Backup Documents 05/09/2023 Item #16B1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E I s
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. Tami Scott, Project Manager CRA TS 5/5/2023
2. County Attorney Office—Scott Teach County Attorney Office
SA1 .5)fb.-3
3. BCC Office Board of County
Commissioners RL Ails( 5/1/Z3
4. Minutes and Records Clerk of Court's Office �r
/Io/;3 '10:73
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 Tami Scott STAFF PERSON 8845
Contact/ Department PHONE#
Agenda Date Item was 5-9-2023 Agenda Item Number 16.6, i
Approved by the BCC
Type of Document CHANGE ORDER Number of Original 1
Attached Documents Attached
PO number or account 4500218097
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 N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, No
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 Yes
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(Insert
Office and all other parties except the BCC Chairman and the Clerk to the Board N/A unless
changes
made after
publication)
5. The Chairman's signature line date has been entered as the date of BCC approval of the Yes
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 Yes
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A(insert N/A
should be provided to the County Attorney Office at the time the item is input into SIRE. unless an
Some documents are time sensitive and require forwarding to Tallahassee within a certain ordinance)
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on above date and all changes made during 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 Leave N/A is not
BCC, all changes directed by the BCC have been made, and the document is ready for the blank an option for
Chairman's signature. (CAO this line.
to
initial)
*Please e-mail Debrah Forester a copy of the recorded agreement and also e-mail
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'" Procurement Services
C ,o;..,,ev Coy414t;;y Change Order Form
(]Contract Modification ❑Work Order Modification
Contract#: 21-7845
J
Change#: 1 J Purchase Order/k 4500218097 project/1: 50208.2
Contractor/Firm Name: Stantec Consulting Services 1 ContractiProject:1 Bayshore Drive Redevelopment Project 1
Project Manager Name: Tami Scott ,-Dtvlstvni+iame CRA/Bayshore Gateway Triangle
I —
Original Contract/Work Order Amount $ 344,932.30 5-24-22; 16.13.1 Original BCC Approval Date; Agenda Item#
Current BCC Approved Amount $ 344,932.3w 5-24-22;16.6.1 Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 344;932.30 5/16/2023 SAP Contract Expiration Date (Master)
Dollar Amount of this Change 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 344,932.30 0.00% Change from Current BCC Approved Amount
Cumulative Changes $ 0.00 0.00% Change from Current Amount
I Completion Date,Description of the Task(s)Change,and Rationale for the Change
Notice to Proceed 6.10.22 Original 5-16-23 Last Approved 5.16.23 Revised Date 8-14-23
Date Completion Date Date (Includes this change)
#of Days Added f fl0 i Select Tasks 0 Add new task(s) 0 Delete task(s) ❑Change task(s) Q 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. Additional 90 Days are being requested to allow for additional time to prepare alternative location option as requested by the BCC
on December 13,2022 and present to the BCC on March 14,2023
2. Staff did not anticipate the project would be reviewed by the Board during the design phase and an alternative location option
would be requested.
3. If additional time is not granted the design professionals will not have sufficient time to complete the project.
Contract was approved at the May 24,2022 BCC Meeting, agenda item 168.1
S cot tTa rn i Digitally dgned by s,otlTamt
Prepared by: oata:lotlo+.wtbn:Te•wao Date:-_ _--
(Project Manager Bayshore CRA
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 fort heroin including claims for impact and delay costs.
Accepted by: ate ___`
(Col/ r 1 V Irupr I Consultant/Design Professional and Name of Firm,if project applicable)
Accepted ,,1,(127.__ :'ii(k I(�'.[: (<�{/)r/.l(t�l( ',cl_{�IIG�'� .(1� Date; "1./7_4_'`' '
cSslhhtr,t. Afar:f o5rgn Iyrofossional •
and Name of Firm,if project applicable)
ForostorQebriah Digitally Signed by FoteslerDebtah
Approved by: Date.2023.012416s5:50 01,00' Date:
(Debrah Forester CRA Director)
DoriaPriscilla Digitally signed by DoriaPriscilla
Approved by:______ Date:2023.04.25 13:07:48-04'00' Date:
(Procurement Professional)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RPM CC E8
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ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. ;i ze1,Clerk of Courts COLLIER COUNTY, FLORIDA
&Comptr.
By: .�L1C1.. By: /r
est as to Chairman's Rick LoCastro,Chairman
4Dtp).,, signature only
Dated:
(SEAL)
Appr s tqormi21 le ality:
By:
S .Teach
Deputy County Attorney
024
40
1 6 81
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
Additional Time 90 430* Additional time to review alternative
design option as directed by BCC.
'The total amot,nt of new days Is arrived at by adding the 90 additional days
to the 340 days provided to c omplete Tasks 1 through 4 in the NTP issued
by the CRA on June 10,202?.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT'use ONLY
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