Backup Documents 08/27/2024 Item #16B 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 68 3
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. County Attorney Office County Attorney Office
4. BCC Office Board of County
Commissioners a 1 )l
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 Dennis McCoy/Transportation Engineering Contact Information 239-252-5844
Contact/Department
Agenda Date Item was August 27,2024 Agenda Item Number 16.B.3
Approved by the BCC
Type of Document Change Order No 5 Agreement No.19-7494 Number of Original 1
Attached with Jacobs Eng. Group for VBR Road Documents Attached
Widening
PO number or account N/A
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 STAMP OK N/A Stamp
ok
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 DM
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/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 DM
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DM
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 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 8/27/2024 and all changes made during DM 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 an option for
Chairman's signature. this line.
1 68 3 16.B.3.a
CO le r County
-'^ -�- Procurement Services Change Order Form
Contract# 19-7494 CO# 5 PO# 4500202325 Project#: 60199
Project Name: Vanderbilt Beach Road 6-Lane Widening
Contractor/Consultant Name: Jacobs Engineering Group
Select One: El]Contract Modification(Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Dennis F. McCoy Division Name: Transportation Engineering Division
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Original Contract/Work Order Amount $1.058.378.00 2/25/2020.11c Original BCC Approval Date;Agenda Item# 2
Current BCC Approved Amount $1,619,970.00 6/13/2023.16b7 Last BCC Approval Date;Agenda Item# c
Current Contract/Work Order Amount $1.619,970.00 8/4/2024 SAP Contract Expiration Date(MASTER) x
Dollar Amount of this Change $0.00 53.06% Total%Change from Original Amount co
Revised Contract/Work Order Total
$1,619,970.00 0.00% %Change from Current BCC E
Approved Amount _
Total Cumulative Changes $561,592.00 0.00% %Change from Current Amount
07
Notice to Proceed Original NTP Original Final Last Final c
3/18/2020 g 1270 g 9/9/2023 8/4/2024 c
Date #of Days Completion Date Approved Date a>
#of Days Added 1080 Revised Final Date 7/20/2027 Current Substantial Completion Date NA §
(includes this change) (if applicable) cv
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Provide responses after each question in box below (Responses should be brief and specific). Attach additional information and/or u,
documentation from the Design Professional and/or Contractor, if needed. with your submission of this Change Order and complete ix
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)
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1.) This Change Order will add 1080 days to the contract to complete Task 5 Bidding Services and v
Post Design Services through the construction phase. The construction phase is expected to be N
completed in 2027. N
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2.) N/A. Currently the contract is not under a Stop Work.
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3.) During the design phase, the estimated construction schedule was increased from 18 to 24 months
largely due to the scope addition of a new box culvert structure crossing Vanderbilt Beach Road. In ix
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addition, the Florida Department of Transportation moved the Transportation Regional Initiative
Program (TRIP) grant construction funding for this project out to the 2023-24 fiscal year. The design �,
phase was extended due to these factors along with other design change orders. o
4.) If this change is not processed, post design services, which are necessary to complete the E
construction process, would not be completed. =
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Page 1 of 4
Change Order Form (2023_ver.1)
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Coiner County
Procurement Services Change Order Form
Contract# 19-7494 CO#5 PO# 4500202325 Project#: 60199
Project Name: Vanderbilt Beach Road 6-Lane Widening
Contractor/Consultant Name: Jacobs Engineering Group
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 c
(+) (-) Added Time .Cy
Added upsized stormwater Stormwater improvements were ,a
crossing,additional included in this project so new d
1 permitting requirements $256,296 90 1360 roadway would not be reconstructed w
and supplemental field later. Permitting was essential to E
testing for asphalt design project. +'
cm
Added dual turn lane Best design options to c
north to East and *c
2 extended right turn lane $129,956 240 1600 relieve current and future co
east bound at intersection traffic congestion
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Design and Post- J
g Best design option to 6
Design for relocation complete services and not g
3 of ARV's and non- $96,412 0 1600 delay construction process >
potable water line
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Design for replacement of nr
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privacy wall and design of More cost efficient to include
4 a directional U-turn $78,928 0 1600 with construction than try to Tr
westbound on VBR east replace as a separate project. ci
of Goodlette Frank Road Improved traffic capacity. r-
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1080 days added to the To provide contract days for c
contract for Bidding and designed to complete post r
5 Post Design Services. 1080 2680 design services during the
No fees to be added. r4
construction phase. >
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❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
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16.B.3.a
%�► _ 168 3
Colter County
Procurement Services Change Order Form
Contract# 19-7494 CO# 5 PO# 4500202325 Project#: 60199
Project Name: Vanderbilt Beach Road 6-Lane Widening
Contractor/Consultant Name: Jacobs Engineering Group
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.
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Contractor/Consultant/Design Professional signature below must be from an authorized person/officer/director of agi
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 a,
Florida Department of State, Division of Corporations (Sunbiz) website(htfps://dos.myflorida.com%sunbiz/search/). E
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. a,
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Prepared by: McCoyDennis Digitally signed by McCoyDennis
Date:2024.07.02 09:55:43-04'00' Date:
Signature-Division Project Manager
Dennis F. McCOY. Project Manager III,TE Division
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Printed Name
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Accepted by: Diana Fiore Francois Digitally signed by Diana Flore Francois
Date:2024.07.02 10:16:16-04'00' Date:
Signature-Design/Engineer Professional (if applicable) N
Diana F. Francois, P.E., Jacobs Engineering Group N
Printed Name/Title/Company Name
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Accepted by: Date: ti
Signature-Contractor!ConsultantlVendor
Printed Name/Title/Company Name
Approved by:
Date: O
Signature-Division Manager or Designee(Optional) •
Printed Name E
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Ah mad J a Digitally signed by AhmadJay
Approved by: Y Date:2024.07.02 10:42:28-04'00' Date:
Signature-Division Director or Designee(Optional)
Jay Ahmad, P.E., Director,Transportation Engineering Division
Printed Name
TO 7/2/24 ScottTrinity Digitally signed by ScottTrinity
Approved by: Date:2024.07.03 16:38:39-04'00' Date:
Signature-Division Administrator or Designee(Optional)
Trinity Scott, Department Head,TMSD
Printed Name
Pape 3 of 4
Change Order Form (2023_ver.1)
Packet Pg. 433
16.B.3.a
Cotter County
Procurement Services Change Order Form
Contract# 19-7494 CO#5 PO# 4500202325 Project#: 60199
Project Name: Vanderbilt Beach Road 6-Lane Widening
Contractor/Consultant Name: Jacobs Engineering Group
FOR PROCURMENT USE ONLY
FY 24 CHO Request# 41 6
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Approved by: ZI Digitallysigned b ZimmermanBecca
fT1CTlet"171at1B2CCa Date:2024.07.11 08:25:01-04'00'
Signature-Procurement Professional Signature/Date m
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Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
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APPROVAL TYPE:
H Administrative i:_ij Administrative-BCC Report 7 BCC Stand-Alone ES (BCC Approval Required)
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BCC APPROVAL
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ATTEST: N
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Crystal K. Kinzel, Clerk of the Circuit Court BOARD OF COUNTY COMMISSIONERS N
and Comptroller COLLIER C N Y, FLO DA
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By: t � ``(L By: r.
6 Attest as to Chairman's
s signature only "_
Dated: Chris Hall, Chairman
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(SEAL) Agenda# I b/3 3 3/47/rY o
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A roved s F nd gality:
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Deputy County Attorney
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Print Name
Page 4 of 4
Change Order Form(2023_ver.1) V"
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16.B.3.a
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Jacobs
June 10, 2024
Mr. Dennis McCoy, PE.
Project Manager Ill
Transportation Management Services Department
Transportation Engineering Division
2885 South Horseshoe Drive
Naples, FL 34104
Subject: VANDERBILT BEACH ROAD 6-LANE WIDENING
(East of US 41 to East of Goodlette Frank Road)
Contract 19-7494- P.O. 4500202325 lan
Request for Additional Contract Time for Post Design Services
Dear Mr. McCoy,
The purpose of this letter is to request that JACOBS Contract(Contract 19-7494) with Collierco
County for the above-mentioned project, be amended to provide:
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• Additional Contract Time
The current Contract expires 08/04/24.
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Based on anticipated post design services required, the remaining contract time will not he rn
sufficient to provide the required Post Design Services for the remainder of the project. Csl
Therefore, by this letter,JACOBS is requesting that the County:
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• Add 1080 Calendar Days to Contract. ti
Please let me know if you require any additional information related to the above request.
Tzt-
Reggaards,At/, —
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Bill Gramer, P.E., AICP
Vice President Transportation
Jacobs Engineering Group, Inc.
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