Backup Documents 10/10/2023 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 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. County Attorney Office County Attorney Office if27
/%'� a-3
2. BCC Office Board of County
Commissioners Chairman ILL bv/1I, j !v/i f/ti
3. Minutes and Records Clerk of Court's Office Ja 4 (23 `Q:20
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 Bendisa E.Zela,Facilities Phone Number 239-252-8440
Contact/ Department Division Email Bendisa.Zelagcolliercountyfl.gov
Agenda Date Item was October 10,2023 Agenda Item
Approved by the BCC Number 16.F.7
Type of Document Administrative Change Order No. Number of Original
Attached 2 adding seventy(70)days to Documents 1
Agreement No.21-7883-ST,Main Attached
Campus Chiller Plant Upgrades,
with O-A-K/Florida, Inc.,d/b/a
Owen-Ames-Kimball Company
PO number or account Facilities Division is r esting a
number if document is to completed copy
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? N/A
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed BEZ
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 BEZ
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 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 July,25 2023 r,
and all changes made during the meeting have been incorporated in the attached
document. The County Attorney's Office has reviewed the changes, if applicable. CAT InIr7
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature. 50(0,
this lrne" .
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
1 6F 7
Procurement Services
Co lee County Change Order Form
®Contract Modification ❑yJork Order Modification
Contract#:[
21-7883-ST ]
Change#: 02 Purchase Order#: 4500217988 Project#: 50214.1
Contractor/Firm Name: O-A-K/Florida, Inc. Contract/Project: Main Campus Upgrades(MCU)
Tim Rygiel-PMP,CFM,Project Manager II Facilities Management
Project Manager Name:, Division Name:
Original Contract/Work Order Amount $ 70,595.00 5/10/22 16C4 Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 70,595.00� 5/10/22 16C4 Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 70,595.00 9/13/2023 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 70,595.00 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 I
Notice to Proceed 5/24/2022 Original ( 3/18/2023 Last Approved 9/13/2023 Revised Date 11/22/2023
Date Completion Date I . Date (Includes this change)
#of Days Added [` 70 Select Tasks ❑Add new task(s) ❑ Delete task(s) ❑Change task(s) ®Other
Provide a response to the following: 1.)detailed and specific explanation/rationale of the requested change(s)to the task(s)and for
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.) This change order will add 70 days to the contract time in order to accommodate the extra time needed for pre-construction
development of the GMP.
2.) The additional time is needed to finalize cost estimate,engage in contractor outreach,final preparation of the solicitation
packages, and development of the GMP.
• 3.) If this change order is not processed,the vendor will be unable to fulfill their contract obligations for delivery of a GMP.
RygielTimothy Digitally signed by RygielTimothy
Date: 2023.08.18 15:58:35 -04'00'
Prepared by: __.-__._..... ____.._._...._ Date:
Tim Rygiel-PMP,CFM,Project Manager II, Facilities Management
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: _...i:- 2.2--- 2�
Matthew Zwack, President,O-A-K/Florida, Inc.
McCormickJohn Digitally signed by McCormickJohn
Approved by. Date:2023.08.22 15:39:56-04'00' -- Date: A
John McCormick, Interim Director,Facilities Management
Digitally signed byYilmazHeather
YilmazHeather
Approved by;______ Date:2023.08.25 14:45:43 04'00' Date:
(Procurement Professional)
Revised.01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY r
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ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. K.izel ' • of 1 outs COLLIER COUNTY, FLORIDA
& Comptrol •;• `3d
By: AsiftrAVA# By:
Rick LoCastro, Chairman
Dated: % J O
(S AR; ` ' t t+;Chairman's
,y su.a ture only la
Appr e a to f an ga y:
By:
Scott R. Teach
Deputy County Attorney
�l
16F7
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive() Added Amount
This change is to accommodate
extra time needed for OAK to
1 Adds 58 days 58 356 develop the GMP.Their schedule is
dependent on the design schedule
and the design schedule has been
amended.
This change is to accommodate
extra time needed for OAK to
2 Adds 70 days 70 426 develop the GMP.Their schedule is
dependent on the design schedule
and the design schedule has been
amended.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet-) PROCUREMENT USE ONLY
Admin CLCD BCC ES