Backup Documents 07/09/2013 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 4
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 02'1 7,41!3
4. BCC Office Board of County \ \its
Commissioners `A/ --��\, `
5. Minutes and Records Clerk of Court's Office *-1,�1 -(1241b
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 Brandy Oter ,Associate Project Mgr. Phone Number 252-5859
Contact
Agenda Date Item was 7/9/2013 Agenda Item Number 16D4
Approved by the BCC
Type of Document Change Order Number of Original a ‘i
Attached Documents Attached
PO number or account
number if document is kt
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. itial) Applicable)
1. Does the document require the chairman's original signature?
2. Does the document need to be sent to another agency for additional signatures? If yes,
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. '4....)
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed e_
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
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
qlf\
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's C1
signature and initials are required. Y
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 a item is input into SIRE.
Some documents are time sensitive and require forwarding to allahassee within a certain
time frame or the BCC's actions are nullified. Be aware our deadlines!
8. The document was approved by the BCC on 7-9-2013 (enter date)and all
changes made during the meeting have been incorporated in the attached document. LD
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,- r
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
16
D 4
MEMORANDUM
Date: July 15, 2013
To: Brandy Otero, Project Manager
TECM Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Change Order #2 to Contract #11-5621
With Atkins North America Inc.
Attached is an original document as referenced above, (Item #16D4) adopted by the Board
of County Commissioners on Tuesday, July 9, 2013.
The second original is being held in the Minutes and Records Department as part
of the Board's Official Records.
If you have any questions, please call 252-8411.
Thank you.
Attachment
1604
MEMORANDUM
Date: July 15, 2013
To: Rhonda Cummings, Contract Specialist
Purchasing Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Change Order #2 to Contract #11-5621
Contractor: Atkins North America Inc.
Attached is a copy of the document referenced above, (Item #16D4) approved by
the Board of County Commissioners on July 9, 2013.
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
1604
CHANGE ORDER
CHANGE ORDER NO. 2 CONTRACT NO. 11-5621
BCC Date: 9/13/11
Agenda Item: 16 A 24
TO: Nathan West
Atkins North America, Inc.
1514 Broadway, Suite 203
Fort Myers, FL 33901
DATE: 6/24/13
PROJECT NAME: Design for CAT Passenger Transfer Facility
PROJECT NO.: 35010
Under our AGREEMENT dated September 13, 2011
You hereby are authorized and directed to make the following change(s) in accordance with
terms and conditions of the Agreement: Add time to contract as shown below.
FOR THE Sum of: $0
Original Agreement Amount $502,451.20
Sum of Previous Changes $9,990.00
This Change Order add or deduct $0
Present Agreement Amount $512,440.20
The time for completion shall be increased by 197 calendar days due to this Change Order.
Accordingly, the Contract Time is now 764 calendar days. The final completion date is December 31.,
2013. Your acceptance of this Change Order shall constitute a modification to our Agreement and will
be performed subject to all the same terms and conditions as contained in our Agreement indicated
above, as fully as if the same were repeated in this acceptance. The adjustment, if any, to the
Agreement shall constitute a full and final settlement of any and all claims of the Contractor arising out
of or related to the change set forth herein, including claims for impact and delay costs.
IN WITNESS WHEREOF,the Contractor and the County have each, respectively, by an authorized person or
agent, hereunder set their hands and seals on the date(s) indicated below. q
Accepted: ��k� \ 20�3
ST. I
16 h
1104 (i , _ OWNER:
a� /
t5wight E. Br ick;:Cle BOARD IF C/ NTY C 6 MMISSIONERS
Attest as is Cha fill 's COLLIE' CO T i, F ORIDA
y
signature onl . ,,,.
By:
Geor_WA. Hiller, Esq., Chairwoman
CONTRACTOR:
Atkin
\tr
orth America By: i�`r∎■`
illiLHI :rand Otero, Associate Project Manager
B : ) a. , .. u�..
Y
Mark D. 1 icikas,PE DEPARTM T DIRECTOR
By:
Michelle Arnold
Contractor First Witness
.kdtLA i(0464- Stui DIVISION A O MINISTRATOR
Type/print witness name 41 / Gj
By: I Ill cI/
Ala o Steve arnell
Cont ctor Second Witness
Mco1r5r-xi Andrew c-, PROCUREMENT$TRATTIST
Type/print witness name 1 /" -.��
By: c �. L. .� '�T�
Rhonda Cummings
Approved as to form and
L sufficienc
e c
94- (ff•41' IL--
Assistetit County Attorney
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Item# 1I
Agenda 1:1211.3
Date
Date S '
Rec'•
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