Backup Documents 07/25/2023 Item #16B 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 B 7
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 Cf G11 a `3
4. BCC Office Board of County
Commissioners y(0,7_ 7/243
5. Minutes and Records Clerk of Court's Office , %/
vir 742,3 c o>
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 Dayan Hernandez—TMSD—Capital Phone Number 239.252.5736
Staff Contact/ Project Planning,Impact Fees,and
Department Program Management
Agenda Date Item 07/25/2023 Agenda Item Number 16.B.7
was Approved by
the BCC
Type of Document Work Order—Quality Enterprises USA, Number of Original Documents 1
Attached Inc, Goodland Drive Culvert Attached
Replacement
PO number or N/A Dayan.Hernandez@colliercountyfl.gov
account number if Nadine.Dunham@colliercountyfl.gov
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 DH
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 DH
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
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DH
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 07/25/2023 and all changes made during DH N/
the meeting have been incorporated in the attached document. The County S
Attorney's Office has reviewed the changes,if applicable. W
9. Initials of attorney verifying that the attached document is the version approved by the DH
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature. i a
Tinie
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
687 -
WORK ORDER/PURCHASE ORDER
Contract 20-7800 "Underground Contractor Services"
Contract Expiration Date: June 21,2026
This Work Order is for professional underground utility services services for work known as:
Project Name: Goodland Drive Culvert Replacement
Project No: 50238,3.2
The work is specified hi the proposal elated June 6th,2023 which is attached hereto and made a part of
this Work Order, In accordance with Terms and Conditions of the Agreement referenced above, this
Work Order/Purchase Order is assigned to: Quality Enterprises USA,Inc,
Scope of Work: As detailed in the attached proposal and the following:
* Task I Repair and replace existing RCP with a precast box culvert
* Task It Owners Allowance
Schedule of Work: Complete work within 150 days from the date of the Notice to Proceed which is
accompanying this Work Order. The Consultant agrees that any Work Order that extends beyond the
expiration date of Agreement 1120-7800 will survive and remain subject to the terms and conditions of
that Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenced above, the County will compensate the
Firm in accordance with following method(s): ®Negotiated Lump Sum (NLS) ❑Lump Sum Plus
Reimbursable Costs (LS+RC) EITime & Material (T&M) (established hourly rate --Schedule A)❑
Cost Plus Fixed Fee (CPFF), (define which method will be used for which tasks) as provided in the
attached proposal.
Task I $822,418.35 NLS b+
Task II $20,000.00 NA
tL �
TOTAL FEE $842,4I8.35
4 ,I,9+I 1.Ilra•:y01.,,
HemandezDayan t;,��•°SC'j.1Mtv:, ----1G,y
fts,f J 4Yi.n.sJc...,•l.••.�vl r,ry.firo�<,,.1�••:i.,
PREPARED BY: 4Y,n•a.t7u.0•.I
, ere lauxuuwofMor
Dayan Hernandez, Project Manager I Date
CPP—Storinwater Management
RomanDaniel 'i' ^-a�:s,a.,r„lfig...:{ ..
APPROVED BY: N..u.;iM Irl...�l w�
Daniel Roman, P.E., Supervisor- Project Mgmt. Date
CPP—Stormwater Management
Digllally signed by Johnssenb
APPROVED BY: JohnsSen_b ❑a;le:2023.00.21 07:43:5741'00'
Beth Johnssen, Division Director Date
CPP—Transportation Management Services
Page 1 of 2
CAO
1 6g7 "
Digitally signed by
ScottTrinity Dale:ScoEiTrinil2o3y
06.29
APPROVED BY: 09:e4:ti7-04b0'
Trinity Scott, Department I-lead Date
CPP---Transportation Management Services
By the signature below, the Firm (including employees,officers and/or agents) certifies, and hereby
discloses, that, to the best of their knowledge and belief,all relevant facts concerning past, present,or
currently planned interest or activity(financial,contractual,organizational,or otherwise)which relates
to the proposed work;and bear on whether the Firm has a potential conflict have been fully disclosed.
Additionally, the Firm agrees to notify the Procurement Director, in writing within 48 hours of learning
of any actual or potential conflict of interest that arises during the Work Order and/or project duration.
ACCEPTED BY: Quality Enterprises USA,Inc.
6/27/23
bauts—rdaudio, Vice President Date
(Remainder of page intentionally left blank)
Page 2 of`2
16B7
IN WITNESS WHEREOF, the parties hereto,have each, respectively, by an authorized person or
agent, have executed this Work Order on the date and year first written below.
ATTEST: _ -1, BOARD OF COUNTY COMMISSIONERS
_'efl;of Courts COLLIER COUNTY, FLORIDA
' - , p- .
13 _ 64
y: --,-q
i
Rick LoCastro,Chairman
;(C�AL, ,,c-Attast as to Cnairman's
signature only Quality Entelhriscs USA, Inc.
A
/2/d Q (•-• Lk.. --- _ By: _-
First Witness Signature
Louis J. Gaudio,_Vice President__
M c CO e I"Type/print signature and title)
TTyp tint ttne• name'
'Second Witness
Glen Stasiak
v TType/print witness name's
pprove s t 'or I am Legality:
�oulfty Attorney
Print Name
Page 1 of I
Pi
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