-6213 "Underground Utility Contractors"
Contract Expiration Date: 7 July 2018
This Work Order is for underground construction services for work known as following:
Project Name:Eagle Creek Weir Refurbishment
Project No: 60124
The work is specified in the proposal dated 13 September 2016 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:Haskins Inc
Scope of Work: As detailed in the attached proposal and the following:
Refurbish Eagle Creek weir: replace weir's water control gates, install security fencing, clear excess
vegetation from channel
* Task 1 Paving Grading,and Drainage
* Task II Weir Gates
* Task III Erosion Control
Schedule of Work: Complete work within 120 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 14-6213-77.
Compensation: In accordance with the Agreement referenced above,the County will compensate the
Firm in accordance with following method(s): ® Lump Sum (QUOTE—attached schedule of
values)as provided in the attached proposal.
Task I $ 85,356.00 LS
Task II $ 127,250.00 LS
Task III $ 11,200.00 LS
TOTAL FEE $ 223,806.00
PREPARED BY: '
Shane Cox,PE,Sr Project Manager Date
Capital Project,Planning,Impact Fees&Program Mgt Div
APPROVED BY: ..tom /
Gei`a1d N tCurtz, E,Principal Project Manager Date
Capital Project,Planning,Impact Fees&Program Mgt Div
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APPROVED BY: ( ` ")`L�. GC.:CC v`--(lL._% j/—b '
-r-
Amy Pattere/n,Director Date
Capital Project,Planning,impact Fees&Program Mgt Div
,§1, / /11// -L
APPROVED BY: Ar r',-._16.7 ( -' ) (oil( 3/f 40
David Wilkison,Dept Head Date
Growth Management Dept
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: Haskins,Inc
10/10/16
Rya acPhee,Treasurer Date
(Remainder of page intentionally left blank)
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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 COLLIE: COUNTY,FLORIDA
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Bpi (J,e • B
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Do a Fiala,Chairman
Dated: ta . ,-
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(SEALPttest as ko C.11alrmans Name of Firm Haskins Inc.
signature only.,
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��������t s�L Ryan MacPhee, Treasurer
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Approve as to Form and Legality:
n 266(-17171Ac,A_Jz__,-
Assistant County Attorney
Cp((eei 1M - Greene,
Print Name
Contract#14-6213-77
Work Order#14-6213-77
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