Backup Documents 04/11/2023 Item #16A14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 A i A
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 C y /a,Q3
4. BCC Office Board of County 1
Commissioners KL_n, M/c( '//(?/Z7
5. Minutes and Records Clerk of Court's Office � t� (Il g 1x•cPI►1.
PRIMARY CONTACT INFORMATION
I
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 John Conti/Transportation Engineering Contact Information 239-348-1328
Contact/Department
Agenda Date Item was April 11,2023 Agenda Item Number 16A14
Approved by the BCC
Type of Document Change Order#2 for adding time to the Number of Original 1
Attached Whippoorwill Road Project 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 original signature STAMP OK ✓JC
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 ✓JC
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 ✓JC
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 V JC
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 4/11/2023 and all changes made during ✓JC N/A is not
the meeting have been incorporated in the attached document. The County 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 )/274 an option for
Chairman's signature. this line.
16A14
Coty County Procurement Services
-- Change Order Form
x Contract Modification ❑Work Order Modification
Contract it: 20-7735 Change#:I 2 I Purchase Order#: 4500210603 Protect#: 60219 1
f
Contractor/Finn Name: Quality Enterprises Contract/Project:J Whippoorwill Ln Marbella Lakes Dr Connection
Project Manager Name: John Conti Transportation Engineering Services
Division Name: I
Original Contract/Work Order Amount $ 4,720,450.00 4-13-21;11A Original BCC Approval Date; Agenda Item#
Current BCC Approved Amount $ 4,720,450.00 10-11-22;16.A Last BCC Approval Date; Agenda Rem#
Current Contract/Work Order Amount $ 4,720,450.00 ** 11/18/2022 SAP Contract Expiration Date(Master)`"05/25/2023
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 4,720,450,00 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 7/12/21 Original 11/18/22 Last Approved 5/25/23 Revised Date 8/28/23
Date Completion Date Date (Includes this change)
#of Days Added 95 Select Tasks ❑Add new task(s)
{ } ❑ Delete task(s) ❑Change task(s) x Other
Provide a response to the following: 1,)detailed and specific explanation/rationale of the requested change(s)to the task(s)and I 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 Contract Days:
1. This change order will add 5 days to the contract time due to the effects of Hurricane Ian and 90 days due to
production and delivery delays for various equipment for light poles,traffic signals and due to labor shortages. For
a total of 95 days, The new Substantial Completion date would be July 29, 2023, and the new Final Completion
date would be August 28,2023.
2. The change being requested was not included in the original contract because the hurricane was an act of God; the
delay in manufacturing and delivery of lighting and signal equipment and labor shortages were not known when this
contract was put in place.
3. If this modification is not processed the contractor would not be able to complete the project within the contract
i tme.
John (�
V l l Conti D e.2yelgned by John Conti
Dale.2023.63.15 14:2y;46
Prepared by: 4400 Date:
John Conti,Project Manager,Transportation Engineering
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: Date: 3 r16-of 3
Louis J. Gaudio, Vice President, Quality Enterprises, Inc.
ThomasMatthe Dlg'le'"°°nhe'b"
ThomnaMedhew
k I Approved by: W Dale:2023.03.1609:05126 pp .04'00• Date:
Matthew Thomas, P.E., Principal Project Manager, Transportation Engineering
Anthony Digitally Open by Anlhony
KhewaJ0 P.E.
Approved by: Khawaja P.E. Dale:4'00' 2s.a3.lbD9s1:3a
Date:
Jay Ahmed,P.E., Division Director,Transportation Engineering
Digitally signed by
ScottTri n ity Date::Trinity
Dat 2023.03.17
Approved by: 09.15:35-04'00' Date:
Trinity Scott, Department Head,Transportation Management Services
Revised;01/14/2021 (Divisions who may require additional signatures may Include on separate sheet.) PROCUREME. USE ONLY
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ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K.Kinzel, Clerk of Courts COLLIER COUNTY,FLORIDA
&Comptroller J
5;e?'
By: 9r4A.A.4 001141-1/aC By:
Rick LoCastro, Chairman
Dated: 4111 (23•
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(SEAL) Attest as to Chatiman'S
iignathf@ on'Y.
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Approv to fo leg' y:
By:
Scott R.Teach
Deputy County Attorney
a r 16A14
DO 1y I U P 1 I S C I I I a Digitally signed by DoriaPriscilla
Approved by: Date:2023,03.22 16:33:55 -04'00' Date:
Procurement Professional
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
Add 188 days 188 682 Needed days to complete project.
Add 95 days111 95 777 Needed days to complete project.
(
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREM T USE ONLY
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