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Backup Documents 11/12/2024 Item #16C 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP �. 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 0111 than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines fit 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#I 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 >/ /` 2b1 t1 4. BCC Office Board of County � Commissioners CA-� , / f.l I(11Y/Z`t 5. Minutes and Records Clerk of Court's Office 9 iih(//)•9 PRIMARY CONTACT INFORMATION )ACo`e s Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is ne c jui a event one of the addressees above,may need to contact staff for additional or missing information. p��, '. 4 .a O (kn. e a 11 p t, 0 k U •-`e Name of Primary Staff • -��( Phone Number Z _Z,SZ—GZ^} eJ`1e o1 Contact/ Department ?(.�I,YY►t rcl, DA-TOe-00C0(ter('oon• •500 Agenda Date Item was oZ vAgenda Item Number ApprovedbytheBCC r12Z (.2. rr 6 Z ` 6, C. Z . Type of Document Number of Original •� I Attached �'F "� Documents Attached "� i 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 original signature? 2. Does the document need to be sent to another agency for additional signatures? If yes, 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 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 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. 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 If f!Z and all changes made during N/A is not the meeting have been incorporated in the attached document. The County rt ei5 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 i, BCC,all changes directed by the BCC have been made,and the document is ready for the (j-(f/%b an option for Chairman's signature. I 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 1 6 C 2 Procurement Services 1�1 1 • Change Order Form ) Co llier County ❑ Contract Modification ® Purchase Order/Work Order Modification Contract#: 19-7622 Change#: 2 Purchase Order#: 4500215169 Project#: 70240.4.2 Contractor/Firm Name: U.S.Water Services Corporation Contract/Project: Pump Station 121.02 Repair and Renovations Project Manager Name: Zamira Deltoro, CSM Division Name: Public Utilities EPMD Original Contract/Work Order Amount $ 561,270.71 10/26/2021;16C4 Original BCC Approval Date;Agenda Item# Current BCC Approved Amount $ 676,607.13112/12/2023;16C4 Last BCC Approval Date;Agenda Item# Current Contract/Work Order Amount $ 676,607.13 4/27/2025 SAP Contract Expiration Date(Master) Dollar Amount of this Change $ 0.00 20.55% Total Change from Original Amount Revised Contract/Work Order Total $ 676,607.13 0.00% Change from Current BCC Approved Amount Cumulative Changes $ 115,336.42 0.00% Change from Current Amount Completion Date, Description of the Task(s)Change,and Rationale for the Change Notice to Proceed 9/13/2023 Original 3/11/2024 Last Approved 1/25/2025 Revised Date 3/26/2025 Date Completion Date Date (Includes this change) #of Days Added 60 Select Tasks El Add new task(s) ❑ Delete task(s) El Change task(s) ®Other Provide a response to the following: Attach additional information from the Design Professional and/or Contractor if needed. 1. Detailed and specific explanation/rationale of the requested change(s) to the task(s) and / or the additional days added (if requested). The purpose of this Change Order is to authorize an extension to the project time by 60 days. There were unforeseen time delays to acquire a dewatering permit, coordinate with the building department as a result of changes to the FEMA Flood Maps, and design modifications due to unforeseen issues with the existing gravity sewer. 2. Why this change was not included in the original contract. Unforeseen time delays were not accounted for in the original contract/Work Order. 3. Describe the impact if this change is not processed. If this change is not processed the contractor may not have substantial time to complete the project. Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY Admin BCC ES 1 6 C 2 Digitally signed by DeltoroZamira DN:E=Zamira.Deltoro@colliercountyf.gov,CN=DeltoroZamira, DeltoroZamira OU=General,OU=PPM User Accounts,OU=PUD Planning and Project Management,OU=PUD,OU=Divisions,DC=bcc, DC=colliergov,DC=net Prepared by: Date:zoza.os.zs,,:az:,a-oaoo Date: Zamira Deltoro, Project Manager, EPMD KLA 9/23/24 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. //f4 Accepted by: Date: 9/23/2024 Steve Stanton, anager Region 3, U.S. Water Services Corporation William H Saum 2024.09.23 11 :11 :27 -04'00' Accepted by: Date: William H. Saum, P.E.,Johnson Engineering, Inc. Digitally signed by FandrichShon DN:E=Shon.Fandnch©colllercountyll.gov, FandrichShon Uset AccohShon,unts, Plaral,ninOPPM User Accounts,OU=PUD Planning and Project Management,OU=PUD, OU=Divisions,DC=bcc,DC=colliergov,DC=net Approved by: Date:2024.09.2512:20:01-04'00' Date: Shon Fandrich, Supervisor of Project Management, EPMD Digitally signed by McLeanMatthew DN:E=Matthew.McLean@colliercountytI.gov, McLean Matthew CN=McLeanMatthew,,OU=General,OU=PPM User Accounts, OU=PUD Planning and Project Management,OU=PUD, OU=Divisions,DC=bcc,DC=colliergov,DC=net Approved by: Date:2024.09.25 16:24:00-04'00' Date: Matthew McLean, Division Director, EPMD Digitally signed by ZimmermanBecca ZimmermanBecca Approved by: Date:2024.10.03 08:39:25-04'00' Date: Procurement Services Division Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY Admin t BCC ES 16C 2 ATTEST: -. BOARD OF COUNTY COMMISSIONERS Crystal K,YCinzeY E of Courts COLLIER C U TY, FLORIDA & Comptrolle • By: By: ttcWas to'Ghairman's is Hall, Chairman c signature only Dated: (S AL) Ap ov as to fo d egality: By: R. each Deputy County Attorney 16C 2 Change Order/Amendment Summary COST TIME CO# AMD# Description Days New Justification Additive(+) Deductive(-) Added Amount The existing stormwater facilities Additional surrounding the pump station site 1 Stormwater $115,336.42 0 120 300 are failing and require Improvements improvements. More time is required to perform this additional work. The purpose of this Change Order is to authorize an extension to the project time by 60 days. There were unforeseen time delays to acquire a 2 Additional time 60 360 dewatering permit, coordinate with the building department as a result of changes to the FEMA Flood Maps, and design modifications due to unforeseen issues with the existing gravity sewer. Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY Admin ® BCC ES 16C 2 From: Natalie Harvey<nharvey@uswatercorp.net> Sent: Friday,September 20, 2024 10:38 AM To:Zamira Deltoro<Zamira.Deltoro@colliercountyfl.gov> Cc:Steve Stanton<sstanton@uswatercorp.net> Subject:Time Extension Request for Collier LS 121.02 Project 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. Good morning Zamira, We would like to request an additional 60 daytime extension for this project due to the additional time spend acquiring a dewatering permit and the coordination with the building department as a result of the changes in the FEMA flood map.The design modifications needed due to the changes with the gravity sewer also delayed our progress. Thank you, Natalie Harvey, MSE Services Corporation U.S.Water Services Corporation M: (239)209-9805 n h a rvevC"&u sw a to rco rp.net 5605 2nd St.W, Lehigh Acres, FL 33971 uswatercora.com