Backup Documents 02/25/2025 Item #16B 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16Ba
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.
2. Coastal Zone Management
3. County Attorney Office County Attorney Office 0 (949
4. BCC Office Board of County
Commissioners 1S 4( 40/4f
5. Minutes and Records Clerk of Court's Office Z/ f 251
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 Andrew Miller—TMSD—Capital Project Phone Number 239.252.2922
Contact/ Department Planning, Impact Fees and Program
Management
Agenda Date Item was 02/25/2025 Agenda Item Number 16.B.8
Approved by the BCC
Type of Document Earth Tech CO#1 —Park Shore Renourishment Number of Original 1
Attached Documents Attached
PO number or account N/A
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 AAM
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 legal sufficiency. (All documents to be AAM
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 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 AAM
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 AAM
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 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 12/12/2023 and all changes made during AAM 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 AAM N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
l: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
16B8
Collier County
Procurement Services Change Order Form
Contract# 24-8292 co# 1 Po# 4500236559 Project#: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, Inc.
Select One: ®Contract Modification(Construction or Project Specific) ✓❑Work Order Modification
Project Manager Name: Andrew Miller Division Name: Transportation Engineering
Original Contract/Work Order Amount $3,817,530.00 12/10/202416.B.14 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $3,817,530,00 12/10/2024 18.1314 Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $3,817,530.00 3/18/2025 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change so.00 o.00%o Total%Change from Original Amount
Revised Contract/Work Order Total $3,817,530.00 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes moo o.00%o %Change from Current Amount
Notice to Proceed 1/2/2025 Original NTP 75 Original Final 3/18/2025 Last Final 3/18/2025
Date #of Days Completion Date Approved Date
#of Days Added 15 Revised Final Date 4/2/2025 Current Substantial Completion Date 2/16/2025
(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:❑✓ Add Time; El Add funds; ❑Use of Allowance;
El Modify/Delete existing Task(s);❑Add new Task(s); ❑ Reallocate funds; ❑ Other(must be explained in detail below)
1.) This $0 Change Order adds 15 days to the contract.
2.) N/A
3.) Additional work is needed due to the changed field conditions caused by the 2024 Hurricane
season.
4.) If this change is not approved, the contract would expire before the re-nourishment adequately
meets the County's design standards, placing the upland structures at risk for future storms and
erosion.
Page 1 of 4 (cPC,Change Order Form(2023_ver.1)
j. B$
CoiLrer County
--� Procurement Services Change Order Form
Contract# 24-8292 CO# 1 PO# 4500236559 Project#: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, 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
add additional time project sand volume
1 to continue 15 90 increased due to previous
renourishment storm season
El Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
/ 6 Be
Colter County
--- ------- Procurement Services Change Order Form
Contract# 24-8292 co# 1 PO# 4500236559 Project*: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, 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.
DarcoChristopher Digitally signed by DarcoChristopher
Prepared by: Date:2025.02.07 08:21:19-05'00' Date:
Signature-Division Project Manager
Printed Name
Digitally signed by Nicole
Nicole Sharp Oate
Date:2025.02.10
Accepted by: 13:53:50-05'00' Date:
Signature-Design/Engineer Professional(if applicable)
Nicole Sharp, Director, APTIM
Printed Name/Title/Company Name
Benjamin M. Figley Digitally signed by Benjamin M.Figley
Accepted by: Date:2025.02.07 09:47:28-05'00' Date:
Signature-Contractor/ConsultantNendor
Printed Name/Title/Company Name
Approved by: Date:
Signature-Division Manager or Designee(Optional)
Printed Name
AhmadJay Digitally signed by AhmadJay
Approved by: Date:2025.02.07 10:09:39-05'00' Date:
Signature-Division Director or Designee(Optional)
Printed Name
Digitally signed by
ScottTrinity DaotetT2025.02.07
Approved by: 12:a2:zs-0soo Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1) CAO
16B8,
CoLiier County
— Procurement Services Change Order Form
Contract# 24-8292 CO# 1 PO# 4500236559 Project#: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, Inc.
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 573
BowdenStephanie Digitally signed by BowdenStephanie
Approved by: Date:2025.02.12 09:11:34-05'00'
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. Kinae'F,Wit'',i the Circuit Court BOARD OF COUNTY COMMISSIONERS
and Comptrb)ler z fy Ptx COLLIER COUNTY, FLORIDA
�ir+'t
a s 5c G)
v m
By: v Yti, `'711 4' By:
k ' Burt L. Saunders , Chairman
Dated. '
Attest as-t0• itmanIs Date: 2413 /i5
`;fin?fnra t'111nl;.
(SEAL) Agenda# /C Q 7
ro Form
and
L ality:
ielmaIn1
D uty County Attorney
co, ,,„ . 6_,,,,,
Print Name
Page 4 of 4
Change Order Form (2023_ver.1) Cq0
16B8
AFFIDAVIT REGARDING LABOR AND SERVICES
Effective July 1, 2024, pursuant to§ 787.06(13), Florida Statutes,when a contract is executed, renewed,or extended
between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the
governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under
penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services.
Nongovernmental Entity's Name: Ell R,TM T EC i•l L,N iL 2 p 2 Ts E. S' Tr
Address: 4, 180 v R•T fort r Ft 3,10`a
Phone Number: c.2 3 zj — '11 4 -L2ez 3
Authorized Representative's Name: i,v s LLrA M 6, ri•'C E ire--
Authorized Representative's Title: VP , n k R C/TD 2
Email Address: CGe EARiRi"C.CR t.sr ri✓ (Lf'!i: rS i S (4 /1
/ AFFIDAVIT
I, tJr`ti Hr., lT"• .Tr (Name of Authorized Representative), as authorized representative attest
that LAR.FH Ttycit (./v T f' P Ci, r'(16me of Nongovernmental Entity)does not use coercion for labor or
services as defined in§787.06, Florida Statutes.
Under penalty f perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
r,?_, 0
(Stlgnatu e of authorized representative) Date
STATE OF r Lull-VOI\
COUNTY OF ,- E
Sworn to(or affirmed)and subscribed before me, by means of physical presence or C]online notarization this
1/ day of FejN•va-r• , 2025, by Tr (Name of Affiant),who produced their
as identification or are personally known to me.
,�a,''u••... JOHN J ECKERLE III
No ary Public (�F ' Notary Public 5t�te of Florida
Commission M NN 60�4Z5
My Comm•Expires Dec 21,I026
/ . /4-/� $� Bonded through National Notary Assn.
Commission Expires
Personally Known t21 OR Produced Identification 61
Type of Identification Produced:
CONTRACT,RENEWAL,OR EXTENSION REQUEST FORM Version:2025.1
CAO