Backup Documents 05/28/2024 Item #16C 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 C 1
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 i; G. Vt 0 -1- / ✓l r 6- y aLf
3. County Attorney Office County Attorney Office 6( 2` /
4. BCC Office Board of County
Commissioners 0171 C/ /2Y
5. Minutes and Records Clerk of Court's Office
47(0i' ll
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 � Phone Number ,�?q_asa_5 3 e�
Contact/ Department J�A I) k) r r N� V .
Agenda Date Item was 5-/98/t,y Agenda Item Number I / •C.Approved by the BCC
Type of Document Number of Original
Attached C 0►n CJ_ Of O-et 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)
I. Does the document require the chairman's original signature? OM r
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. /1//4
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 All r
by the Office of the County Attorney. I`
4. All handwritten strike-through and revisions have been initialed by the County Attorney's ,,y�
Office and all other parties except the BCC Chairman and the Clerk to the Board v�f
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. 01 1'
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. 0 F
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 S 2 and all changes made during N/A is not
the meeting have been incorporated in the attar ed document. The County an option for
Attorney's Office has reviewed the changes, if applicable. cift(Ao 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 an option for
Chairman's signature. Y2-1.(tel this line.
C 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
16 C1
Col Lier County
Procurement Services Change Order Form
Contract# 23-8064 Co#1 Po#4500225317 Project#: 70118.8
Project Name: North County Regional Water Treatment Plant Roof Improvments
Contractor/Consultant Name: Advanced Roofing, INC.
Select One: ✓❑Contract Modification(Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Matthew Fortune Division Name: PUD
Original Contract/Work Order Amount $1,222,591.00 6/27/2023;16C1 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $1,222,591.00 N/A Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $1,222,591.00 6/15/2024 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change o.00% Total%Change from Original Amount
Revised Contract/Work Order Total $1,222,591.00 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes $o.00 0.00% %Change from Current Amount
Notice to Proceed 12/18/2023 Original NTP 180 Original Final 6/15/2024 Last Final 6/15/2024
Date #of Days Completion Date Approved Date
#of Days Added 30 Revised Final Date 7/15/2024 Current Substantial Completion Date 5/16/2024
(includes this change) (if applicable)
Provide responses after each question in box below (Responses should be brief and specific). Attach additional information and/or
documentation from the Design Professional and/or Contractor, if needed, with your submission of this Change Order and complete
summary on next page. Check all that apply to this Change Order request: ❑✓ Add Time; ❑Add funds; ❑ Use of Allowance;
❑ Modify/Delete existing Task(s); ❑Add new Task(s); ❑ Reallocate funds; ❑ Other(must be explained in detail below)
1.) Staff is requesting an extension in time of 30 days to the current contract with no effect on
costs/expenses to the agreed upon contract amount stated above. Calculated as follows: 6/15/2024 +
30 days = 7/15/2024
2.) N/A
3.) The additional time extension request is necessary as a result of delays in material delivery,
necessitating an extension of the construction timeline.
4.) If this change is not processed, Advanced Roofing will not have sufficient time to complete the
installation of the wall panels once they arrive.
Page 1 of 4 CPO
Change Order Form(2023_ver.1)
16C1
Coiiier County
Procurement Services Change Order Form
Contract# 23-8064 CO# 1 PO# 4500225317 Project#: 70118.8
Project Name: North County Regional Water Treatment Plant Roof Improvments
Contractor/Consultant Name: Advanced Roofing, INC.
Change Order/Amendment Summary
(If additional spaces needed,attached a separate Summary page to this amendment request)
COST TIME
CO# AMD# Description Additive Deductive Days Total New Justification
(+) (-) Added Time
Added time The additional time extension request
is necessary as a result of delays in
1 30 210 material delivery, necessitating an
extension of the construction
timeline.
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
160 ?
Collier County
Procurement Services Change Order Form
Contract# 23-8064 CO# 1 PO# 4500225317 Project#: 70118.8
Project Name: North County Regional Water Treatment Plant Roof Improvments
Contractor/Consultant Name: Advanced Roofing, INC.
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.
Contractor/Consultant/Design Professional signature below must be from an authorized person/officer/director of
the Company or listed as the qualified licensed Professional"Project Coordinator"or Design/Engineer Professional
under the agreement. Signature authority of person signing will be verified through the contract OR through the
Florida Department of State, Division of Corporations (Sunbiz) website (https://dos.mvflorida.com%sunbiz/search/).
If the person signing is not listed, we will require signature authority by one of the listed officers/directors of the
company giving that person signature authority.
FortuneMattheW Digitally signed by FortuneMatthew
Prepared by: Date:2024.04.10 15:07:55-04'00' Date:
Signature-Division Project Manager
Matthew Fortune
Printed Name
Vincent A Zaliauskas Digitally signed by Vincent A Zaliauskas
Accepted by: Date:2024.04.10 14:32:28-04'00' Date:
Signature-Design/Engineer Professional (if applicable)
Vince Zaliauskas,PE
Printed Name/Title/Company Name
DgialH vgned by Zach Solomon
ZachUS.E=00charysaadnncodroofing.com,O=AManced Roofing Inc,
OIAComreaur,CN=loch Solomon Date:
Accepted by: aw.2024.04.0E 14:10:2244'00'
Signature-Contractor/ConsultantNendor
Zach Solomon, Project Manager Advanced Roofing
Printed Name/Title/Company Name
Approved by: Date:
Signature-Division Manager or Designee(Optional)
Printed Name
Approved by: Date:
Signature-Division Director or Designee(Optional)
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1) GP,O
16C1
Collier County
Procurement Services Change Order Form
Contract# 23-8064 CO# 1 PO# 4500225317 Project#: 70118.8
Project Name: North County Regional Water Treatment Plant Roof Improvments
Contractor/Consultant Name: Advanced Roofing, INC.
FOR PROCURMENT USE ONLY
FY 24 CHO Request# 363
ZimmermanBecca Digitally signed by ZimmermanBecca
Approved by: Date:2024.05.07 15:26:55-04'00'
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative I Administrative-BCC Report ❑ BCC Stand-Alone ES (BCC Approval Required)
BCC APPROVAL
ATTEST:
Crystal K. Kipzet, Cfei1yof the Circuit Court BOARD OF COUNTY COMMISSIONERS
and ComptOl)e ls,,e, COLLIER C , FLORIDA
- D/ 4 '
As
By: hisiti.`' . %�__ ' By:
mar .�
Dated:. . O. ,.!-• 7 Chris Hall, Chairman
Attesfsst•'Chairman's Date: 5/2 B/ vi
signature only / 1
(SEAL) Agenda# 16. (. 1
Ap roved o r an eg ity:
Deputy County ttorney
Print Name
Page 4 of 4 43
Change Order Form(2023_ver.1)
i A�' :
16C1
From: Zachary Solomon
To: Matthew Fortune
Subject: Request for time extension
Date: Tuesday,April 2,2024 2:32:28 PM
EXTERNAL EMAIL: This email is from an external source. Confirm this is a trusted sender
and use extreme caution when opening attachments or clicking links.
Good afternoon,
I am requesting a 30 day extension of our current schedule due to delays in fabrication and
shipping of materials.
Please let me know if you have any questions.
Thanks,
Zach Solomon
Project Manager
Advanced Roofing Inc.
o: 813-885-5811
m: 813-678-7824
e: ZacharyS@advancedroofing.com
w: www.advancedroofing.com
a: 4909 W. Knollwood St, Tampa, FL, 33634
Advanced Roofing logo
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