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Backup Documents 04/11/2023 Item #16C 3 16C3 , 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 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 a a d original documents must be received in the County Attorney Office no later than Monday preceding the Hoard meeting. **NEW** ROUTING SLIP Complete routing lines#1 through 112 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 112,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 to i113/ 3 4, BCC Office Board of County Commissioners -; Y1 LI113/27 5. Minutes and Records Clerk of Court's Office ' (3f2t3 PRIMARY ONTACT 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 Tom Sivert PUEPMD Phone Number 252-5376 Contact/ Department Agenda Date Item was 4/11/2023 Agenda Item Number 16.C.A 3 Approved by the BCC Type of Document Change Order#3 Number of Original 1 Attached Documents Attached PO number or account 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) Apg, able) I. Does the document require the chairman's original signature? TA 2. Does the document need to be sent to another agency for additional signatures? If yes, 'I'AS 0 ',i r ; . 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 ?16 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 /!1) 5. The Chairman's signature line date has been entered as the date of BCC approval of the ,.AC��rti.�t document or the final negotiated contract date whichever is applicable. ti 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's / � 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. ?l Some documents are time sensitive and require fo yarding to Tallahassee within a certain t time frame or the BCC's actions are nullified. g alwa a of your deadlines! 8. The document was approved by the BCC on . I I'!1?and all changes made during N/A,is;no( the meeting have been incorporated in the attacl`led{document. The County an option foil Attorney's Office has reviewed the changes,if applicable. this linei 9. Initials of attorney verifying that the attached document is the version approved by the N/A'Is no( BCC,all changes directed by the BCC have been made,and the document is ready for the an option for Chairman's signature. this linei ,,r•__._,n_.......,-._....non r•.�..,n_:,,:..-,n...._..-._n_...:.._,',:.. i nvo n:-:_-,n n,na n...:_.a,v nr n...:__a n n.nr.n...:..a,i norm 1 6 C 3 afRe Procurement Services COMM'ter County Change Order Form lJ Contract Modification ❑Work Order Modification Contract#: 21-7912 Change#: 3 Purchase Order#: 4500215511 Project#: 71066 32 2 Contractor/Firm Name:I R2T.Inc. Contract/Project: NCRWTP Chem Bulk Tank Replacement Tom Slvert PUEPMD Project Manager Name: Division Name: Original Contract/Work Order Amount $ 519,556.00 10/26/21;16C7 Original BCC Approval Date; Agenda Item# Current BCC Approved Amount $ 519,566.000 1/24/23;16C2 Last BCC Approval Date;Agenda Item# Current Contract/Work Order Amount $ 519,566.00 ** 1/11/2023 SAP Contract Expiration Date(Master)"o5/2442o23 Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount Revised Contract/Work Order Total $ 519,566.00 0.00% Change from Current BCC Approved Amount Cumulative Changes $ 10.00 0.00eY0 Change from Current Amount .__ Completion Date,Description of the Task(s)Change,and Rationale for the Change 1 Notice to Proceed 12/3/21 Original 12/3/22 Last Approved 5/•1-1/23- Revised Date 4$8— Date Completion Date Date ""05/2412023 (Includes this change) '''07/2312023 #of Days Added 60 Select Tasks ❑Add new task(s) 0 Delete task(s) ❑Change task(s) El 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. *Reactivation/Start work letter issued on 03/21/2023 **The addition of Go days will result In new substantial completion date is 06/23/2023 and the new final completion date is 07/23/2023 (1)This change order requests a contract lime extension of 60 days necessary to complete the project.The contractor's ability to complete the scope of work by the current substantial completion date has been impacted by a delay In the manufacture and delivery of critical equipment necessary to complete the project' d-wberrttle (2)This change was not included in the original contract as it was not known at that time of supply chain issues that would negatively impact the contractor's ability to meet the schedule. (3)If the time extension is not processed,the contractor will not be able to complete the project on schedule and would be liable for liquidated damages for no fault of their own. Digitally signed by SivertTom S lye rtTo m Date:2023.03.16 07:54:28 Prepared by -04'00' ro Date (Tom Slvert,PUEPMD) Acceptance of this Change Order shall constitute a modification to contract/work order identified above and will be subject to all the same j 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 ou • or related to the change set forth herein,Including claims for impact and delay costs Accepted by: v Date 3.H. Z S Cav- ieri . ?'`'w' 1,11"�," ' Accepted by: •,•.•.,.w•. Date (Ron Cavalieri,AECOM) pwwn,r�wr pp by: McLeanMatthew "- Date Approved (Malt McLean,Division Director or Designee) Digitally signed by DoriaPrlscllla * Approved by: DoriaPriSCItia Date:2023.0311100440-041Kr /9Z7 Date (Procurement Professional) Revised 01/14/2021 (Divisions who may require additional signatures may Include on separate sheet) PROCUREMENT USE ONLY A-,a) 03162023 Admin (RP,t UCCES • c0 i6C3 ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel,Clerk of Courts COLLIER COUNTY,FLORIDA & Comptroller / By: l0•C• By: l 'Att@St aS t0 Chairman's Rick LoCastro, Chairman Dated: `1/+_13/2-3..siiinature only. (SEA) Appro e as for nd gality: By. Scott R. ach Deputy County Attorney 121 AO 1 6 C 3 Champ Ordnr/Arnendment Summary COST T(ME COht AMD4 Description Days New Justification Additive(+) Deductive(-) Added Amount Tinto extension due to supply 1 Time Extension 57 422 chain impaels to malarial delivery. Time extension due to supply 2 Time Extension 84 506 chain to maiorial delivery. Time extension due to supply 3 Time Extension fie 566 Oak impacts to material delivery. Revised 01/14/2021 (Divisions who may require additional signatures may include on separate sheet) 1,151:uNLY 03162023 Adrift rCt: fliCC Fipt CAO