Backup Documents 03/12/2024 Item #16C4 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.
** ROUTING SLIP**
Complete routing lines#I 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 Yiy/icz
4. BCC Office Board of County
Commissioners t4Y//3/4 -5/H/z y
5. 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
addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Benjamin N. Bullert/PUD- EPMD Phone Number 239-252-2583
Contact/Department
Agenda Date Item was 3/12/2024 Agenda Item Number 16.C.4
Approved by the BCC
Type of Document(s) Change Order Number of Original
Attached Documents Attached
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. (Initial) Applicable)
1. Does the document require the chairman's original signature(instead of stamp)? BNB
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 legality. (All documents to be signed by BNB
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 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 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 uploaded to the
agenda. 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 1/23/2024 and all changes made during BNB N/A is not
the meeting have been incorporated in the attached document. The County Attorney an option for
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the BNB 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.
•
1:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05;11/30/12;4/22/16;9/10/21
16C4
Colt'r Procurement Services
er County Change Order Form
®Contract Modification ❑Work Order Modification
Contract#: 22-7981 Change#: 2 Purchase Order#: 4500220595 Project#: 70136.2.1.2
Contractor/Firm Name: OneSource Construction Co.&Builders, Inc. Contract/Project: NCRWTP Storage Building
Project Manager Name: Benjamin N. Bullert Division Name: Engineering and Project Management
Original Contract/Work Order Amount $ 1,242,797.00 9/13/2022;11C Original BCC Approval Date; Agenda Item#
Current BCC Approved Amount Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 1,242,797.00 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 1,242,797.00 #DIV/0! 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 10/18/2022 Original 11/17/2023 Last Approved 3/11/2024 Revised Date 3/15/2024
Date Completion Date Date (Includes this change)
#of Days Added 4 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.
This change order provides for a 4-day no cost time extension for both substantial completion and final completion. The new substantial
completion date will be February 14,2024.
1. The contractor has requested additional time due to seasonal rains which have impacted the contractor's ability to complete
the construction project.
2. This change was not included in the original contract as it was not known how many rain days would occur during the
construction of this project.
3. If this change is not processed,contract days will be lost at no fault of the contractor.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RP° BCC ES
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16C4
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Prepared by:
Date:
Benjamin N. Bulled, Supervisor—Project Management, EPMD KLA 2/9/24
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 r related to the change set forth herein,including claims for Impact and delay costs.
Accepted by: /' ?qL C �C 1�Ut 11 r Date: - `�George Chauvin,One$orce Construction Co. &Building, Inc.
TI e r C ► �/a � n r� ti t Digitally signed by Tyler C Wainright
Y V V g Date: 2024.02.12 0 c5:38 -05'00'
Accepted by: _
Tyler Wainwright, Engineer of Record,Tetra Tech, Inc.
Digitally signed by McLeanMallhew
DN:E=Matthew.McLean@colllercounlyll.gov,CN=McleanMalthew,
M c L e a n M a fit h ew OU=General,OU=PPM User Accounts,OU=PUD Planning and
Project Management,OU=PUD,OU=Divisions,DC=bce,
DC=colliergov,DC=net
Approved by: Date:2024.02.1210:21:57-05'00' Date:
Matt McLean, EPMD Director
Digitally signed by
McNealLindsey McNealLindsey
Approved by: Date:2024.02.13 08:34:00-05'00' Date:
Procurement
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin Rp BCC ES (f
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1 6 C 4
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. Kinzel,Clerk of Courts COLLIER 0 NTY, FLORIDA
&Comptroller
By: tilli
iitql're, By:
hris Hall, Chairman
Dated: 3'i 24
Attest as of hairman's
aw..._ Si9nature only
,
Approve as to f deg ity:
By: c.
Sco . Teach
Deputy County Attorney
i
i
1
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16C4
•
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
Time extension due to permitting
1 Time Extension 75 470 duration, signed and sealed
building plans submittal duration
and weather delays.
2 Time Extension 4 474 Time extension due to weather
delays.
•
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin Rp! BCC ES
CAO