Backup Documents 08/27/2024 Item #16F 1 ORIGINAL DOCUMENTS CHECKLIST&ROUTING SLIP 1 6 F l
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. County Attorneys Office County Attorney Office 1/er eia, 7
2. BCC Office Board of County Commissioners Chairman //
CI�kMI5/ S. zY
3. Minutes and Records Clerk of Court's Office /�/I /I I q'
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
addresses above,may need to contact staff for additional or missing information.
Name of Primary Staff Bendisa E.Miller,Facilities Division Phone 239-252-8440
Contact/Department Number Bendisa.Miller@colliercountyfl.gov
_ Email
Agenda Date Item was August 27,2024 Agenda
Approved by the BCC Item 16.F.1
Number
Type of Document Attached Recommendation to approve Change Order No. 2, Number of
adding 180 days to the project time for Purchase Order Original 1
No. 4500227467 under Agreement No. 19-7525 with Documents
EBL Partners, LLC, for repairs to the "Growth Attached
Management Community Development Department
Front and Walkway Canopy"project,and authorize the
Chairman to sign the attached change order.
PO number or account The Facilities Division is requesting a completed copy
number if the document is to
be recorded
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. Does the document require the chairman's original signature? N/A
2. Does the document need to be sent to another agency for additional signatures? If yes,provide the Contact N/A
Information(Name,Agency,Address,Phone)on an attached sheet.
3. The original document has been signed/initialed for legal sufficiency. (All documents to be signed by the
Chairman,except for most letters,must be reviewed and signed by the Office of the County Attorney. BEM
4. All handwritten strikethroughs and revisions have been initialed by the County Attorney's Office and all . N/A
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 BEM
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 N/A
provided to the County Attorney's 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 BCC approved the document on August 27,2024,and all changes made during the meeting have N/A is not an
been incorporated in the attached document. The County Attorney's Office has reviewed the cf` I46 option for this
changes,if applicable. line.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes N/A is not an
directed by the BCC have been made,and the document is ready for the Chairman's signature. C p�l, option for this
7K- 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
6 F i
Corr County
Procurement Services Change Order Form
Contract# 19-7525 CO# 02 PO#4500227467 Project#: 50161.1
Project Name: GMD Front and Walkway Canopy
Contractor/Consultant Name: EBL Partners, LLC
Select One: ❑Contract Modification (Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Christopher Cook Division Name: Facilities Management
Original Contract/Work Order Amount $449,570.87 8/22/2023 16F4 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $449,570.87 8/22/2023 16F4 Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $449,570.87 6/24/2025 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change o.000k Total%Change from Original Amount
Revised Contract/Work Order Total $449 570.87 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes so.00 o.00 k %Change from Current Amount
Notice to Proceed 10-23-2023 Original NTP 11 180 Original Final 4-20-2024 Last Final 8-18-2024
Date #of Days ( Completion Date Approved Date
#of Days Added 180 Revised Final Date 2.14-2025 Current Substantial Completion Date NA
(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, your submission of this Change Order and complete
summary on next page. Check all that apply to this Change Order request(✓ dd 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.) Detail of change/s to be made through this Change Order.
This change order adds 180 to the project time.
2.) If this Change Order is currently under a Stop Work, please identify the date issued and number of
days remaining or "N/A" if not applicable.
N/A
3.) Explain why this change was not included in the original contract/Work Order.
Project was scheduled to occur during business hours but had to be moved to weekend work to not
disrupt GMD operations and to ensure the safety of county personnel and citizens.
4.) Describe the impact if this change is not processed.
The rules within the Procurement Ordinance and Manuel will not be adhered to and the work will occur
after the expiration of the NTP.
Page 1 of 4
Change Order Form(2023_ver.1)
■ 6F
Colter County
Procurement Services Change Order Form
Contract# 19-7525 CO# 02 PO# 4500227467 Project#: 50161.1
Project Name: GMD Front and Walkway Canopy
Contractor/Consultant Name: EBL Partners, LLC
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
Uses $13,976,59 of If this change order is not
1 the Owners processed the structural
Allowance for integrity and overall safety of
WD#1. the building is at risk.
Adds 180 days to The rules within the
Procurement Ordinance and
2 the project. 180 360 Manuel will not be adhered to
and the work will occur
after the expiration of the NTP.
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
NSF 1
Car County
Procurement Services Change Order Form
Contract# 19-7525 CO# 02 PO# 4500227467 Project#: 50161.1
Project Name: GMD Front and Walkway Canopy
Contractor/Consultant Name: EBL Partners, LLC
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.mvfforida.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.
CookChristopher Digitally signed by CookChristopher
Prepared by: Date:2024.07.19 09:00:50-04'00' Date:
Signature-Division Project Manager
Christopher Cook, Project Manager II, Facilities Management
Printed Name
Accepted by: Date:
Signature-Design/Engineer Professional (if applicable)
Printed Name/Title/Company Name
Digitally signed by Paul A Benson
Accepted by: Date.2024.07.19 12:04:30-04'00' Date:
Signature-Contractor/ConsultantNendor
Paul Benson, President, EBL Partners LLC
Printed Name/Titlel Company Name
Approved by: Date:
Signature-Division Manager or Designee (Optional)
Printed Name NA CCo rm i CkJ oh n Digitally signed by McCormickJohn
Approved by: Date: 2024.07.22 13:34:17-04'00' Date:
Signature-Division Director or Designee (Optional)
John McCormick, PE, Division Director, Facilities Management
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee (Optional)
Printed Name
Page 3 of 4
Change Order Form (2023_ver.1)
6F 1
Coffer County
Procurement Services Change Order Form
Contract# 19-7525 CO# 2 PO# 4500227467 Project#: 50161.1
Project Name: GMD Front and Walkway Canopy
Contractor/Consultant Name: EBL Partners, LLC
FOR PROCURMENT USE ONLY
FY 24 CHO Request# 445
Digitally signed by
ZimmermanBecca ZimmermanBecca
Approved by: Date:2024 08.01 14:51:59-04'00'
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative ❑ Administrative-BCC Report • BCC Stand-Alone ES (BCC Approval Required)
BCC APPROVAL
ATTEST:
grin
Crystal K. Ktn±el;.CJerk okthe Circuit Court BOARD OF COUNTY COMMISSIONERS
and Compt'toll'er .. COLLIER C N Y, FLOR DA
i
By; t[ I By:
t
Dated: .' "4 10t. Chris Hall, Chairman
��`. AttestI ,
�-4� �� „ y tor✓hairman5
signature only
(SEAL) Agenda# 16F1 427/2 /
roved? to Fr anArl,egal
Deputy unty Attorney
Ob 7 'L -
Print Name
Page 4 of 4
Change Order Form(2023_ver.1)