Backup Documents 09/24/2013 Item #16A13ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATIA A 13
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
exce tion of the Chairman's signature draw a line throw h routing lines # 1 throu #2, complete the checklist, and forward to the Coon Attorney Office.
Route to Addressees (List in routing order)
Office
Initials
Date
1.
appropriate
(Initial)
Applicable)
Agenda Date Item was
September 24, 2013
Agenda Item Number
16.A.1�
1.
Does the document need to be sent to another agency for additional signatures? If yes,
/
Type of Document
Change Order
Number of Original
1
3. County Attorney Office
County Attorney Office]
Documents Attached
J ?
4. BCC Office
Board of County
Commissioners
X
5 Minutes and Records
Clerk of Court's Office
rN
to be recorded
I 03%
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 mav need to contact staff for additional or missing information.
Name of Primary Staff
June Lehmann/Transportation Engineering
Phone Number
252 -5834
Contact / Department
appropriate
(Initial)
Applicable)
Agenda Date Item was
September 24, 2013
Agenda Item Number
16.A.1�
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
/
Type of Document
Change Order
Number of Original
1
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
signed by the Chairman, with the exception of most letters, must be reviewed and signed
X
number if document is
by the Office of the County Attorney.
to be recorded
All handwritten strike - through and revisions have been initialed by the County Attorney's
N/A
INSTRUCTIONS & CHECKLIST
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
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?
X
2.
Does the document need to be sent to another agency for additional signatures? If yes,
X
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
signed by the Chairman, with the exception of most letters, must be reviewed and signed
X
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
X
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
X
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
N/A
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 9/24/13 (enter date) and all changes
X
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
lip
BCC, all changes directed by the BCC have been made, and the document is ready for the
&
C hairman'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
16A13
MEMORANDUM
Date: October 3, 2013
To: June Lehmann, Operations Coordinator
Transportation Engineering
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Change Order No. 4 to Contract #12 -5820R with
ZEP Construction, Inc. to complete White Boulevard
Bridge Replacement Project 66066
Attached for your records is a copy of the document referenced above, (Item #16A13)
approved by the Board of County Commissioners on Tuesday, September 24, 2013.
The Minutes and Record's Department has held the original copy for the Board's
Official Record.
If you have any questions, please call me at 252 -8406.
Thank you.
Attachment
CHANGE ORDER NOA-
TO:Mr. Rade Vujaklija
ZEP Construction, Inc.
7802 Jean Blvd.
Ft. Myers FL 33967
DATE: September 10, 2013
RECEIVED 6A13
onia
CHANGE ORDER S E P 11
T.E. & C.M. Dept-)
CONTRACT NO. 12 -5820R
BCC Date: 9/11/12
Agenda Item: 11 B
PROJECT NAME: White Blvd Bridle Replacement
PROJECT NO.: 66066
Under our AGREEMENT dated September 11, 2013, you are directed to move funds from the
ALLOWANCES to various ITEMS to cover over runs (See Attachment A).
FOR THE Sum o£ $0 Zero dollars.
Original Agreement Amount $1,982,066.74
Sum of Previous Changes $0
This Change Order $0
Present Agreement Amount $1,982,066.74
The time for completion shall be increased by 0 calendar days due to this Change Order.
Accordingly, the Contract Time is now 285 calendar dayVour e substantial completion date is July 19,
2013 and the final completion date is August 19, 2013. 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.
Prepared by:, _
/ i� Date: r'
Kevin Dugan, ct M er
Transportation n/.V/, giineering Department
Accepted By: G�-- Date:
P
Rade Vujaklija, Pr ' ct M er
ZEP Construction, Inc. Q
Approved by: Date: / J%-
Steve Ritter, Road Construction Manager
Transportation Engineering Department
-APPro -ed bv: --- - Date:
a Ahmad Direc r
Y >
Transpo tion Engineering Department
Approved Date:
C al a, mistrator
Approved by:
Growth anageme ivisi
Date.
nda Cummins, r cureme Strategi
16A13
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.
r :
Accepted: �x� �l 20 3
ATTE:S d' OWtGeoi
BOA TY O MISSIONERS
t E. Brai cie COL �[N Y, DA
.;
e5� �S.'�O��YaItIYk1Ci� By
A. iller, Esq., Chairwoman
,�i�rtatuCe onFy:��`
Approved as to form and
Legal'sertc .
,9ssief&rrrCounty Attorney
%µ�
2
Accelerated Bridge Construction, Project #66066
Change Order #4 Description
Part I
Roadwa Items
16�i3
Transfer $125,000.00 from Bridge Items Allowance to Roadway Items Allowance to cover
overruns
Delete From Existing Pay Items
CC- 950 — BRG — Bridge Items Allowance 1 LS @ $150,000.00 = ( +) $125,000.00
Revised Allowance $150,000.00 $(125,000.00) = $25,000.00
Balance to date $25,000.00
Add to Existing Pa. Items
CC- 950 -RDW — Roadway Items Allowance 1 LS @ $27,468.00 = + $125,000.00
Revised Allowance $27,468.00 + $125,000.00 = $152,468.00 f'/
Balance to date $152,468.00
TOTAL = $0.00
Part II
Bridge Items
Transfer $21,326.00 from Bridge Items Allowance to Items 400 -2 -4, 455 -34.3 and 530 -1, to
cover overruns
16A13
Delete From Existing _Pay Items
CC- 950 — BRG — Bridge Items Allowance 1 LS @ $25,000.00 = ( +) $21,326.00
Revised Allowance $25,000.00 $(21,326.00) = $3,674.00
Balance to date $3,674.00
Add to Existing Pay Items
400 -2 -4 — Concrete Class II, Superstructure Sidewalk = + $9,360.00
Original Quantity: 50 CY
Increase Quantity by: 12 CY x $780.00
Revised Quantity: 62 CY
Increase Existing Pay Item 400 -2 -4: $39,000.00 + $9,360.00 =
Revised Contract Amount: $48,360.00
455 -34 -3 — Prestressed Concrete Piling = + $11,880.00
Original Quantity: 2240 LF
Increase Quantity by: 132 LF x $90.00
Revised Quantity: 2372 LF
Increase Existing Pay Item 455 -34 -3: $201,600.00 + $11,880.00 =
Revised Contract Amount: $213,480.00
530 -1 — Riprap — Sand — Cement = + $86.00
Original Quantity: 60 CY
Increase Quantity by: .20 CY x $430.00
Revised Quantity: 60.20 CY ✓ �/
Increase Existing Pay Item 530 -1: $25,800.00 + $86.00 =
Revised Contract Amount: $25,886.00
Subtotal Bridge Items: j� = + $21,326.00
TOTAL = $0.00
Roadwa. Items
16A13
Transfer $84,492.92 from Roadway Items Allowance to Items 104 -11, 110 -7 -1, 334 -1 -13, 337 -7-
32, 350 -1 -1, 520 -2 -41, 522 -2, 530 -3 -4 and 530 -78 , to cover overruns
Delete From Existing Pay Items
CC- 950 — RDW — Roadway Items Allowance 1 LS @ $152,468.00 = ( +) $90,476.18
Revised Allowance $152,468.00 $(84,492.92) _ $61,991.82
Balance to date $61,991.82
Add to Existing Pa. Items
104 -11 — Floating Turbidity Barriers = + $594.50
Original Quantity: 518 LF
Increase Quantity by: 82 LF x $7.25 `! /
Revised Quantity: 600 LF V
Increase Existing Pay Item 104 -11: $3,755.50 + $594.50 =
Revised Contract Amount: $4.350.00
110 -7 -1 — Mail Box. F &I Single = + $186.62
Original Quantity: 6 EA
Increase Quantity by: 1 EA x 186.62
Revised Quantity: 7 EA
Increase Existing Pay Item 110 -7 -1: $1,119.72 + $186.62 =
Revised Contract Amount: $1,306.34
334 -1 -13 — Super Pave Asphalt = + $43,337.64
Original Quantity: 341 TN
Increase Quantity by: 353.2 TN x $122.70 /
Revised Quantity: 694.2 TN r/
Increase Existing Pay Item 334 -1 -13: $41,840.70 + $43,337.64 =
Revised Contract Amount: $85,178.34
337 -7 -32 — Friction Course Asphalt
Original Quantity: 114 TN
_ + $5,353.39
Increase Quantity by: 31 TN x $172.69
Revised Quantity: 145 TN V
Increase Existing Pay Item 337 -7 -13: $19,686.66 + $5,353.39 =
Revised Contract Amount: $25,040.05
3 50-1 -1 — Cement Concrete Pavement
16A13
_ + $6,645.12
Original Quantity: 344 SY
Increase Quantity by: 159.7 SY x $41.61
Revised Quantity: 503.7 SY
Increase Existing Pay Item 350 -1 -1: $14,313.84 + $6,645.12 = V/
Revised Contract Amount: $20,958.96
520 -2 -41 — Drop Curb = + $12.50
Original Quantity: 64 LF /
Increase Quantity by: 1 LF x $12.50
Revised Quantity: 65 LF
Increase Existing Pay Item 520 -2 -41: $800.00 + $12.50 =
Revised Contract Amount: $812.50
522 -2 — Concrete Sidewalk = + $5,983.26
Original Quantity: 301 SY
Increase Quantity by: 129.62 x $46.16
Revised Quantity: 430.62
Increase Existing Pay Item 522 -2: $13,894.16 + $5,983.26 =
Revised Contract Amount: $19,877.42
530 -3 -4 — Rip -Rap Rubble
/ _ + $25,808.56
Original Quantity: 293 TN
Increase Quantity by: 468.65 TN x $55.07
Revised Quantity: 761.65 TN
Increase Existing Pay Item 530 -3 -4: $16,135.51 + $25,808.56 =
Revised Contract Amount: $41,944.07
530 -78 — Rip -Rap Articulating Block
Original Quantity: 281 SY
Increase Quantity by: 20.7 SY x $123.41
Revised Quantity: 301.7 SY
_ + $2,554.59
16A13
Increase Existing Pay Item 530 -78: $34,678.21 + $2,554.59 =
Revised Contract Amount: $37.232.80
Subtotal Roadway Items: = + $90,476.18
TOTAL ROADWAY = $0.00
Signing and Pavement Markinsz Items
Transfer $284.02 from Signing & Pavement Marking Items Allowance to Items 706 -3, 711 -11-
I I I and 711 -11 -211 , to cover overruns
Delete From Existing Pa. Items
CC- 950 — SPM — Signing & Pavement Items Allowance 1 LS @ $612.00 = ( +) $284.02
Revised Allowance $612.00 $(284.02) = $327.98
Balance to date V $327.98
Add to Existing _Pay Items
706 -3 — Retro Reflective Pavement Markings
Original Quantity: 44 EA
Increase Quantity by: 4 EA x $5.68
Revised Quantity: 48 EA
Increase Existing Pay Item 706 -3: $249.92 + $22.72 —
Revised Contract Amount: $272.64
711 -11 -111 — Thermoplastic Pavement Markings (White)
Original Quantity: 0.32 NM
Increase Quantity by: 0.02 NM x $5,226.07
Revised Quantity: 0.34 NM x $5,226.07
Increase Existing Pay Item 711 -11 -111: $1,672.34 + $104.52 =
Revised Contract Amount: $1.776.86
= + $22.72
= + $104.52
16A13
711 -11 -211 — Thermoplastic Pavement Markings (Yellow) _ + $156.78
Original Quantity: 0.32 NM
Increase Quantity by: 0.03 NM x $5,226.07
Revised Quantity: 0.35 NM
Increase Existing Pay Item 711 -11 -211: $1,672.34 + $156.78 =
Revised Contract Amount: $1.829.12
Subtotal Roadway Items: _ + $284.02
TOTAL SIGNING & PAVEMENT = $0.00
Net amount of Notification #4 = $0.00
Cotner County
Adm nisItaiive dices Division
Purchasing
® Contract Change Request
16A13
Purchasing Department
Change Modification Form
❑ Work Order Modification
Contract #: 12-
Change#: 4
PO/Work Order #:
Project Name: White Blvd Bridge
5820R
$ 1,982,066.74
4500139885
Replacement
Project #: 66066
Project Manager: Kevin
Department: Transportation
Contractor /Firm Name: ZEP
Dollar Amount of this Change
Dugan
Construction M mt
Construction
Original Contract/Work Order Amount
$ 1,982,066.74
9/11//12
Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount
$ 1,982,066.74
N/A
Last BCC Approval Date; Agenda Item #
Current Contract/Work Order Amount
$ 1,982,066.74
submitting for approval (this box must be initialed by Project Manager)
SAP Contract Expiration Date (Master)
Dollar Amount of this Change
$0.00
® Other (specify): Balance
0.00%
Total Change from Original Amount
Revised Contract/Work Order Total
$1,982,066.74
1. Provide a detailed and specific explanation of the requested change(s) to the task(s): Several items were
0.00%
Change from Current BCC Approved Amount
Cumulative Changes
$0.00
3. Provide explanation why change was not anticipated in original scope of work: The overruns arose due to
0.00%
Change from Current Amount
Completion Date, Description of the Task(s) Change, and Rationale for the Change
Original completion date: July 5,
Last approved completion date:
Revised completion date (includes this
2013
August 19, 2013
change): August 19, 2013
Number of days added: 45
Each step on the contract modification checklist form has been reviewed prior to me
Purchasing Professional Participated in Negotiation of Change / Modification: ❑ Yes ❑ No
submitting for approval (this box must be initialed by Project Manager)
Add new task(s)
❑ Change task(s)
Delete task(s)
® Other (specify): Balance
Overruns
1. Provide a detailed and specific explanation of the requested change(s) to the task(s): Several items were
overrun in Road items. Funds need to be transferred from the Bridge Allowance to cover the overruns in Road items.
2. Provide detailed rationale for the requested change: A change order is required to move funds between
separate allowance items within the same contract to properly reflect final quantities of items used in the construction
project. An overall savings of $102,726.27 was achieved from the original contract amount for the project.
3. Provide explanation why change was not anticipated in original scope of work: The overruns arose due to
conditions encountered in the field.
4. Describe the impact if this change is not processed: The contractor will not receive compensation for work that
was necessary to complete the project.
Type of Change / Modification
1. Planned / Elective
® 2. Unforeseen conditions /circumstance
I ❑ 3. Quantity or price adjustment
4. Correction of errors
❑ 5. Value added
I ❑ 6. Schedule adjustment
Change Requested By
❑
Contractor /Consultant
® Owner
I ❑ Using Department
❑
Design Professional
❑ Regulatory Agency (specify):
❑ Other(specify):
Purchasing Professional Participated in Negotiation of Change / Modification: ❑ Yes ❑ No
Revised: 7/27/11
1
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V ./
U
3
Revised: 7/27/11