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Backup Documents 01/23/2024 Item #16F 4 ORIGINAL DOCUMENTS CHECKLIST& ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 F 4 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's Office County Attorney Office L,23`,� /g3/2 � Ytt2. BCC Office Board of County Commissioners Chairman ( �N1� �_ 3. Minutes and Records Clerk of Court's Office 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 addresses above,may need to contact staff for additional or missing information. Name of Primary Staff Bendisa E. Zela, Facilities Division Phone Number 239-252-8440 Contact/Department Email Bendisa.Zela@colliercountyfl.gov Agenda Date Item was January 23,2024 Agenda Item Approved by the BCC Number 16.F.4 Type of Document Administratively approved Change Number of Attached Order No. 1, adding 16 days and Original 1 utilizing $47,484 of the owner's Documents allowance for Purchase Order No. Attached 4500223994 under Agreement No. 19- 7539 with Advanced Roofing, Inc. PO number or account Facilities Division is requesting a number if document is completed copy 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? 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. The original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman, except for most letters,must be reviewed and signed by the BEZ Office of the County Attorney. 4. All handwritten strikethroughs 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's 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 January 23,2024,and all changes made N/A is not during the meeting have been incorporated in the attached document. The County S(Z1 ffir 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 N/A is not BCC,all changes directed by the BCC have been made, and the document is ready for the 54(I an option for Chairman's signature. _ this line. 1: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 16F 4 Procurement Services Cotter" COMM, Change Order Form ❑Contract Modification ❑Work Order Modification Contract#: 19-7539 Change#: 01 Purchase Order#: 4500223994 Project#: 50229.3 Contractor/Firm Name: Advanced Roofing, Inc. Contract/Project: CCSO Jail(building J2)Roof Replacement Tim Rygiel I Facilities Management Project Manager Name: , Division Name: I Original Contract/Work Order Amount $ 749,352.00 11/12/19 16C3 _Original BCC Approval Date; Agenda Item# Current BCC Approved Amount $ 749,352.0(7 2/28/23 16C2 i Last BCC Approval Date; Agenda item# j Current Contract/Work Order Amount $ 749,352.00 11/11/2024 'SAP Contract Expiration Date (Master) Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount Revised Contract/Work Order Total $ 749,352.00 0.00% .Change from Current BCC Approved Amount Cumulative Changes $ 0.00 0.00% 'Change from Current Amount ' ECompletion Date,Description of the Task(s)Change,and Rationale for the Change Notice to Proceed 4/3/2023 Original 12/29/2023 Last Approved[ 12/29/2023 Revised Date 1/14/2024 Date _ Completion Date Date —(Includes this change) #of Days Added 16 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 I 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. I 1. This change order will add 16 days to the contract time providing a new Substantial Completion Date of 12/15/2023.This change order will also utilize$47,484 of the Owners Allowance leaving a balance of$29,516. 2. This change was an alteration of a proposed secondary drainage system included on the plans and not included in the original contract because the roof drainage issues were more severe than previously understood. 3. If this change is not processed, primary and secondary roof drainage system will be inadequate and could potentially lead to roof leaks and interior damage during heavy rain events. RygielTimothy Digitally signed by RygielTimothy Prepared by: Date: 2023.11.02 12:21:18 -04'00' 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 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/Consultant/ Design Professional arising out of or related to the change set forth herein,including claims for impact and delay costs. / ' ) A` fix.';,` ) Accepted by: _ ' `" """ �- %` �.-�'•" -,- r- " Date: Michael Komahrens,Adva'hced Roofing, Inc. McCormickJohn Digitally signed by McCormickJohn Date: 2023.11.02 15:11:14 -04'00' Approved by: Date: John McCormick,Division Director,Facilities Management Sq u itieriVi rg i n is Digitally signed by SquitieriVirginia Approved by: Date: 2023.12.06 12:16:32 -05'00' Date: (Procurement Professional) Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE AGmIn 1 e CC EB 1 6 F 4 ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel. Clerk of Courts Alf 0 Y, FLORIDA & Comptroller By: _ 411, /' By: ' 1 ,hrns Hall, Chairman '7g Dated f i7 •i r• 0 i t;'/ at, a `a airman's ki signature only Appr ved as to f Tit . By: Sco R. Teach Deputy County Attorney ,4„°` ,1 • n 6 .Change Order/Amendment Summary COST TIME cc# AMC# Description -------------' Justification Additive DeductiveH —, r—Amount— — Adds 1O days ha | If this change'"not processed, the project and | primary and--secondary-- system will be inadequate 1 utilizes�7�84ny | drainage-- the Owners ( and could potentially lead to roo l��i��m�ma� *!!o�anovduring koovy rain events. | | ( \ | | | ' ------- ! ------ --- ' ----7 -- ----- ! | | -- — | ' eown,m:ov14/2ou1 (Divisions who may require additional signatures may include on separate vhee ) PROCUREMENT USE ONLY Admin �� .�