Backup Documents 01/25/2022 Item #16C4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 C 4 —4
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
l'rint 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 he received in the County Attorney Office no later than
Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines In 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#I through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. -- ._—_ _--
3. County Attorney Office County Attorney Office
ee p_a,
4. BCC Office Board of County 4j 3i l , /`Z 2-1Commissioners
5. Minutes and Records Clerk of Court's Office
Ad all(aa- t0'.eRArK.
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 t R l L r E-`r' Phone Number l�� 7Contact/ Department fi�3 L(C- t�1,17 L i 77 ES
Agenda Date Item was Agenda Item Number J /
Approved by the BCC 1 /Z>'1 a ZZ / ! 6 c . Ll
Type of Document Number of Original
,l-f/tA)G�
Attached c�(Zi7C I Documents Attached
PO number or account
number if document is Ti
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)
I. Does the document require the chairman's original signature? A114
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. / i/a
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 L.
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 11 ("k
5. The Chairman's signature line date has been entered as the date of BCC approval of the
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 C
signature and initials are required.
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 the item is input into SIRE. t„ .'
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 1 075 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County i an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the SRT/a) an option for
Chairman's signature. this line.
t.r_�__,r_.._...r_..._._i nnn r__..,n-:_:--'n__..____.-n_...:__m:_ nnvn n_:_c__,n n�nA n_..:__a 4 ^+i nc n__.:__J fl nA nc.n...:__J.•nnn-+
1 6 C 4
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Monday, February 7, 2022 10:42 AM
To: FeyEric
Subject: Item #16C4 1-25-22 BCC Meeting
Attachments: Item #16C4 (1-25-22 BCC Meeting).pdf
Good Morvtivtg Eric,
Please see the attached (executed)
chavtge order for your records.
Thank you!
Ann Jennejohn
13MR Senior Deputy Clerk 1I
„t n <<.rk, Clerk to the Value Adjustment Board
Office: 239-252-8406
7, Fax: 239-252-8408 (if applicable)
Avtvt.Jevtvtejohvt@CollierClerk.covv4
,, �,�� Office of the Clerk of the Circuit Court
�toli,R'.�� & Comptroller of Collier County
3299 Tawtiavvti Trail, Suite #4O1
Naples, FL 34112-5324
www.CollierClerk.com
i
Clr
Procurement Services
Cotter County Change Order Form
E Contract Modification ❑Work Order Modification
Contract#: 18-7370 Change#: #3 Purchase Order#: 4500201196 Project#: 70031.9
Contractor/Firm Name: AECOM Technical Services, Inc. Contract/Project: Public Utilities Water-Sewer District Master Plan
Project Manager Name: Eric Fey Division Name: Engineering and Project Management
Original Contract/Work Order Amount $ 994,087.00 12/10/19; 16C7 Original BCC Approval Date; Agenda Item#
Current BCC Approved Amount $ 994,087.00 12/10/19: 16C7 Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 994,087.00 6/25/2021 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 994,087.00 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 1/2/20 Original 3/27/21 Last Approved 6/25/21 Revised Date TBD
Date Completion Date Date (Includes this change)
#of Days Added 120 Select Tasks ❑Add new task(s) ❑ Delete task(s) E Change task(s) ❑ Other
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.
1. Detailed and specific explanation/rationale of the requested chanae(s)
This is a zero-dollar change order to add 120 days to the agreement for the completion of the Master Plan. Work was suspended on
06/24/2021 with one day remaining to allow for this change.
2. Why this change was not included in the original contract;
This change was not included in the original agreement because it was anticipated that there would be sufficient time to conduct
workshops to discuss County comments, alternative options, and to provide a final report.
3. Describe the impact if this change is not processed
If this change is not processed,the Master Plan will be incomplete and the County will not have the benefit of this guiding document.
FeyEric Digitally signed by FeyEric
Prepared by: y Date:2022.01.06 17:44:43-05'00' Date:
(Project Manager Name and Division)
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.
Accepted by: C • 1, 44 Date: 12/13/21
(Contractor/Vendor/Consultant/Design Professional and Name of Firm, if project applicable)
Accepted by: Date:
(Design Professional and Name of Firm, if project applicable)
Approved by: ChmelikTom ,aa
Date:
(Division Director or Designee)
SchneebergerSara Digitally signed by SchneebergerSara
cneeer
Approved by: g Date:2022.01.18 09:36:37-05'00' Date:
(Procurement Professional)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RpL BCC ES
16C4
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
To obtain population projections
90 day time 90 540 and sewershed delineations which
1extension. were provided by the County and
other sub-consultants.
2 Reallocate task 0 540 Multiple listed in Change Order#2
amounts.
3 120 day time 120 660 Vendor requested additional time.
extension.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin Rp BCC ES
16C4
3TTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. Kinzel,Clerk of Courts COLLIER CO •
&:Comptroller, ,
Ce) .•41°
By. ()4A4A.
Willia / . McDanie ,Jr., Chairman
Date t p t' �—
(SEAL)t) `,�Y' f
A as to f tmjan s
signafttre Daily.
Appro e s to for legality:
By:
R.Teach
Deputy County Attorney
,YI