Backup Documents 10/22/2024 Item #16C 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 C 4
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.
** ROUTING SLIP**
Complete routing lines#I 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. (Enter your Dept here)
3. County Attorney Office County Attorney Office
C—S l.aj2/
4. BCC Office Board of County CH by MB
Commissioners [s] /p/,�p V/
5. Minutes and Records Clerk of Court's Office rr
944- 10130124 1 :31eak
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 Madison Bird Phone Number 2939
Contact/Department 'rt o Gibe:' ,ceJc ( —
Agenda Date Item was 10/22/24 Agenda Item Number 160
Approved by the BCC
Type of Document(s) rr � Number of Original
Attached L(Jo r K Cj- {l 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)
1. Does the document require the chairman's signature?(stamped unless otherwise stated) MB
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 legality. (All documents to be signed by MB
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 MB
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 MB
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 MB
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 uploaded to the
agenda. 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_10/22/24 and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County J174
an option for
Attorney 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 G3S,/t-9 an option for
Chairman's signature. tl. a),.t1,
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05; 11/30/12;4/22/16;9/10/21
1 6C4
WORK ORDER/PURCHASE ORDER
Contract 20-7800 "Underground Contractor Services"
Contract Expiration Date: June 21, 2026
This Work Order is for professional services for work known as:
Project Name: NESA—Irrigation System
Project No: 70194.7.1
The work is specified in the quote dated July 26, 2024 which is attached hereto and made a part of this
Work Order. In accordance with Terms and Conditions of the Agreement referenced above,this Work
Order/Purchase Order is assigned to: Douglas N. Higgins, Inc.
Scope of Work: As detailed in the attached quote and the following:
* Section 1: General
* Section 2: Water System Improvements
* Section 3: Allowance
Schedule of Work: Complete work within 180 days from the date of the Notice to Proceed which is
accompanying this Work Order. The Consultant agrees that any Work Order that extends beyond the
expiration date of Agreement#20-7800 will survive and remain subject to the terms and conditions of
that Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenced above, the County will compensate the
Firm in accordance with following method(s): ®Negotiated Lump Sum (NLS) FLump Sum Plus
Reimbursable Costs (LS+RC) Time & Material (T&M) (established hourly rate — Schedule A) ❑
Cost Plus Fixed Fee (CPFF), (define which method will be used for which tasks) as provided in the
attached proposal.
Section 1: General $86,000.00
Section 2: Water System Improvements $610,466.00
Section 3: Allowance $50,000.00
$746,466.00
PREPARED BY:
Storm Gewirtz, P.E., Project Manager III Date
Engineering &Project Management
APPROVED BY:
Shon Fandrich, P.E., Supervisor Date
Engineering &Project Management
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ONO
1 6C4
APPROVED BY:
Matthew McLean, P.E., Director Date
Engineering & Project Management Director
APPROVED BY:
Steve Nagy, Manager - Wastewater Collections Date
APPROVED BY:
Robert Von Holle, Wastewater Director Date
APPROVED BY:
Joseph Bellone, Division Director-Utilities Finance Date
APPROVED BY:
Dr. George Yilmaz, Public Utilities Department Head Date
By the signature below, the Firm (including employees, officers and/or agents) certifies, and hereby
discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or
currently planned interest or activity (financial, contractual,organizational, or otherwise)which relates
to the proposed work; and bear on whether the Firm has a potential conflict have been fully disclosed.
Additionally,the Firm agrees to notify the Procurement Director,in writing within 48 hours of learning
of any actual or potential conflict of interest that arises during the Work Order and/or project duration.
ACCEPTED BY: Douglas N. H. ins, Inc.
Da tel kliggi s, esident Date
(Remainder of page intentionally left blank)
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1 6C 4
IN WITNESS WHEREOF,the parties hereto,have each,respectively, by an authorized person or
agent, have executed this Work Order on the date and year first written below.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. Kinzel,Clerk of Courts COLLIER COUNTY, FLORIDA
ri
� � � By:
`"' Chri all, Chairman
Hated 1 0 13-0,4
(SE )..' ,`Attest as to Chairman's
1/D4 , :�' signature only Name of Firm Douglas N. Hi ins, Inc.
By:First Witness gnature g �fI t)
1.),4f,j„e, Daniel Higgins, President
TType/print witness nameT 'TType/print signature and titleT
\
Second Witn ss
�f f\C‘ Slot o \LL
TType/print witness nameT
Approved as to F and Legality:
7
Depu ounty Attorney
/Print Name
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