Backup Documents 05/09/2023 Item #16C 3 16C 3
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 and original documents must be reedsed In the County Attorney Office no later than
Monday preceding the Board meeting,
**NEW** ROUTING SLIP
Complete routing lines/I I 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 ill 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 3/2/5h 3
4. BCC Office Board of County
Commissioners it 4 Lc/ . /I /23
5. Minutes and Records Clerk of Court's Office 'n„, ' �" /043- —
r IV�J 5(1 l0I 2023
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 Phone Number
Contact/ Department /o/`Yj (l/��'-�,/�/1i �'�? - �/�
Agenda Date Item was _ C(— ,� Agenda Item Number i n
Approved by the BCC ` (_
Type of Document ,J .? Number of Original
Attached C''j�,a �t. i,.`^�'°r Documents Attached t
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. `(It itial Applicable)
I. Does the document require the chairman's original signature? /�
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.
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
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
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
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.
Some documents arc time sensitive and require forwarding to Tallahassee within a certain •.
time frame or the BCC's actions are nullified. Be va a of your deadlines!
8. The document was approved by the BCC on � '3 and all changes made during N/A is not
the meeting have been Incorporated in the atta h I document. The County
n option foil
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 an option for
Chairman's signature. this line
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16C 3
Otis: Procurement Services
C:011le'Y C01411t1)' Change Orcior form
❑Contract Modification ®Work Order Modification
Contract II: 20.7800 Change II: 3 Purchase Order!I: 4500218701 Project It: 10173A.2
Contractor/Firm Namo: Duality Enterprises USA,Inc. Contract/Project: OTWWTP Driveway Relocation
Project Manager Name: Tom ShiedDivision Name: PUEPMD
Original ContractWork Order Amount $ 492,279,27 6/2212021;11B Original BCC Approval Date;Agenda Item It
Current BCC Approved Amount $ 492,279.277 6122/2021;11B Last BCC Approval Date;Agenda Item//
Current Contract/Work Order Amount $ 492,270,27 6/22/2026 SAP Contract Expiration Date(Master)
Dollar Amount of this Change $ 0.00 0,00% Total Change from Original Amount
Revised Contract/Work Order Total $ 492,279,27 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 J,
Notice to Proceed 818/2022 Original 11/6i2022 Last Approved 02/11/2023 Revised Date
Date Completion Date Date ``Includes this change)
i!of Days Added 0 Select Tasks 0 Add now task(s) ❑Delete task(s) ❑Change lask(s) (Xs)Other
Provide a response to the following:1.)detailed and specific explanation/rationale of the requested changes)to the task(s)end!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 change order provides for the funding of Work Directives 1 &2 by utilizing the owner's allowance.No additional days aro required,
and the contract is complete.
The total cost of the draw ogainst allowance Is(WDii1$2,237.74)+(WDII2$6,988.75)=$9,226.40,Allowance Balance=$30,000.00
less($9,226,40)=$20,773.51 remaining allowance balance.
Work Directive Ii1 provided for additional labor and materials necessary to install on under-pavement gate opening sensor.This change
•
was not part of the original contract because it was unknown at the time that the existing sensor was not relocatable to the new location.
If this change is not processed,exit from the plant site would be prohibited via automatic means,
Work Directive!I2 provided for the additional labor and materials necessary to replace the existing gale controller.This change was not
Included in the original contract because It was unknown at Iho time that the existing gate controller could not be calibrated to the new
gate opening travel distance.If this change is not processed,the gale would bo incapable of closing completely and therefor creating
potential plant site security issues.
Digitally signed by SlvertTom
Si ve rtTo m Date:2023.03,14 10:17:41
Prepared by: 04'00' Data:
(Tom Sivert,PUEPMD)
Acceptance of this Change Order shall constitute a modification to contract I work order Identified above and will be subject to all the same
terms and conditions as contained In the contract I 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 I Consultant/
Design Professional arising out of or related to the change set forth herein,Including claims for impact and delay costs.
Accepted by: // Date:
(Lou Gaudin c Quailt enterprises)
Accepted by: NA Date:
(Jared Brown,Johnson Engineering,Inc.,If project applicable)
McLeanMatthew ^� '•��•~
Approved by: t.r,.,�,:... -- ..—_ Dale:
(Malt McLean,Division Director or Designee)
Digitally signed byDoilaPslscilla
DoriaPrisciI
Approved by: Dale:2023.04.07 11:45,55.04.00' Date:
(Procurement Professional)
Revised:01/14i2021 (Divisions who may require additional signatures may Include on separate sheet.) PROCUREMENT U6E ONLY
Admin occ ' )
A, 6/- 0310202.3 RPI
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16C 3
ATIIIST: BOARD OF COUNTY COMMISSIONERS
Crystal I;.Kiuzol,.Cleik of Courts COLLIER COUNTY,FLORIDA
&Ca,uliirbltcr
` �� Rick LoCastro,Chairman
Date: II M h1 ' ?'.3
AtteNotele___
airman's
L signature only
Appr cd as t forn nd I gality:
By
t R.'I one
Deputy County Attorney
, —:(,)
(6Q0
0
16C 3
Chance Order/Amendment Summary
•
COST TIME
COO AMDt! Description Days New Justification
Additive(+) Deductive(-) Added Amount
This change order requests a
contract limo extension of 39 days
necessary to complete the project.
The contractor's ability to complete
1 Time Extension 39 129 the scope of work by the substantial
completion date has been impacted
by a delay in the manufacture and
delivery of critical equipment
necessary for project completion.
This change order requests a
contract time extension of 30 clays
necessary to complete the project.
The contractor's ability to complete
2 Time Extension 30 159 the scope of work by the substantial
completion dale has been impacted
by a delay in the manufacture and
delivery of critical equipment
_ necessary for project completion._
This change order provides for the
3 WD Ill &f12 0 169 funding of Work Directives 1 &2 by
utilizing the owner's ailoviance
0) 03102023 CAO
Revised:0 11102021 (Divisions who may require additional signatures may include on separate shoot.) PROCUREMENT USE WILY_
Adni eCC