Agenda 10/27/2020 Item #16E 4 (Administrative Reports)10/27/2020
16. E.4
EXECUTIVE SUMMARY
Recommendation to approve the administrative reports prepared by the Procurement Services
Division for change orders and other contractual modifications requiring Board approval.
OBJECTIVE: To promote accountability and provide transparency to the public and gain the
Board's approval/ratification for various procurement -related transactions.
CONSIDERATIONS: In accordance with the Board's Procurement Ordinance 2017-08 and the
Procurement Manual, the Procurement Services Division produces a regular administrative report which
provides for Board approval of the following transactions:
• Change Orders that do not exceed ten (10%) of the current Board approved aggregate amount,
and/or require change in schedule (number of days);
• Amendments to contracts;
• After the fact memos from various County Divisions, as requested by the Clerk's Finance staff
for the timely process of invoices.
• Other items as determined by the County Manager or designee that require Board approval.
This administrative report includes the following:
• One (1) change order that in aggregate modify contracts by $0.00 and add 28 calendar days to
completion periods, see attached summary and backup for details; and
• Zero (0) amendments this period with a fiscal impact of $0.00; and
• Three (3) after the fact memos with a fiscal impact of $962.02 for additional services
FISCAL IMPACT: The net total for the four (4) items is $962.02.
LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority
vote for Board action. -JAK
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this
action.
RECOMMENDATION: To ratify/approve change orders and/or contract amendments and other items
as determined by the County Manager or designee in accordance with Procurement Ordinance 2017-08.
Prepared By: Sara Schneeberger, Procurement Strategist, Procurement Services
ATTACHMENT(S)
1. 1027 Change Order Report - FY21 (PDF)
2. 1027 Change Order Backup - FY21 (PDF)
3. 1027 After the Fact Report - FY21 (PDF)
4. 1027 After the Fact Backup - FY21 (PDF)
Packet Pg. 1682
16. E.4
10/27/2020
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.4
Doe ID: 13879
Item Summary: Recommendation to approve the administrative reports prepared by the
Procurement Services Division for change orders and other contractual modifications requiring Board
approval.
Meeting Date: 10/27/2020
Prepared by:
Title: Business Technology Analyst, Senior — Procurement Services
Name: Sara Schneeberger
10/09/2020 12:13 PM
Submitted by:
Title: Manager - Procurement — Procurement Services
Name: Sandra Herrera
10/09/2020 12:13 PM
Approved By:
Review:
Procurement Services
Administrative Services Department
Procurement Services
Procurement Services
Administrative Services Department
Office of Management and Budget
Office of Management and Budget
County Attorney's Office
County Manager's Office
Board of County Commissioners
Opal Vann
Level 1 Purchasing Gatekeeper
Paula Brethauer
Level 1 Division Reviewer
Catherine Bigelow
Additional Reviewer
Sandra Herrera
Additional Reviewer
Len Price
Level 2 Division Administrator Review
Laura Wells
Level 3 OMB Gatekeeper Review
Laura Wells
Additional Reviewer
Jeffrey A. Klatzkow
Level 3 County Attorney's Office Review
Nick Casalanguida
Level 4 County Manager Review
MaryJo Brock
Meeting Pending
Completed
10/09/2020 12:15 PM
Completed
10/09/2020 1:58 PM
Completed
10/12/2020 8:25 AM
Completed
10/12/2020 1:36 PM
Completed
10/14/2020 3:53 PM
Completed
10/15/2020 11:21 AM
Completed
10/15/2020 11:21 AM
Completed
10/16/2020 11:36 AM
Completed
10/20/2020 3:06 PM
10/27/2020 9:00 AM
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c��� C�Omnt 1 Procurement S 16.E.4.b
Change Order Form
❑ Contract Modification ❑ Work Order Modification ❑ Amendment
70247.1,
Contract #: 19-7611 Change #: 1 Purchase Order #: 4500202742 Project M 70247.2
Contractor/Firm Name: PWC, LLC Contract/Project: F
US 41 North Water Main Replacement Phase II
Diana Dueri, PMP EPMD
Project Manager Name: Division Name:
Original Contract/Work Order Amount $ 2,488,340.00 11/12/19;11C Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 2,488,340.0 11/12/19;11C Last BCC Approval Date; Agenda Item #
Current Contract/Work Order Amount $ 2,488,340.0 5/11/2021 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 2,488,340.00 0.00% Change from Current BCC Approved Amount
Cumulative Changes $ 0.001 0.00% Change from Current Amount
Completion Date, Description of the Task(s) Change, and Rationale for the Change
Notice to Proceed 5/4/2020 Original 11/20/2020 Last Approved 11/20/2020 Revised Date 12/18/2020
Date Completion Date Date I (Includes this change)
# of Days Added 28 Select Tasks ❑ Add new task(s) ❑ Delete task(s) ❑ Change task(s) ® 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 / 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.
Additional Time — Covid-19
1. Add an additional 7 calendar days. As a result of a potential Covid-19 exposure by PWC crew members, PWC
quarantined their employees the week of the 18th of July.
2. This change was not included in the original contract because it was not anticipated that the Covid-19 pandemic
would occur during this contract.
3. Without the additional days, the Contractor would not be able to achieve substantial completion of the project and
the water main being replaced would not be operational for the Collier County Water Department and surrounding
water customers.
Work Directive #4
1. Add an additional 21 calendar days and subtract from the contract allowance an estimated $60,972.10.
2. This change was not included in the original contract because it was not anticipated that the existing asphalt
thickness was approximately 12-inches, which is abnormal. During construction it was determined by excavation
that the existing roadway asphalt within the FDOT ROW was approximately 12-inch thick. As a result of this
unforeseen condition, the FDOT was contacted and the FDOT provided direction that 7" of black base must be
installed to meet the equivalent roadway structural number that existed as a result of the existing thickened asphalt.
3. If this change is not approved, the construction will not follow FDOT requirements and the FDOT permit
associated with this project will not be able to be closed.
Revised: 10/28/2014 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin packet Pg. 1685
2 16.E.4.b
This Change increases the contract time by 28 calendar days. The monetary impact of this Change will
be confirmed once the installation takes place and is field verified at the time of installation by the on -site
construction engineering inspector.
This Change is to use $60,972.10 from the project allowance. This Change DOES NOT increase the
contract amount.
Beginning Allowance $200,000.00
Allowance Draw WD#4 $(60,972.10)
Remaining Allowance $139,027.90
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Prepared by:
Diana Dueri, Senior Project Manager EPMD
Date: 9/3/2020
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.
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Accepted by:
nit
Date:
BrettCarne — egional Manager PWC
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9-17-2020
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Approved by:
Date:
Justin rederiksen, Director of Utilities Q. Grady Minor
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9/17/2020
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Approved by:
Date:
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Benjamin Bullert_ Princinal Proiect Manaaer FMPD
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9/ 18/2020
Approved by:
Date:
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Ben Bullert for
Tom Chmelik, Director EMPD
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Digitally signed by Joseph Bellone
Joseph Bellone
Approved by:
Date: 2020.09.1816:03:48-04'00'
Date:
V
Joseph Bellone, Director Operations Division
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Dan Rodriguez Digitally signed by Dan Rodriguez
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Approved by:
Date: 2020.09.23 10:58:43 04'00'
Date:
George Yilmaz, Department Head Public Utilities
SchneebergerSara Digitally signed by SchneebergerSara
Approved by:
Date: 2020.10.07 10:52:16-04'00'
Date:
Procurement Professional
Q
09102020
Revised: 10/28/2014 (Divisions who may require additional signatures may include on separate sheet.)
PROCUREMENT USE ONLY
Admin BCC BCC ES
Packet Pg. 1686
3 16.E.4.b
4tPWC - Public Works Constructors
5256 Summerlin Commons Way Suite 203 Bldg. #2
Fort Myers, FL 33907
Phone: 239-270-5907
Fax: 239-270-5943
Collier County July 29, 2020
3339 Tamiami Trail East Suite 303.
Naples, FL 34112
Attn: Diana Dueri — Senior Project Mgr.
Re: Time Extension Request — COVID19 Shut Down
Ms. Dueri,
PWC was mandated to shut down the project the week of the 18'h of July due to a
possible COVID19 exposure. We are requesting a time extension of 7 calendar days.
Should you have any questions please feel free to contact me at your earliest
convenience.
Sincerely,
Public Works Constructors LLC
la�ft ��&L
Brett Carner
Florida Division Manager
Packet Pg. 1687
4
Collier County Engineering & Project Management Division
WORK DIRECTIVE CHANGE
CONTRACT # /PROJECT NAME:
#19-7611 US 41 North Water Main Replacement Phase II
PURCHASE ORDER #: 4500202742
OWNER: Collier County Board of Commissioners
CONTRACTOR: PWC Joint Venture, LLC
WORK DIRECTIVE # 4
DATE OF ISSUANCE: July 31', 2020
PROJECT#: 70247.1 /70247.2
ENGINEER/DESIGN PROFESSIONAL: Q. Grady
Minor & Associates, P.A.
You are directed to proceed promptly with the following change(s):
Description: To direct the Contractor to install 7" of black base at open cut trench restoration locations within US41 ROW
in lieu of limerock base as required by the FDOT.
Purpose of Work Directive Change: To adhere to the FDOT's requirements as a result of the existing asphalt within the
FDOT ROW being thicker than typical and assumed in the contract documents.
Reason/Justification: During construction it was determined by excavation that the existing roadway asphalt within the
FDOT ROW was approximately 12-inch thick. As a result of this unforeseen condition, the FDOT was contacted and the
FDOT provided direction that 7" of black base must be installed to meet the equivalent roadway structural number that
existed as a result of the existing thickened asphalt. The existing thickened asphalt requires additional resources for
removal. Additionally, black base will replace limerock base for open cut restoration. The removal of the thickened
asphalt and installation of the 7" of black base have been estimated at $36,763.85, but the actual amounts will be field
verified at the time of installation. Additionally, as 7" black base will be installed, there it is no longer necessary to install
the contract required limerock base. This will result in a reduction in the limerock base quantity payment item (Unit Price
= $20.00/SY, Total Cost = TBD, based on actual quantities installed and field verified).
Attachments: Quote and Time Extension Request from PWC
If a claim is made that the above change(s) have affected Contract/Allowance Price or Contract Times any
claim for a Change Order based thereon will involve one or more of the following methods of determining the
effect of the changes(s).
Method of determining change in
Contract/Allowance Price:
❑ Unit Prices
❑ Lump Sum
® Time & Material
❑ Other
Estimated increase (decrease) in Allowance
$ TBD
RECOM 1DED:
By:
ustin Frederiksen, P.E.
Project Engineer
Method of determining change in Contract Times
❑ Contractor's records
❑ Engineer's record
❑ Other
E ated change in Contract Time:
Increase r decrease by 21 calendar days.
AUTHORIZED:
By: d-�
Diana Dueri, PMP
Owner's Representative
09 Packet Pg. 1688
5
4tPWC - Public Works Constructors
5256 Summerlin Commons Way Suite 203 Bldg. #2
Fort Myers, FL 33907
Phone: 239-270-5907
Fax: 239-270-5943
Collier County July 29, 2020
3339 Tamiami Trail East Suite 303.
Naples, FL 34112
Attn: Diana Dueri — Senior Project Mgr.
Re: Time Extension Request — Added Depth Asphalt
Ms. Dueri,
As you are aware PWC has encountered Asphalt more than 16" deep in many locations.
PWC began excavation for our pipe bursting Subcontractor and encountered the thickened
asphalt which slowed our progress. The pipe bursting was delayed 1 day at each intersection of
93rd 951h981h and 100'h Avenues.
In addition to this work PWC was delayed 1 day at each lateral location 5 of which are
completed and 1 remaining to complete (7-Eleven). PWC also is requesting 5 days to place the
additional asphalt. The total request is for 21 calendar days for delays in performance of our
work. PWC trusts that this will not be an issue since the additional asphalt depth is considered a
change and pricing for this work is forthcoming under separate cover.
Should you have any questions please feel free to contact me at your earliest
convenience.
Sincerely,
Public Works Constructors LLC
OIA&
Brett Carner
Florida Division Manager
16.E.4.b
Packet Pg. 1689
6 16.E.4.b
itPWC Joint Venture, LLC.
5256 Summerlin Commons Way Suite 203
Bldg #2
Fort Myers, FL 33907
(239)270-5907 Office
(239)270-5943 Fax
PROJECT NAME: US 41 Watermain Replacement Phase II CONTRACT Y19-7611
PROJECT NO: Y19-7611 PWC JOB NO. 2019-05
GENERAL CONTRACTOR: PWC Joint Venture DATE: 8/26/2020
DESCRIPTION OF CHANGE: black base 7" required to be reinstalled per FDOT
Approx 15 areas have thickened asphalt- pricing is for added removal and labor, equipment and
asphalt subcontractor
PWC Direct Costs
Additive Costs
A Labor 13,524.00
B Material 2,000.00
C Equipment 4'575.00
D Subtotal of Additive Cost F $20,099.00
Deductive Costs (use minus sign to denote negative figures)
E Labor 0.00
F Material 0.00
G Equipment 0.00
H Subtotal of Deductive Cost 0.00
I Contractor's Total Direct Cost (D+H) 20 0099.00
J General Contractor's Mark-up 2,009.90
10% markup
K ITotal PWC Direct Costs + Mark-up (Line I + J) $22,108.90
L Total Subcontractor Direct Costs - per ton black base asphalt cost to be measured at each area $35,212.00
estimated 200 tons of asphalt total @ $176.06 per ton
M General Contractor's Mark-up on Subcontractor Direct Costs $3,521.20
5% Markup
N Subtotal $60,842.10
Tax
$130.00
O Total PWC Change Request (Line K + L + M + N) $60,972.10
To the best of my knowledge and belief, 1 certify that all costs listed above are correct.
812612020
Contractor Signature Date
7
16.E.4.b
ame
uassitication LAt3UK GUST
Hrly Rate Hrs/Unit
Total Cost
Richard
Superintendent $63.00 60.00
$3,780.00
-------------- --------------•-
y�
------ -------}-------------- F------------- 1
Hillario
Foreman ; $43.50 ; 60.00 ;
$2,610.00
---------------- ------------------------------------------------------
Dennis
T-------------- r---------- - 0 .
Operator ; $36.25 ; 60.00 ;
$2,175.00
---------------- ---------------------------
Juan----------------
Layer I $2---- ; 60.00 ;
$1,653.00
Emillo
----------Pipe
Pipe Layer I $27.55 I 60.00 I
$1,653.00
-------------- --------------------•-------------
Antonia
--- -------------1--------------L-------------
Pipe Layer $27.55 I 60.00
$1,653.00
-------------- --------------
--------------------------------------
- -------------- --------------4 -------------- F----------- -- 1
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•------------------------------- T--------------r-------------
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1 1 I
--------------------------------------
______________________________________._______________________________1
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--------------------------------------•-------------------------------
;LABOR ;TOTAL ;
I I 1
$13,524.00
MATERIAL
I I 1
Description IQty
---------- `Price--------
fees
hauling of asphalt to Dump 5.00 $400 00 I
$2,000.00
----------dumpster
-------- --
-i---- ----------L-------------- --------------------
0.00I $0.00I
$0.00
--------------------------------------
--------------------------------------
------------------------------- T-------------- r--------------
0.00 ; $0.00 ;
-------------------------------- T-------------- r--------------
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$0.00
-------------------
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.------------------------------- T______________F------------- Y--------------------
1 1 1
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RIA
-------------------------------1 MAT E---- TOTAL
--- L-------------1
$2,000.00
-------------------
EQUIPMENT
I 1 1
jjI 1 1
Description
,
Mini Excavator
takeuchi 28 ; 60.00 ; 36.25 ;
$2,175.00
--------------------------------------'-------------------------------+--------------r----------------------------------
Loader
S60 I 60.00 ; 35.00 I
+I--------------+-------------------
$2,100.00
---------------- ------------------------------------
----------- Asphalt Saw----------- -
------------------ --------------
walk behind I ------ 6- 00-�-------- 5_00-L-
---------------- ---- 1-
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----------$300. 0
------ 0
•-------------------------------------•-------------------------------T--------------r-------------T-------------------
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.------------------------------- T-------------- r-------------Y-------------------
;_EQUIPMENT ;TOTAL ; $4,575.00
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Co1Lie-r County Collier County
Administrative Services Department After the Fact Form
Procurement Services Division
Instructions
As per section 21 of the Procurement Manual, all purchases shall be consistent and in compliance with the Procurement
Ordinance (2017-08). Should work be authorized or purchases made that is inconsistent with County policy, procedure, or
contract terms, an After -the -Fact Procurement Form is required. This includes purchases made in advance of a Purchase Order,
when a Purchase Order is required to authorize such activity, and purchases made under an expired contract, or for goods and
services not covered by the current contract or purchase order. All such `After the Fact Procurements" will be reported to the
County Manager.
Requester Name: Jen Reynolds
Division: Corporate Business Operations
Division Director: Sean Callahan
Vendor Name: ECOIab
Amount: $962.02
Contract #:
Purchase Order: 4500199677
Why is this deemed a non -compliant purchase? Choose one.
Contract
Ordinance
Manual ❑
P-Card ❑
Other
Details of Purchase: Explain the circumstances behind this purchase.
Collier County assumed control of the Immokalee Culinary Accelerator in July 2019, after
equipment had been installed and been in use for several months. Certain supplies for the
dispensers can only be purchased from the original vendor, as the products are calibrated for
those specific dispensers. The Culinary Accelerator had a Purchase Order created at the
beginning of FY20 in which to order supplies, but after a discussion with Procurement and
Finance, it was determined that in order to continue purchasing these specific items, a waiver
needed to be completed. Before the waiver could be completed and signed by Procurement,
staff at the Culinary Accelerator purchased additional supplies.
Action Required: What are you asking to be done to remedy the situation, include list of invoices if applicable?
We are requesting the invoice 6255644574 in the amount of $962.02 be paid, as the materials
have been delivered and used.
Corrective/Preventive Action: What action is being taken to prevent this violation from re -occurring?
A review of County and Division purchasing procedures was had with staff and they were given a
list of approved County vendors to use for certain other supplies. Accounts were created with
County vendors of Office Depot and Grainger to purchase non-specific items. Procurement
approved a waiver on September 21, 2020 for the proprietary supplies necessary for the
dispensers.
The requestor affirms that to the best of their knowledge the information provided in this document is true.
Requested by: Jen Reynolds
Digitally signed by
Signature: ReynoldsJennifer RaynoldsJennlfer
Date: 2020.09.10 15.47.16-04'00'
Date:
Division Director: Sean Callahan
Digitally signed by Callahan Sean
Signature: Callahan can Date: 2020.09.2811:4611-01
Date.
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: invoice Date-
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CULINARY ACCELERATOR
05/21/2020
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IMMOKALEE FL 34142-3a33
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Mode of Transportation: Road
IMMaKALEE FL 34142-3833
Payment Due Date: OU2012020
Payment Terms: Due within 30 days net
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Total Weight, 1gz.202 Ibs
Sub Total
891.27
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Invoice Notes'
Min.Order Chg-Weight
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Total Before Taxes
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Sales Tax
0.00
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For questions please contact Customer Service INSTITUTIONAL at 800-352-5326
PAYMENT DUE US 962.02
Unit price includes the rental fee for any dispensing equipment that may be provided by ECOLAB for the exclusive use of ECOLAB products. Al such
ume as customer has consumed all ECOLAB products and fails to timely reorder the ECOLAB product, the rental agreement shaU terminate, and
ECOLAS will take possession of such dispensers- ECOLAB agrees to provide all servicing, repair and maintenance of such dispensers or replace
any dispenser rendered unusable through normal use and wear. Packet Pg. 1695
4
kr C.ozMty
+4&vM1"altve $ervioes Depar"m
PrawmmmN Services DrAs n Instructions
Collier County
After the Fact Form
1 6.E.4.d
As per section 29 of the Procurement Manual, all purchases shall be consistent and in compliance with the Procurement
Ordinance (2017-08), Should work be authorized or purchases made that is inconsistent with County policy, procedure, or
contract terms, an After -the -Fact Procurement Form is required. This includes purchases made in advance of a Purchase Order,
when a Purchase Order is required to authorize such activity, and purchases made under an expired contract, or for goods and
services not covered by the current contract or purchase order. All such After the Fact Procurements" will be reported to the
County Manager.
Requester Name: Roosevelt Leonard Division: Facilities Management
Division Director: Damon Grant VendorName: Carroll and Carroll
Amount, 3,000
1Contract #: 18-7482
Purchase Order: 4500204368
Why is this deemed a non -compliant purchase? Choose one.
Contract ® FOrdt ance iWantral P Card i' Other O
Details of Purchase: Explain the circumstances behind this purchase
The Real Property Section was asked to obtain an appraisal report update on a previous
appraisal project that Carroll and Carroll had performed. The previous purchase order had
expired and a direct select form should have been obtained.
Action Required: What are you asking to be done to remedy the situation, include list of invoices if applicable?
Pay the vendor invoice 5466-TS in the amount of 3,000 dollars for appraisal services for the
Hyde Park Developers agreement.
Corrective/Preventive Action: What action is being taken to prevent this violation from re -occurring?
Real Property will obtain 3 vendor quotes on all expired Purchase orders or fill out the direct
select form as required.
The requestor affirms that to the best of their knowledge the information provided in this document is true.
Requested by: Roosevelt Leonard
Signature: �
Date: 9/30/2020
Division Director: Damon Giant
Signature:
Date- 9/30/2020
Packet Pg. 1696
5
Carroll & Carroll
Real Estate Appraisers & Consultants
August 5, 2020
VIA E-MAIL
Collier County Board of County Commissioners
Attn: Accounts Payable
3299 Tamiami Trail E., Suite 700
Naples, FL 34112-5749
bccapclerk@collierclerk.com
RE: Invoice for Appraisal Services
PO Number: 4500204368
Hyde Park Village - Appraisal
Invoice #5466-TS
Inspection, research, analysis, appraisal, preparation & delivery of reports
Amount Due $3,000.00
Less: Retainer in Advance 0.00
Balance Due $3,000.00
Use Pay Now button on our web site home page, or make check payable to:
CARROLL & CARROLL
Federal Tax Number 82-3601952
Please return one copy of this statement if you pay by check
FULL PAYMENT DUE IN 30 DAYS
After 30 days outstanding balances accrue interest at the maximum allowable rate.
Packet Pg. 1697 1
16.E.4.d
Colli6 e-r Cou"ty Collier County
Administrative Services Department After the Fact Form
Procurement Services Division
Instructions
As per section 21 of the Procurement Manual, all purchases shall be consistent and in compliance with the Procurement
Ordinance (2017-08). Should work be authorized or purchases made that is inconsistent with County policy, procedure, or
contract terms, an After -the -Fact Procurement Form is required. This includes purchases made in advance of a Purchase Order,
when a Purchase Order is required to authorize such activity, and purchases made under an expired contract, or for goods and
services not covered by the current contract or purchase order. All such `After the Fact Procurements" will be reported to the
County Manager.
Requester Name: Tim Ryglel
Division: Facilities Management
Division Director: Damon Grant
vendor Name: Capital Contractors LLC
Amount: $73,500.00
Contract #:19-7525
Purchase Order:4500203363
Why is this deemed a non -compliant purchase? Choose one.
Contract W]
Ordinance
Manual ❑
P-Card ❑
Other ❑
Details of Purchase: Explain the circumstances behind this purchase.
This project was to create ten penetrations in the exterior chiller yard walls and install louvers to
allow for proper ventilation for new 300 ton chillers.
There was poor communication from the sub -contractor claiming delays due to COVID-19 which
resulted in not processing a change order to add additional contract time prior to the expiration of
the notice to proceed.
Action Required: What are you asking to be done to remedy the situation, include list of invoices if applicable?
Please authorize payment of invoice# Inv _125_cc100295_P04500203363_PAl — FINAL in the
amount of $73,500.00. A copy of the invoice is attached.
Corrective/Preventive Action: What action is being taken to prevent this violation from re -occurring?
Project Manager will take corrective action to assure change order is submitted in a timely
manner
The requestor affirms that to the best of their knowledge the information provided in this document is true.
Requested by: Tim Ryglel
Digitally signed by RygielTimothy
Signature: RygielTimothy Date 2020.09.2512:11:37
Date:
oa'00'
Division Director: Damon Grant
Digitally signed by GrantDannon
Signature. Gral Y1 ItDamol Y1 1 Date 2020.10.0516:05:51
Date:
-oa 00,
r
Q
Packet Pg. 1698
7 16. E.4.d
❑ this exhibit is not applicable
EXHIBIT E
FORM OF CONTRACT APPLICATION FOR PAYMENT
Tim Rygiel (County Project Manager)
Collier County Facilities Management (County Department)
Collier County Board of County Commissioners (the OWNER) or
Collier County Water -Sewer District (the OWNER)
FROM: AdamAhmad (Contractor's Representative)
Capital Contractors, LLC (Contractor's Name)
9010 Strada Steil Ct., Suite 108, Naples, FL 34109 (Contractor's Address)
RE: CON ESC CHILLER YARD MODIFICATION
Original Contract Time: 52days
Revised Contract Time: 82 days
Retainage @ 10% thru[insert date] $ 0
Retainage @ _% after [insert date] $ 0
Percent Work completed to Date: 100
Percent Contract Time completed to Date 162 %
Liquidated Damages to be Accrued
Bid No. 20-5505
Project No. 100295
Purchase Order No. 4500203363
Application Date September 25, 2020
Payment Application No. 1 -FINAL
for Work accomplished throua_h the Date
May 15, 2020 thru September 25, 2020
roject Name)
Original Contract Amount:
Total Change Orders to Date
Revised Contract Amount
Total value of Work Completed
and stored to Date
Less previous payment (s)
AMOUNT DUE THIS
APPLICATION:
$ 72,500
$ 1,000.00
$ 73,500.00
$ 73,500.00
$0
$ 73, 500.00
ATTACH SCHEDULE OF VALUES AND ACCOMPANYING DOCUMENTATION TO THIS APPLICATION LL
rn
r`
CONTRACTOR'S CERTIFICATION: The undersigned CONTRACTOR certifies that: (1) all previous progress payments r'
received from OWNER on account of Work done under the Contract referred to above have been applied to discharge in full
all obligations of CONTRACTOR incurred in connection with Work covered by prior Applications for Payment numbered 1
through 1 inclusive; (2) title to all materials and equipment incorporated in said Work or otherwise listed in or covered by LL
this Application for Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interests and '
encumbrances (except such as covered by Bond acceptable to OWNER); (3) all amounts have been paid for work which z
previous payments were issued and received from the OWNER and that current payment is now due; (4) and CONTRACTOR U
agrees that all overruns as shown on the monthly estimate summary shall, in fact, be added to the revised contract and shall m
be incorporated into a future Change Order: T
U
By CONTRACTOR: CAPITAL c TORS, LLC (Contractor's Name)LL
(Signature)
September 25, 2020 L
d
ADAM AHMAD, OWNER/MANAGING MEMBER (Type Name & Title)
(shall be signed by a duly authorized representative of CONTRACTOR)
N
O
Payment to the CONTRACTOR for the above AMOUNT DUE THIS APPLICATION is recommended. -
By Design Professional (DP's Name) °'
E
DATE: (Signature)
c�
(Type Name & Title) a
Payment to the CONTRACTOR for the above AMOUNT DUE THIS APPLICATION is approved:
By OWNER'S Project Manager: (Signature) DATE:
(Type Name and Title)
Packet Pg. 1699
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