Backup Documents 10/24/2023 Item #16C 6 1 6 C 6
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 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 `� G 116 °7-�
4. BCC Office Board of County
Commissioners aC 09 f/ //7j/j3
5. Minutes and Records Clerk of Courts Office /� �"
. 1A1 (frin
PRIMARY N CO TACT 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, R141--70 POW-0S / Phone Number 2Q
Contact/ Department tip j J"1 3 i S,2l3
Agenda Date Item was Agenda Item Number / .
Approved by the BCC /0/2 4/2-02. 3 (�
Type of Document Number of Original
Attached C-�//� J( L U��L 7�- Documents Attached
PO number or account
number if document is
to be recorded -4 12 U S
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?
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. 2V
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 AI/4
5. The Chairman's signature line date has been entered as the date of BCC approval of the A)/fit-
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 14)j`�
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 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 /-/'•-i w'and all changes made during 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 kI/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.
16C 6
Ci+C7ir �✓OLlrit Procurement Services
Change Order Form
® Contract Modification Work Order Modification
Contract#: 20-7760 Change#: 1 Purchase Order#: 4500212054 Project#: 50391.16&
50391.17
Contractor/Firm Name: Quality Enterprise USA, Inc. Contract/Project: Design Build Emergency Power Resilience
Harry Raftopoulos Engineering and Project Management
Project Manager Name: Division Name:
Original Contract/Work Order Amount $ 3,655,000.00 06/08/2021;11.1 Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 3,655,000.00 '"06/08/2021;11.1 Last BCC Approval Date; Agenda Item #
Current Contract/Work Order Amount $ 3,655,000.00 10/07/2023 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 3,655,000.00 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 07/31/2021 Original 09/14/2022 Last Approved 10/07/2023 Revised Date TBD
Date Completion Date Date (Includes this change)
#of Days Added 325 Select Tasks ❑Add new task(s) ❑ Delete task(s) ❑ Change task(s) ® Other(see
below)
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. Detailed and Specific explanation/rationale of the requested change(s)to the task(s)and/or the additional days
added (if requested): This project is currently under a Stop Work Order effective August 30,2023 with 7 days remaining to
Substantial Completion. The purpose of this Change Order is add 325 days to extend the contract time.
2. Why this change was not included in the original contract: This project was bid and awarded with an original duration
of 410 days. It was not known that additional time would be required due to supply chain issues resulting in generator delivery delays.
To address this issue an additional 325 days are required.
3. Describe the impact if this change is not processed: If this change order is not approved,the contractor will not have
sufficient time to complete the generator installation.
KLA 8/31/23
1"--(43.11C)
Prepared by: )G.AfJ.' Date: 8-31-2023
(Zamira Deltoro, Project Manager EPMD)
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.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RpS BCC ES
Accepted by: Date: 8/31/2023
(Louis J. Gaudio, Vice President, Quality Enterprises USA, Inc.)
FandrichShon w=a:,."'
Accepted by: �-P•.,;""—•`T' Date:
(Shon Fandrich, Principal Project Manager/Supervisor of Projects, PU Engineering&Project Management, EPMD)
McLeanMatthew
Approved by: Pee,®,>^ 11-S1W Date:
(Matthew McLean, Director, PU Engineering and Project Management)
Y I I m az H ea t h e r Digitally signed by YilmazHeather
Approved by: Date:2023.09.08 10:48:29-04'00' Date:
(Heather Yilmaz, Procurement Services Division)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin Rp� B C ES C
16C 6
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
Complete the The additional time is required
equipment to complete the remaining
installation, start-up n/a n/a 325 735 contractual work once the
and testing at all 14 generators are
sites. delivered/accepted,.
Revised:0 1 11 412 0 21 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin ecc
431)
Rpt
co4
16C 6
ATTEST
BOARD OF COUNTY COMMISSIONERS
Crystal`K. Kmzel, tic ,Af courts COLLIER COUNTY, FLORIDA
& Comptroller -
'AiN4t ...(�
By:. By;
Rick LoCastro, Chairman
414 Dated: e"9
(SEAL) Attest as'fo Chairman's
signature only
Appr ed as to f an ity;
By: d`
Sco R. Teach
Deputy County Attorney
Of
CAI