Backup Documents 10/22/2024 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 he fonnarded 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. lithe 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 )D)��7)�,1,,,/cy'd/a
4. BCC Office Board of County
Commissioners Ge !l (O/2/(2
5. Minutes and Records Clerk of Court's Office [I
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 f r additional or missing information.
Name of Primary Staff `� Phone Number Ls Z
Contact/ Department q Y it a v 4 C v dd r d 4 a 531 7
Agenda Date Item was /Zy / Agenda Item Number G
Approved by the BCC 0 6 ` Z t 'b
Type of Document Number of Original
Attached C IA ti V At 0 r dQ r Documents Attached /
PO number or account '1
number if document is 4, 5 0 0 Z 3 0 9 t3
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 i
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 ]"yJ)
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 N l A
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 /r.//A
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 input into SIRE. mil./
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!
S. The document was approved by the BCC on 10!2L/ land 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 lity 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
teC1
Cofer County
Procurement Services Change Order Form
Contract# 23-8187 CO# 02 PO# 4500230813 Project#: 50280.6.4
Project Name: 33 Lift Station Panels Replacement Project
Contractor/Consultant Name: Powerserve Technologies, Inc.
Select One: ✓❑Contract Modification(Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Damian Cuadrado Division Name: Engineering & Project Management
Original Contract/Work Order Amount $3,267,404.20 03/12/2024;16C3 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $2,767,224.67 11/06/2024 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change $o.00 -15.31/ Total%Change from Original Amount
Revised Contract/Work Order Total $2,767,224.67 0.00/ %Change from Current BCC Approved Amount
Total Cumulative Changes -$500,179.62 0.00% %Change from Current Amount
Notice to Proceed 04/10/2024 Original NTP 210 Original Final 11/06/2024 Last Final 11/06/2024
Date #of Days Completion Date Approved Date
#of Days Added 11 Revised Final Date 11/17/2024 Current Substantial Completion Date 10/07/2024
(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:ElAdd Time;❑Add funds; ❑ Use of Allowance;
❑Modify/Delete existing Task(s);El Add new Task(s);El 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 10 work days due to rain to the contract amount (see attached emails). It
should be noted that because these days are work days (Monday through Saturday), the calculation
adding the days to substantial and final completion does not include Sunday. Therefore, 11 calendar
days have been added and the new Substantial and Final Completion dates are as follows:
Substantial Completion: 10/18/2024
Final Completion: 11/17/2024
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.
This change order is for rain days.
4.) Describe the impact if this change is not processed.
The contractor will not have approved rain days added to their contract time.
Page 1 of 4
Change Order Form(2023_ver.1)
CA{ .
16C1
Cofer County
Procurement Services Change Order Form
Contract# 23-8187 CO#02 PO# 4500230813 Project#: 50280.6.4
Project Name: 33 Lift Station Panels Replacement Project
Contractor/Consultant Name: Powerserve Technologies, 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
Removal of the following lift The County was compelled to
stations from project scope: replace the panels on these lift
1 INN
($500,179.62) - - stations prior to the contract
134.00, 101.03,101.05,
101.08,and 308.02 being
fully executed
Addition of 11 11 calendar days added for
calendar days for 10 rain days because
2 10 rain (work) days. — — 11 221 added days are work days.
❑ Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
A
16C1
Collier County
Procurement Services Change Order Form
Contract# 23-8187 CO#02 PO# 4500230813 Project#: 50280.6.4
Project Name: 33 Lift Station Panels Replacement Project
Contractor/Consultant Name: Powerserve Technologies, 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.
°w°,aE v„"'°'`"'w'a�:�,.Eaw,.c.:•...,,.�..,.,.a,.w.«.,a,..R.",.r
CuadradoDamian �r.
Prepared by: n., .,.ter.„w,.a> Date:
Signature-Division Project Manager KLA 9/18/24
Damian Cuadrado,Project Manager III(Licensed),PUD-Engineering&Project Management Division
Printed Name
Francisco J. Bohorquez, PE �`"":`:;�`"""`"""`•"""°"- "' ""
Accepted by: n.• ,..,.r,,.ar�Ea Date:
Signature-Design/Engineer Professional (if applicable)
Francisco J.Bohorquez,Senior Engineer,AECOM
Printed Name/Title/Company Name
Delany siywd by Mi.rc0 O.ng
Antonio Oruga Dec-us,E=.nnga axa th.a nseneie corn O Po•"Orsen.TecMNoD.s.Inc.•.
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Accepted by: Oat 2024 og my.
po" ,a,zo..z-0,Oil Date:
Signature-Contractor/ConsultantNendor
Antonio Oruga,Business Development Manager,Powerserve Technologies, Inc.
Printed Name/Title/Company Name
DAY it a rar 015
Fa nd ri ch S hon ..Svar, w a .�.0go..C....< sr.n.a..09.�a,.PP:"Wag.
Approved by: « Date:
Signature-Division Manager or Designee(Optional)
Shon Fandrich,Supervisor-Project Management(Licensed),PUD-Engineering&Project Management
Printed Name
McLeanMatthew o .."..�"•,E;�a�...,�,�. ,,.�E..,.,.w.E,u.�.,.•a,...,""r.
Approved by: o'20,4w•9a•45904994 Date:
Signature-Division Director or Designee(Optional)
Matthew McLean,Division Director,PUD-Engineering&Project Management
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1)
16C1
Colt T County
Procurement Services Change Order Form
Contract# 23-8187 CO#2 PO# 4500230813 Project#: 50280.6.4
Project Name: 33 Lift Station Panels Replacement Project
Contractor/Consultant Name: Powerserve Technologies, Inc.
FOR PROCURMENT USE ONLY
FY 24 CHO Request# 481
Approved by:
Digitally signed by ZimmermanBecca
ZimmermanBecca Date:2024.09.20 13:39:06-04'00'
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:
Crystal K. Kinzel, Clerk of the Circuit Court BOARD OF COUNTY COMMISSIONERS
and Comptroller COLLIER CO FLORIDA
By: 't'J tt.u,4,c By:
Dated .�1c1)::q.f.2- Chris Hall, Chairman
r Attest as to Chairman's
;,; F `' I signature only
r ,
3 SEAL Agenda# 1of22 Z`I IC.C.
'4 b'!l 1 l'' • '
A roved a t For nd gality:
C
Deputy Coun---,, -ity A orney f
,.
Print Name
Page 4 of 4 01
Change Order Form(2023_ver.1)
6C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday,June 19, 2024 2:24 PM
To: Damian Cuadrado
Cc: Robert Konger; Danys Montero;Joel D.Cuesta
Subject: Station Panels Replacement Project- Rain Days
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,
Powerserve Technologies is requesting allowance for five rain days last week; June 10 through June 14.
Thanks,
Joseph Miller, P.E.
Project Manager
Powerserve Technologies, Inc.
15074 Park of Commerce Blvd. I Unit#4
Jupiter, FL 33478
561-840-1441 I Office
407-756-7268 I Cell
Email:JMiller@powerservetech.com
www.powerservetech.com
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i6C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday,August 7, 2024 4:37 PM
To: Damian Cuadrado
Cc: Robert Konger;Joel D. Cuesta
Subject: Rain Days
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,
Powerserve Technologies is requesting allowance for the following rain days as reported by Joel Dollar.
7/23: half day
7/30: half day
8/5:full day
Thanks,
Joseph Miller, P.E.
Project Manager
Powerserve Technologies, Inc.
15074 Park of Commerce Blvd. I Unit#4
Jupiter, FL 33478
561-840-1441 I Office
407-756-7268 I Cell
Email: 1Millerpowerservetech.com •
www.powerservetech.com
1
16C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday,August 28, 2024 4:32 PM
To: Damian Cuadrado
Cc: Robert Konger;Joel D.Cuesta
Subject: Rain Days-Week of August 19
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,
Powerserve Technologies is requesting allowance for the following rain days as reported by Joel Dollar.
8/20: half day
8/21: half day
Thanks,
Joseph Miller, P.E.
Project Manager
Powerserve Technologies, Inc.
15074 Park of Commerce Blvd. I Unit#4
Jupiter, FL 33478
561-840-1441 I Office
407-756-7268 I Cell
Email:JMiller( powerservetech.com
Yy.!mai_powerservetech.com
1
1 C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday, September 4, 2024 1:09 PM
To: Damian Cuadrado
Cc: Robert Konger;Joel D.Cuesta
Subject: Rain Days-Week of August 26
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,
Powerserve Technologies is requesting allowance for the following rain days as reported by Joel Dollar.
8/28: half day
8/29: half day
8/30: half day
Joseph Miller, P.E.
Project Manager
Powerserve Technologies, Inc.
15074 Park of Commerce Blvd. I Unit#4
Jupiter, FL 33478
561-840-1441 I Office
407-756-7268 I Cell
Email:JMiller@powerservetech.com
www.powerservetech.com
I6C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday,September 11, 2024 11:38 AM
To: Damian Cuadrado
Cc: Robert Konger;Joel D.Cuesta
Subject: Rain Days-Week of September 2
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,
{
Powerserve Technologies is requesting allowance for the following rain day as reported by Joel Dollar.
9/4: half day
Thanks,
Joseph Miller, P.E.
Project Manager
Powerserve Technologies, Inc.
15074 Park of Commerce Blvd. I Unit#4
Jupiter, FL 33478
561-840-1441 I Office
407-756-7268 I Cell
Email:JMillerfapowerservetech.com
www.powerservetech.com
1
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