Backup Documents 01/24/2023 Item #16A11 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1641J1
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office
?32))01
4. BC
C Office Board of County
Commissioners RL by /0// //31/Z3
5. Minutes and Records Clerk of Court's Office ?2 01
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 Mark Zordan—GMD—Capital Project Phone Number 239.252.5606
Contact/ Department Planning, Impact Fees and Program
Management
Agenda Date Item was 01/24/2023 Agenda Item Number 16. A. 11
Approved by the BCC
Type of Document Change Order Number of Original
Attached Documents Attached
PO number or account N/A
number if document is
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)
1. Does the document require the chairman's signature(stamped)? ND
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 ND
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 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 ND
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 MB
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 01/24/2023 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County 3,1' 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 50, an option for
Chairman's signature. this line.
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
10A 1 1'
CoLl`ier County Procurement Services
`,,,,,, �r—A Change Order Form
® Contract Modification El Work Order Modification
Contract#:121-7847 I Change#: 2 Purchase Order#: 4500212114 60102.9.3
Project#:
Contractor/Firm Name: Water Resources Management Assoc, Contract/Project: Goodlette-Frank Road Ditch Improvements-A
Project Manager Name: Mark Zordan Capital Project Planning, Impact Fees, &Program
Division Name: Management
Original Contract/Work Order Amount $ 598,817.00 7/13/21 16.A.24 Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 598,817.0M7/13/21 16.A.24 Last BCC Approval
Current Contract/Work Order Amount $ 598,817.00 8/7/2022 SAP Contracctt Expiration Datete; n(Master)da Item #
Dollar Amount of this Change °
g $ 133,681.00 22.32/o Total Change from Original Amount
Revised Contract/Work Order Total $ 732,498.00 22.32% Change from Current BCC Approved Amount
Cumulative Changes $ 133,681.00 22.32% Change from Current Amount
Completion Date, Description of the Task(s) Change,and Rationale for the Change
Notice to Proceed 1 08t131202-1- Original ( 07/08/2022 Last Approved 8/07/2022 Revised Date TBD Date 8/16/2021 sj- Completion Date I Date (Includes this change)
J
i_
____
#of Days Added 308 Select Tasks ® Add new task(s) 0 Delete task(s) 0 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.
`This contract is currently on a STOP-WORK order with 2 days left.
1. On the original contract,time was not allocated to task 8.0 but was left as"to be determined°(TBD). This change order(CO) adds time for this tasks.
No additional fee is associated for the above referenced task, Also,the County requested additional design services for an additional box culvert,and
design of signalization,mast arm replacement,mobilization of traffic(MOT),and lighting plans for the Goodlette-Frank Road I 221d Avenue
intersection. To accomplish this request,this CO will add subtasks 2.7,2.8,4.9 through 4.13. Subtasks 2,7,2.8,and 4.9-4.13 will add$133,681.00
to the original contract. The previously approved tasks with TBD time allocated and the proposed new tasks will add 308 days to the contract.
2, The additional SUE was not included in the original contract because the design requires a deeper ditch cross-section than anticipated by the Gordon
River Improvements Master Plan and Is needed to discover any potential utility conflicts below the ditch bottom due to the addition of mast arm
relocation. This request was determined to be necessary after 30%design was completed.The additional box culvert design was determined to be
necessary for consistency with the Gordon River Improvements Master Plan and the West Goodlette Frank Drainage Improvements Phase 2 project
(60142.6).
3. If this change order is not approved,the consultant will not be able to determine crucial design information to properly design the project,and will not
have time to complete the work thus the project will be deemed incompleted.
Zo rd a n M a rk Ulgitaily signed by LordanMark
Prepared by: Date: 2022.11,23 11:36:45-05'00' Date:
(Mark Zordan, Project Manager)
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.
Raul M. Mercado Digitally signed by Raul M.Mercado
Accepted by: Date:2022.11.2216:to:ao-os'o0' Water Resources Management Associates,Inc. Date: 11/22/2022
(Design Professional and Name of Firm, if project applicable)
DYuy,pv,lynrrA..M
RomanDaniel
Approved by: A;o.,b�.frv,.r-. ,--..-^
�»w���.,...D�... Date:
(Daniel Roman,Principal Project Manager)
Johnssen b Digitally signed by Johnssen_b
Approved by: _ Date: 2022.11.29 09:24:24-05'00' Date:
(Beth Johnssen Division Director)
�.. Digitally signed by
•�,,. ScottTri nity Date 202y12.1209.13:18
Approved by: .es'00' Date:
(Trinity Scott, Department Head)
er5ara Digitally signed by SchneebergerSara
SchneebergerSara Approved by: Date:2022.12,27 08:55:54 05'00' Date:
(Procurement Professional)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RCC .xx,M
• . * *
16A 1 1
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days
Justification
Additive(+) Deductive(-) Added New Amount
This change order adds
Add 30 days to additional 30 days to address
1 address issues 30 356 right-of-way determination along
identified during the western boundary of the
the design. project, as identified during the
survey,
Adds additional This CO adds survey necessary
308 days and to complete ditch and culvert
$133,681.00 to design and adds additional
address design design, MOT, and time
2 issues and $133,681.00 308 664 necessary to complete the mast
for pre- arm relocation at 22nd Street and
construction Goodlette Frank Road.
support. Without this additional time,
consultant will not be able to
complete the project.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin BCC
X
16Ai1
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K.Kinzel,Clerk of Courts COLLIER COUNTY,FLORIDA
&Comptr ller
By: • By:
Rick LoCastro, Chairman
Dated: ! 31-1 23
(SEAL)
Attest as to Chairman's
sign • only.
Appi ved as to form n 1 gality:
By:
Scott R. each
Deputy County Attorney
f��.8