Backup Documents 05/28/2019 Item #16A 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 S
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 SRT 7/16/19
4. BCC Office Board of County 1Z\--P'1
Commissioners y14-4/ '1...\\\ \
5. Minutes and Records Clerk of Court's Office �i c
/link 'f 144
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 Mario Puente/Transportation Engineering Contact Information 239-252-5828
Contact/Department
Agenda Date Item was May 28,2019 Agenda Item Number 16A
Approved by the BCC
12G3Type of Change Order No. 1 with Jacobs Number of Original 1
Document Attached Engineering Group, Inc., (formerly CH2M Documents Attached
Hill Engineers,Inc.),to add 730 days to the
project schedule for design and post-design
services on Project No. 66066.14,"Palm
River Boulevard Bridge Replacement."
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS KLIST
Initial the Yes column or mark"N/A"in the Not Applicable olumn,whi hever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signat re STAMP OK —SRT -
2. Does the document need to be sent to another agency for additional signat s? If yes, SRT
provide the Contact Information(Name;Agency;Address; Phone)on 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!
on
8. The document was approved by the BCC on 05/28/2019 and all changes made during SRT •
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 /
Chairman's signature. , o
QF,� c,3,kN(\ n - Tc
16 A5'
Ann P. Jennejohn
From: Ann P. Jennejohn
Sent: Thursday,July 18, 2019 8:19 AM
To: PuenteMario
Subject: Item#16A5 (May 28, 2019 BCC Meeting)
Attachments: Backup Documents 05_28_2019 Item #16A5.pdf
Good Morning Mario,
An executed copy of the change order, (Itevvi #16A5) approved
at the May 28, 2019 13CC Meeting, is attached for your records.
Thank you!
ror. Ann Jennejohn
BMR Senior Deputy Clerk
Clerk to the Value Adjustment Board
Office:239-252-8406
Fax:239-252-8408(if applicable)
Ann.Jennelohn@CollierClerk.com
Office of the Clerk of the Circuit Court
&Comptroller of Collier County
3299 Tamiami Trail,Suite#401
Naples, FL 34112-5324
www.CollierClerk.com
1
irk
Procurement Services
.erC.UE4fltty Change Order Form
0: Contract Modification 0 Work Order Modification 0 Amendment
Contract#; 16-7011 Change#: 1 JPurchaseorder#:1 4500185272 Project#: 66066.14
Contractor/Firm Name: CH2M Hit Engineers,Inc.(Jacobs) Contract/Project: Palm River Boulevard Bridge Replacement
Project Manager Name: Mario A.Puente Division Name: Transportation Engineering Division
Original Contract/Work Order Amount $ 580,680,00 119/18 1 , 16 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $ 560,680.0 1/9/18 16A16 Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 560,680.00 SAP Contract Expiration Date(Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 560,680.00 0.00% Change from Current BCC Approved Amount
Cumulative Changes $ 0.00 0.00% Change from Current Amount
Completion Date,Description of the Task(s)Change,and Rationale for the Change
Notice to Proceed 3/5/2018 Original 5/29/2019 Last Approved 5/29/2019 Revised Date 5/28/2021
Date Completion Date Date f (Includes this change)
#of Days Added 730 Select Tasks 0 Add new task(s) 0 Delete task(s) 0 Change task(s) ►,.rA Other(see
below)
Provide a response to the following:1.)detailed and specific explanation/rationale of the requested change(a)to the task(s)and/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. This change order is to add an additional 730 days to the project schedule. Per Articles 3.8-"Post Design Services"and
3,12-"Other Project General Tasks"of the project's Scope of Work,the Consultant shall provide services during
construction which include bidding assistance,construction meeting preparation and attendance,construction assistance,
field reviews,response to contractors requests for information,shop drawing review,survey services,as-built drawing reviews
and project completion certifications.
2, The additional days requested for services during construction were not included in the original contract time because the
construction schedule for the project was not known at the time the original contract was executed,The intent was to add
sufficient contract time once the County determined a construction schedule for the project.
3. If this modification is not processed for time,the Consultant will not have a contract mechanism to provide the previously
contracted services during construction and will not be able to assist County staff as necessary during the planned
construction of the project.
977 ..,
Prepared by:_ Date:
h /f
Mario A('Puente P.E.,CGC,Senior Project Manager
Revised;10/28/2014 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
CC
Admin R BCC ES
I
f
Acceptance of this Change Order shall constitute a modification to contract!work order identified above 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/Vendor/Consultant/
Design Professional arising out of or related to the change set forth herein,including claims for Impact and delay costs.
I t�
Accepted by.--. 1.' "i Date:-.`t`f' /` 9
(Contractor I Vendor/Consultant/Design Professional and Name of Firm,if project applicable)
,fit.A.M, A.y, q nI L�
Approved by: ,ii, .rr "ate- "� f
Jay•••• a.,Divi-,if Director
fj /
Approved by: , I/. (.� Date — 'z i/
Cl
Tha deus Cohen,Department Head
Digitally signed by
SChneebergerSara SchneebergerSara
Date:2019.04.12 14:26:08-04'00'
Approved by: Date:
(Procurement Professional)
BOARD OF C 0 UNTY COMMISSIONERS
Item# gaitS
COLLIER" ', -, I RIDA
Agenda O,'
Gate 01�'�, C..� v-... !_
Date / , ,1'1 � Wi11� zg
• L.McDaniel,Jr.,Chairm,n S ,��ci
Recd IN ,
„1
,ref
deputy lark 4 4
/-(r 'l 1 •' ''.0
c AV t ;�K1NZEl~,CLERK
`$� �¢.T.ttr, ;pprov r as t d legality ;
111
re Attes h ,"a $ Sc. r."
a&.` each, Deputy County Attorney
i
Revised.10/2812014 (Divisions who may require additional signatures may Include on separate sheet.) .Ta1 aewerrt useoNur 1
1 P. Admin Rpt BCC 1 (ICC Es