Backup Documents 08/13/2024 Item #16C 4 •
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 4 h 4'
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 he fonsarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must he 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 f
�4fl/,.j 8'13/7/'
4. BCC Office Board of County
Commissioners 04/1 /s/ g(i(ky
5. Minutes and Records Clerk of Court's Office
Yt4 V/(if))
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 r additional or missing information.
Name of Primary Staff �l1 Phone NumberZ
Contact/ Department a M i k v C i t d r&4vWI 53 7 7
Agenda Date Item was fl , i3 Z Z Agenda Item Number ( b e
Approved by the BCC D
Type of Document ff Number of Original
Attached 1, q H ie 0 f-de r Documents Attached
PO number or account
number if document is 5 Z2,5 3
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?
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 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 N
O'
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 N rA
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. Al a
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 g/13/t7 and all changes made during N/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 � N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the .fife an option for
Chairman's signature. this line.
I: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
16C4
Co "�er County
Procurement Services Change Order Form
Contract# 20-7800 CO#01 PO# 4500225493 Project#: 70166.20
Project Name: Eagle Lakes Metering Assemblies Replacement and Improvements
Contractor/Consultant Name: Quality Enterprises USA, Inc.
Select One: El Contract Modification (Construction or Project Specific) 0 Work Order Modification
Project Manager Name: Damian Cuadrado Division Name: Engineering & Project Management
Original Contract/Work Order Amount $599 123 00 6/22/21 11B Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $599,123 00 06/21/2026 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change so.00 o.00 i Total%Change from Original Amount
Revised Contract/Work Order Total $599,123.00 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes so.00 o.00i %Change from Current Amount
Notice to Proceed 01/10/2024 Original NTP 150 Original Final 06/08/2024 Last Final 08/09/2024
Date #of Days Completion Date Approved Date
#of Days Added 30 Revised Final Date 09/08/2024 Current Substantial Completion Date 07/10/2024
(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: 0 Add Time; El Add funds; ❑ Use of Allowance;
El Modify/Delete existing Task(s); ❑Add new Task(s); ❑ Reallocate funds; ❑Other(must be explained in detail below)
1.) This Change Order adds 30 days to the Work Order.
2.) N/A
3.) This change was not included in the original contract/Work Order because unforeseen conditions
were encountered in the project which included the following:
a. discovery of an existing abandoned pipe which had to be removed.
b. existing piping having differing alignment than what was in the plans which required the
procurement of additional fittings.
4.) If this change is not processed it is probable that the Contractor will not be able to finish the project
by the current Final Completion Date of 08/09/2024.
Page 1 of 4
Change Order Form(2023_ver.1) CAS
16C4
Colter County
Procurement Services Change Order Form
Contract# 20-7800 CO#01 PO# 4500225493 Project#: 70166.20
Project Name: Eagle Lakes Metering Assemblies Replacement and Improvements
Contractor/Consultant Name: Quality Enterprises USA, 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
addition of time unforeseen conditions
01 30 180 encountered at the project
site
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1) (CAC)
I b C4
Co aer County
Procurement Services Change Order Form
Contract# 20-7800 CO# 01 PO# 4500225493 Project#: 70166.20
Project Name: Eagle Lakes Metering Assemblies Replacement and Improvements
Contractor/Consultant Name: Quality Enterprises USA, 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.myflorida.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.
CuadradoDamian ` m"` � �`" �" °" � " "°`"�° ` ° °
kfa,n..a.fuo w .y.a iv.n M�.wm..,,ou.wD.ou•a..o-...oc•xf.oami»,ao,.
Prepared by: 0.W102ADa06Pa,at, Date:
Signature-Division Project Manager
Damian Cuadrado KLA 6/6/24
Printed Name
DPpDNy•rwned by Stevan Agap
Accepted by: Steven Agapi YC.US.E St�v 06 en a tech cum.0..sln Tad u,.SWan A,ap
Date:
Signature-Design/Engineer Professional(if applicable)
Steven Agapi/Project Manager/Tetra Tech
Printed Name/Title/Company Name
Lou Gaudio Digitally signed by Lou Gaudio
Accepted by: Date:2024.06.06 10:26:29-04'00' Date:
Signature-Contractor/ConsultantlVendor
Louis J.GaudioNice President/Quality Enterprises USA,Inc.
Printed Name/Title/Company Name
oyue..q..a M f.MrW.an.
FandrichShon DW�Ems.,;✓b. . myr aw.`N.F.Mn&m Di.Da,..OU aPN U.w
Approved by: D..A Inonn and ' w D�.4,D«.D.,aro.D DD DD.no
Date:
Signature-Division Manager or Designee(Optional)
Shon Fandrich
Printed Name
McLeanMatthew `"� ��°�.....!•. ."'�'"""°""""°"""""
.rc.un..OIFOUD q.^^•q wM awn Wi.p.mra.gMR10.OW DFpnu DC•Mc DC.aWrnev.
Approved by: n.�. .a�a Date:
Signature-Division Director or Designee(Optional)
Matthew McLean
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee (Optional)
Printed Name
Page 3 of 4
Change Order Form (2023_ver.1) CA®
� 16C4
Colt tr County
Procurement Services Change Order Form
Contract# 20-7800 CO# 1 PO# 4500225493 Project#: 70166.2
Project Name: Eagle Lakes Metering Assemblies Replacement and Improvements
Contractor/Consultant Name: Quality Enterprises USA, Inc.
FOR PROCURMENT USE ONLY
FY 24 CHO Request# 407
ZimmermanBecca Digitally signed by ZimmermanBecca
Approved by: Date:2024.06.28 08:46:58-04'00'
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative Q Administrative-BCC Report ❑ BCC Stand-Alone ES (BCC Approval Required)
BCC APPROVAL
ATTEST:
Crystal K. Kinzel, Clerk of the Circuit Court BOARD OF COUNTY COMMISSIONERS
and Comptroller COLLIER CO T , FLORIDA
By: TUP-'-+
B :
Attest as foLnairman's y
I signature only
Dated: (- . (le/0.9
Chris Hall, Chairman
(SEAL) Agenda# 16•C.4 STOP/
Approved as to Form and Legality:
AshkarSaI Iy Dale 12024 0 7 26 15 171 8-04'00'
Asst. County Attorney
Sally Ashkar.Asa stsnl County Attorney on bettst of Jeffrey A.Klalzkow,County Attorney
Print Name
Page 4 of 4
Change Order Form(2023_ver.1) Cry®
16C4
Damian Cuadrado
From: Lou Gaudio <Igaudio@qeusa.com>
Sent: Wednesday,June 5, 2024 6:03 AM
To: Damian Cuadrado
Cc: Agapi, Steven
Subject: Eagles Lakes Time Extension Request
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.
Damian
We would like to request a 30 day extension due to the unforeseen conditions encountered at the site. The
discovery of an existing abandoned pipe for which a work directive was provided required additional time waiting
for work directive,then removal-backfill-compaction required. Additionally,due to the differing alignment of
existing pipes that we are tying into,we had to order additional fittings to make the tie in's work.
Please let me know if you have any questions.
Thanks
Louis J. Gaudio
_ Vice President
- c:239-207-0660
o:239-435-7200
QUALITY e:Igaudio oeusa.com
ENTERPRISES 3494 Shearwater Street,Naples,FL 34117
NOTICE:
This email contains information that is legally privileged and confidential. If you have received this
message in error, please notify me immediately and delete this message. Any unauthorized disclosure,
copying, distribution or other use of this proprietary information is strictly prohibited.
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