Backup Documents 04/23/2024 Item #16C 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C 2
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#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
ge-q ievic.711
4. BCC Office Board of County
Commissioners 00113/1 S/6/Z`(
5. Minutes and Records Clerk of Court's Office S
11,9/2)/
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 Diana C. Dueri/PUD-EPMD Phone Number 239-252-4218
Contact/Department
Agenda Date Item was 4/23/2024 Agenda Item Number 16.C.2
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)? DD
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 DD
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. Ai,/y
5. The Chairman's signature line date has been entered as the date of BCC approval of the Ai
document or the final negotiated contract date whichever is applicable. �j
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 4/23/2024 and all changes made during DD 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 DD 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.
l: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
o county Procurement StvitsC► 2
Change Order Form
g
Z Contract Modification Work Order Modification
67001123390..55..33
,
Contract#: 22-7982 Change#: 1 Purchase Order#: 4500222454 Project#: 70120.5.4,
60139.5.4
Contractor/Firm Name: D. N. Higgins Inc. Contract/Project: 105'n& 106t"Avenue North Public Utilities
ProjectManager Name: Diana Dueri, PMP EPMD
Division Name:
Original Contract/Work Order Amount $ 16,806,410.00 10/25/22;11A Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 16,806,410.00 10/25/22;11A Last BCC Approval Date; Agenda Item #
Current Contract/Work Order Amount $ 16,806,410.00 4/10/2024 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 16,806,410.00 /0.00 ° Change from Current BCC
° 9 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 01/02/23 Original 3/27/24 Last Approved 4/10/24 Revised Date 5/27/24
Date Completion Date Date (Includes this change)
#of Days Added 46 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/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 adds 46 days to the Contract Substantial and Final Completion dates.
Additional Days (45)— Lumen Utility Conflict and Material Delay
I. The purpose of this change is to add forty-five (45) days to the contract time due to the utility conflict with
Lumen/CenturyLink that delayed the Contractor installing the proposed stormwater infrastructure improvements
along 6th Street N near 105'h Avenue N. and the availability of suitable material to complete the proposed roadway
restoration.
2. The additional forty-five (45) days were not included in the original contract as it was unforeseen that the utility
conflict would delay the Contractor from working on the stormwater infrastructure improvements within this area
from 5/15/23 through 8/24/23 and that suitable material would not be available causing an additional delay in
roadway restoration (5/3/23 through 6/14/23).
3. If the additional forty-five (45) days is not added to the contract, the Contractor will not be able to complete the
project within the contract time,at no fault to the Contractor due to circumstances out of the Contractor's control,
This Change increases the amount of days in the contract by forty-five(45)days. This Change DOES NOT change
the contract amount.
Additional Day (1)—Delay Due to Rain
1. The purpose of this change is to add one (1) day to the contract time due to unforeseen weather conditions that
prevented the Contractor for working on Wednesday 9/27/2023.
2. The additional one (1) day was not included in the original contract as it is was unknown that unforeseen weather
conditions would prevent the Contractor from working.
3. If the additional one (1) day is not added to the contract, the Contractor will not be able to complete the project
within the contract time, at no fault to the contractor.
This Change increases the amount of days in the contract by one (1) day. This Change DOES NOT change the
contract amount
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin Rpl BCC ES
16C2
Prepared by:
Diana Dueri, PMP Project Manager Ill, EPMD Date: 24
KLA tA 1 1/2/25/24
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 or related to the change set forth herein, including claims for impact and delay costs.
Digitally signed by Michael
Michael Lo B el l o
LoBello
Accepted by' Date:2024,01.25 14:58:50 05'00'
Mike Lobello—D. N. Higgins, Inc. Date:
Digitally signed by Justin A.Frederiksen,P.E.
Justin A. Frederiksen, P,E
Accepted by: Date:2024.01 zs t sao:oe•os o0
Justin Frederiksen, P.E.—Q. Grady Minor&Associates, P.A. Date:
BullertBenjamin
Approved by:
Ben Bullert, P.E., Principal Project Manager, EPMD Date:
Dn.E.uw...+nram+rmv,Mw•.fia.nopN�w lA OWv..
Approved by: McLeanMatthew . = . ow�.
Matt McLean, RE., Director EPMD o Date:
Mc N ea(Lindsey Digitally signed by McNealLindsey
Approved by: Date:2024.01.30 08:31:38-05'00' Date:
(Procurement Professional)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RPt oCCES
16 C2
ATTEST: BOARD OF COUNTY COMMISSIONERS
• P'4izistal K. Kinzel,Clerk of Courts COLLIER C TY
, FLORIDA
y; y&��Crnptroller
f jb' By
?` ris Hall, Chairman
»'� Dated:- 6 (Q
..... (S AL,)
Appro c a; 0 17 a legality.
ott R. Teach
Deputy County Attorney
I
S
' 6C2
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive (-) Added Amount
This CO adds 46 Days Days are added for delays in work
to the Contract N/A N/A 46 496
Substantial and Final
1 1 due to utility conflict, material
acquisition, unforeseen inclement
dates weather.
( A
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RpI BCC ES