Backup Documents 12/10/2024 Item #16C 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 Cl.
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 forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must he 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
',Y1 14.01
4. BCC Office Board of County
Commissioners CA k,, ,/5J i 2/1 Z
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 r additional or missing information.
Name of Primary Staff 'n� Phone Number 5
Contact/ Department a'Y i t A 1.4 L j Oet 1 a(, �4 G 21 5
Agenda Date Item was Agenda Item Number
Approved by the BCC ` Z / i 0 / 2021 i b - C
Type of Document �t l Number of Original
Attached t, A V At 1' �" ci.a Documents Attached
PO number or account y
number if document is 45 0 0 2.5c t3 5
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? te'
2. Does the document need to be sent to another agency for additional signatures? If yes, n`�
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 t .,
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attomey's
Office and all other parties except the BCC Chairman and the Clerk to the Board 40
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. N/A-
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 kti.
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on iZ it/lland all changes made during N/A is not
the meeting have been incorporated in the atta hed ddcument. The County +C, 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 K., an option for
Chairman's signature. this line.
1: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 1
Colter County Procurement Services Change Order Form
Contract# 23-8187
CO# 03 PO# 4500230813 Project#: 50280.6.4
Project Name: 33 Lift Station Panels Replacement Project
Contractor/Consultant Name: Powerserve Technologies, Inc.
Select One: 0 Contract Modification(Construction or Project Specific) ❑
Work Order Modification
Project Manager Name:I Damian Cuadrado Division Name: Engineering & Project Management
Original Contract/Work Order Amount $3267404.29 03122024:46c3 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount 10/222024:16c1 Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount X,767,224.67 11 062024 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change $0.00 -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
Original NTP I lOriginal Final 11%06/2024 Last Final L,,/28,2024
Datice to Proceed 04;10i2024 #of Days l210 Completion Date Approved Date 11/27/24
Date
i
#of Days Added Revised Final Date Current Substantial Completion Date 110/20/2024
30 I (includes this change) (if applicable)1227.24 10i28t24 —
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: LI 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)
1.) Detail of change/s to be made through this Change Order.
This Change Order adds 30 days due coordination issues with tasks required to be completed by
Florida Power and Light. These issues have been exacerbated by Hurricanes Helene and Milton. The
new Substantial and Final Completion dates are as follows:
Substantial Completion: 11/28/2024 11/27/2024
Final Completion: 12/28/2024 12/27/2024
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.
Difficulties in FPL coordination exacerbated by Hurricanes Helene and Milton are an unforeseen
condition.
4.) Describe the impact if this change is not processed.
The contractor will be unable to complete the work needed by Substantial Completion through no fault
of their own.
Page 1 of 4
Change Order Form(2023_ver.1)
16C1
Coder County Procurement Services Change Order Form
Contract# 23-8187 CO# 03 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 — ($500.179.62) - - stations prior to the contract
134.00, 101.03. 101.05. being
101.08,and 308.02 fully executed
Addition of 11 11 calendar days added for
calendar days for 11 221 10 rain days because
2 10 rain (work) days. — — added days are work days.
Addition of 30 days 30 days added due to
30 251 coordination issues with
3 — — FPL
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
16C1
Cott County Procurement Services Change Order Form
Contract# 23-8187 CO# 03 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.myflorida.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.
DC 11/12/2024
CuadradoDamian °"-°�"`�tl°° "pe'"' � � . P�
Prepared by: "" Date:
Signature-Division Project Manager KLA 10/21/24
Damian Cuadrado. Project Manager III(Licensed),PUD-Engineering&Project Management Division
O gOt,Wren ey F(M'CMCe J B°Mry=
Printed Name Francisco J. R,.r.FM a°JBomrcuPE.
e•aECOM.au•UB iPAt.
rvNrarcac°Le1e9�Oaawm cen
Bohorquez PE ae��^caa
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Ile koa.+Pr c.JS -aErSO. T.P.-uS wvw.na�,nvww.>accm t..- 1 Dau 2°1a,f t2,a t p5-0STA
Francisco J. Bohorquez, PE Pow En ...� 10/21/24
Accepted by: Date:
Signature-Design/Engineer Professional (if applicable)
Francisco J.Bohorquez.Senior Engineer.AECOM
Printed Name/Title/Company Name OONCAU,SneaEYA^m^°°r
Antonio Oruga E"°"°°t°°"'�°nt=
D¢Yy s 9ned oy Artorio Orup O�-Pov.<ree Or Te[�no�opwa
.,N=Mmn,o Orupa
Antonio Oruga u g a 0•[c.US E.aoru0a@ W+°ser`°:xh.com.0-Powerserve Techrwbyes.Ix' t O'ZZ Z4 Dolor 2 11 1215 tz?S-O
°N.Ant 24.322 0 Date:Accepted by. °"'n:<."z-ud'u''�.°°
Signature-Contractor/ConsultantNendor
Antonio Oruga,Business Development Manager. Powerserve Technologies, Inc.
Printed Name/Title/Company Name
SDF 11/13/2024
..--WwabY covcn9m
FandrichShon AUDMom,apePp.r�..er°OFa M`°""'"""""®'.
�m,�w n,aLae a, no, rat x.r..,a a_r Date:
Approved by: "'n t
Signature-Division Manager or Designee(Optional)
Shon Fandrich,Supervisor-Project Management(Licensed),PUD-Engineering&Project Management
Printed Name
MDM 11/14/2024
pere1 Mar^Mser*
McLeanMatthew De"M Vda mr,��. Ma.wa,�. OU.Gww..OU...Mte.
,y,yn3.OJ-PJDrwnSmPro.t'cv+ine^,OU-PIJC W-Mfrs.0DC•brsc..PPP ocsds.Ar.
Approved by: w.Y=•.>=`t=• N� Date:
Signature-Division Director or Designee(Optional)
Matthew McLean.Div lion Director,PUD-Engineer ng&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)
i 6 C 1
Terutsty Procurement Services Change Order Form
Contract# 23-8187 CO#3 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 25 CHO Request# 508
Approved by: Zimmerman BeCCa
Digitally signed by ZimmermanBecca
Date:2024.10.23 09:11:29-04'00' /G, 11.18.24
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative 0 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 Compkrb)ter, `� COLLIER CO T , FLORIDA
it
By: 4 By:
nx1-� >i _-, Attest as to Chairman's
r Chris Ha II Chairman
Dated: si nature only.
t'< ' �` Date: IZ.- 10 - 24
(SEAL) Agenda# 16 C I
A roved a to F,k a d Legality:
De y County Attorney'
S4* 4i I
Print Name
Page 4 of 4
Change Order Form(2023_ver.1)
16C1
Damian Cuadrado
From: Joseph Miller <JMiller@powerservetech.com>
Sent: Wednesday, October 16, 2024 3:16 PM
To: Damian Cuadrado
Cc: Bohorquez, Francisco;Wolter, Cherie; Frank Inzano; Robert Konger; Kathryn Evans;
Antonio Oruga
Subject: Collier County Station Panels Replacement Project Extension
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,
As a follow up to today's Collier County/AECOM meeting, Powerserve Technologies is requesting a 30
day extension to the contract substantial completion date due to coordination issues with FPL beyond
our control.
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