Backup Documents 03/25/2025 Item #16B 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 S 4
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
l'rint 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
4. BCC Office Board of County
Commissioners /�j/$/ `11 f ZS
5. Minutes and Records Clerk of Court's Office
t S36 41
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 03/25/2025 Agenda Item Number 16.B.4
Approved by the BCC
Type of Document Earth Tech Change Order#3 —Park Shore (Sea Number of Original 1
Attached House) 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.
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
1634
__-__,'er County
�....., ` Procurement Services Change Order Form
Contract# 24-8292 co#3 PO#4500236559 Project#: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, Inc.
Select One: 0 Contract Modification(Construction or Project Specific) D Work Order Modification
Project Manager Name:lAndrew Miller I Division Name:!Transportation Engineering
Original Contract/Work Order Amount 13,817,530.00 12/10/2024 18.8.14 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $8,558.683.00 2/25/2025 15.e.9 ' Last BCC Approval Date;Agenda item#
Current Contract/Work Order Amount 18.558.883.00 5/2/2025 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change 17,000.00 71.94% Total%Change from Original Amount
Revised Contract/Work Order Total 58se3s83.00 0.11% %Change from Current BCC Approved Amount
Total Cumulative Changes 52.748.153.00 0.11% %Change from Curren t Amount
Notice to Proceed 1/2/2025 Original NTP 75 Original Final Last Final
Date 1 I #of Days Completion Date 3/18/2025 Approved Date I 5/2/2025
#of Days Added 10 I Revised Final Date I N/A I Current Substantial Completion Date
(includes this change) (if applicable) 4/2/2025
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:D Add Time;I]Add funds;❑Use of Allowance;
❑Modify/Delete existing Task(s);❑Add new Task(s);D Reallocate funds;❑Other(must be explained in detail below)
1.)This Change Order will add $7,000 to re-blade the newly constructed beach after filling the skipped
parcel at Sea House.
2.) N/A
3.)This change was not included in the contract because the original intent was to construct the beach
linearly without gaps. Unfortunately the county did not have a right-of-access agreement in place when
the construction reached this area.
4.) If the change is not processed, the skipped parcel will not be re-nourished, introducing a gap in the
protection provided by the filled beach.
Page 1 of 4 EA-0)
Change Order Form(2023 ver.1)
I 6 B 4 "
c; ,l County
Procurement Services Change Order Form
Contract# 24-8292 CO#3 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 i
15 90 increased due to previous
renourishment storm season
add additional time, Increased volume is
additional funding and
2 the use of the allowance $2.739,153 30 120 necessary to provide County
funds of$254,000 design standard beach width
add additional right-of-access agreement
3 funding to close the $7 000 was delayed
gap at Sea House
Condos
1111
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
i CAO)
1684
CviPE/' Cattrity
Procurement Services Change Order Form
Contract# 24-8292 CO# 3 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:/idos.rnvilorida.corn/sunbiz/search/i.
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.
M i l l e rAnd rew Digitally signed by MillerAndrew
Prepared by Date.2025.02.19 12:41:09-05'00' _ Date:
Signature-Division Project Manager
Printed Name
Nicole Sharp DaI:7075 C7.Ny signed by 7 15:35 Sharp
Dater"I07S C7.7417.15:35
Accepted by -0500 Date:
Signature- [)esign!Engineer Professional (if applicable)
Panted Nartlle/Company Name / r
J / /
2 �Accepted by Date / /��
Signature-ContractorlConsultantNendor
Printed Name/Title/Company Name 'f
Approved by Date:
Signature-Division Manager or Designee(Optional)
Printed Name
AhmadJay Digitally signed by AhmadJay
Approved by Date 2025 02 19 12:59:12 05'00' Date:
Signature-Division Director or Designee(Optional)
Printed Name
Digitally signed by
Date:
SCOttTrinity ScoUT2025nnity
.03 17
Approved by 11 22:47-04'00'
Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1)
16B4 P
Colter County Procurement Services ChangeOrder Form
_._._-.,_..,
Contract* 24-8292 coo 3 PO#4500236559 Project it: 90067
Project Name: 2024 Park Shore Renourishment
Contractor/Consultant Name: Earth Tech Enterprises, Inc.
FOR PROCURMENT USE ONLY
FY25 CHO Request# 622
Digitally signed by
BowdenStephanie BowdenStephanie
Approved by: Date:2025.03.17 15:30:10-04'00'
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
0 Administrative CK Administrative-BCC Report 0 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 COUNTY, FLORIDA
ByAet../t194a€41•10-.
- n s Burt L. Saunders
v, ,Attest as to Chairman ,Chairman
D (24 2, Y 2.5 signature only
i Date: 3/25/2S
jr s� .
, �_ e' Agenda nda# 16 134
• y
i iii c)`*
roved�tofr a7d Legality
Deputy Coun Attorney
�.�,•C
rc - (27€7-it GL
Print Name
Page 4 of 4
Change Order Form(2023_ver.1)
CAO
-- ,� 111110 tbB4
EARTH TECH
ENTERPRISES Proposal
Date: 2/11/2025
6180 Federal Court
Ft. Myers, FL 33905
Phone 239-774-1223
Fax 239-774-1227
Submitted To: Collier County
Project Name: Parkshore truck haul
Furnish equipmentr and labor to regrade beach area previously graded
Schedule of Values
Item # Descripton Quantity Measure Price Total
Dozer 24 hr $ 180.00 $ 4.320.00
Foreman 16 hr $ 43.00 $ 688.00
Escourt with side by side 24 hr $ 55.00 $ 1,320.00
labor for pedestrian control 24 hr $ 28.00 $ 672.00
Sitework Total $ 7,000.00
16B4
Transportation Management Services
WORK DIRECTIVE CHANGE
CONTRACT#/PROJECT NAME: 24-S292 Park Shore Renourishment CHANGE#2
DATE OF ISSUANCE: February 19, 2025 EFFECTIVE DATE: February 19, 2025
OWNER: Collier County Board of Commissioners PROJECT#: 90067
CONTRACTOR: Earth Tech Enterprises.Inc. ENGINEER/DESIGN
PROFESSIONAL: APTIM Environmental and Infrastructure, I.l.C.
You are directed to proceed promptly with the following change(s):
Description:
• Return operations to beach at Sea House parcel approximately R-45+700 to fill per design template.
• Re-blade completed beach to remove ruts from hauling activities between Sea house and Horizon Way
Purpose of Work Directive Change: Complete desigm beach template at Sea House parcel previously skipped
due to lack of executed right-of-access agreement.
If a claim is made that the above change(s)have affected Contract Price or Contract Times any claim for a
Change Order based thereon will involve one or more of the following methods of determining the effect of the
changes(s).
Method of determining change in Contract Price: Method of determining change in Contract Times:
❑ Unit Prices ❑ Contractor's records
❑ Lump Sum ❑ Engineer's record
Other lump sum for additional re-grading ❑ Other
Estimated increase in Contract Price Estimated change in Contract Time:
$7,000.00 Increase by 0 calendar days.
RECOMMENDED: AUTHORIZED:
Digsaby signed by Nicole Digitaly signed by
By: Nicole Sharp o'2025.02 18 13 MillerAndrew o;`zoZS to
15:47:21.0 OO' y: 15:08 29-05'00'
Engineer Owner's Representative
684
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: r Ati7N TEC K Iry GR p12rSE5
Address: (o 1 8 U F1r0
Phone Number: Ell.• to✓ter Fort; rnyERS FL. 339vc
.239 — '7 '79 - cat
Authorized Representative's Name: MA-ITN ci%) ?Arc.
Authorized Representative's Title: V'P Q /Z 6 c roR-
EmailAddress: /11 PR rcE- e SEAGATE DEYELOPMCI, ;
Cr-iz n u P. co
AFFIDAVIT
l q-aif t H1 P2 S C
(Name of Authorized Representative), as authorized representative attest
that EMtn1 n, ., r vz p,ctSC s r:c(Name of Nongovernmental Entity) does not use coercion for labor or
services as defined in § 787.06, Florida Statutes.
Under penalty of perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
3- ri oZ 00e5
(Signature of authorized representative) Date
STATE OF TL
COUNTY OF
Sworn to(or affirmed)and subscribed before me, by means of a physical presence or❑online notarization this
day of %Porgy, , 2023 , by (71HeXe..,-- �,'cg (Name of Affiant),who produced their
as identification areperspnally known to me.
2
e1 JCIHN J ECKEALE
Notary Public State ofIII Florida
Notary Public(not required when digital) commission C NN 604425
or•►t My Comm.Expires Dec 21,2028
BondeC through National Notary Assn.
Commission Expires ?' � Kotd J- itt
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Comm
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Personally Known C1 OR Produced Identification ❑ 9°nOpC through t Eapi� '' 2028
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Type of Identification Produced:
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CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025 1