Backup Documents 03/25/2025 Item #16C 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 C 3
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
than Monday preceding the Board meeting.
** 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
4. BCC Office Board of County
Commissioners '1 z/i5
5. Minutes and Records Clerk of Court's Office 1 y4›6
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 Mike Raabe Phone Number 239 537 6819
Contact/Department
Agenda Date Item was 3.25.25 Agenda Item Number 16.C.3
Approved by the BCC
Type of Document(s) Change Order Number of Original 1
Attached 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)
I. Does the document require the chairman's original signature(instead of stamp)? MR
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 MR
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 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
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 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_3/25/25_and all changes made during MR N/A is not
the meeting have been incorporated in the attached document. The County Attorney an option for
Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the MR 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.
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
16C3
Co -r County Procurement Services Change Order Form
Contract# 22-7952 CO# 1 PO# 4500222141 Project#: 70278.1
Project Name: NCWRF - Electrical Services#1 Upgrade Project
Contractor/Consultant Name: Johnson Engineering, LLC.
Select One:0 Contract Modification (Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Mike Raabe Division Name: PUD- Engineering and Project Management
' Original Contract/Work Order Amount $430,180.00 10/2512022;ITEMi116C2 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount i Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $430,180.00 3/27/25 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change $o.00 o.00i Total%Change from Original Amount
Revised Contract/Work Order Total $430,180.00 0.00^% % Change from Current BCC Approved Amount
Total Cumulative Changes $o.00 o.00% % Change from Current Amount
Notice to Proceed 11/28/2022 Original NTP 850 Original Final 3/27/2025 Last Final 3/27/2025
Date #of Days Completion Date Approved Date
#of Days Added 165 Revised Final Date TBD Current Substantial Completion Date N/A I
(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:O 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.) This project involves a large, highly custom and complex piece of critical electrical distribution
equipment that has been delayed due to supply chain disruptions and labor-related manufacturer
delays.
2.) Stop work issued for 2/12/2025 with 43 days remaining on the contract.
3.) While we did plan on the new switchgear taking a while from the manufacturer, the actual lead time
was even longer than anticipated.
4.) If this change is not processed, the remaining time available under this contract will expire before
the project is complete.
Page 1 of 4
Change Order Form(2023_ver.1)
16C3
Corner County
Procurement Services Change Order Form
Contract# 22-7952 CO# 1 PO# 4500222141 Project#: 70278.1
Project Name: NCWRF - Electrical Services#1 Upgrade Project
Contractor/Consultant Name: Johnson Engineering, LLC.
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
Time Extension Extraordinary long lead time
1 165 1,015 for electrical switchgear
❑ Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
16C3
Corr C.,outnty
Procurement Services Change Order Form
Contract# 22-7952 CO# 1 PO# 4500222141 Project#: 70278.1
Project Name: NCWRF - Electrical Services#1 Upgrade Project
Contractor/Consultant Name: Johnson Engineering, LLC.
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.
RaabeMike Digitally signed by RaabeMike
Prepared by: Date:2025.02.07 12:32:32-05'00' Date:
Signature-Division Project Manager
Mike Raabe, Supervisor Project Management(Licensed)Public Utilities Engineering KLA 2/9/25
Printed Name
Accepted by: Michael S Dickey Dat�ea1ly signed 2025.02.10y08:41 11 05 Michael S 5''00'ey Date:
Signature-Design/Engineer Professional (if applicable)
Michael Dickey, PE., Vice President
Printed Name/Title/Company Name
Accepted by: Date:
Signature-Contractor/Consultant/Vendor
Printed Name/Title/Company Name
McLeanMatthew
Approved by: o E..Moo,005 2.�:. a ,M. �.w...��o�r��.n.PP4,...
.,I,..�o11,,, •w Date:
Signature-Division Manager or Designee(Optional)
Matthew McLean, Division Director Public Utilities Engineering
Printed Name
Approved by: Date:
Signature-Division Director or Designee (Optional)
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1)
16C3
Cal r County
Procurement Services Change Order Form
Contract# 22-7952 CO# 1 PO# 4500222141 Project#: 70278.1
Project Name: NCWRF - Electrical Services#1 Upgrade Project
Contractor/Consultant Name: Johnson Engineering, LLC.
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 577
Bowden Stephan 1 e Digitally signed by BowdenStephanie
Date:2025.02.13 15:38:04-05'00'
Approved by:
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative N) 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 Comptroller COLLIER COUNTY, FLORIDAi4
i
, ,eZeollia".
By: � �� - , Attest as tot ; mans
r) (,r f i v,. signature only Burt L. Saunders , Chairman
•Dated u rp
t /
eL,.* `1
�� Date: 3 � 25
Jf 1,.�$ I') Agenda# 16 C 3
� `A
-•1, tl i?tGm
proved as to m a Legality:
Gam.
it_
Deputy County Attorney S<J i 7 , ?
Print Name
(404)
Page4of4
Change Order Form(2023_ver.1)
16C3
JOHN S 4111 SIN. .E..__94.6.
ENGINEERING
— An Apex Company --
DATE: 2/6/25
TO: Mike Raabe, PE
Principal Project Manager
Engineering & Project Management Division
3339 Tamiami Trail East, Suite 303
Naples, Florida 34112
P: 239-252-5379 ■ M: 239-537-6819
Mike.Raabe@colliercountyfl.gov
SUBJECT: Change Order#1 Request for Time Extension
The NCWRF Electrical Room #1 Switchgear Replacement project involves the
procurement of a highly customized and highly complex piece of critical electrical
distribution equipment. Due to circumstances beyond the control of the project team
including supply chain disruptions and labor-related manufacturer delays, I would like to
request approval of a Change Order to consist of a 165-Day extension to the contract at
No Cost.
Sincerely,
1/11.1yt t.
Wayne Wright, PE
2122 Johnson Street• Fort Myers,Florida 33901-3408• (239)334-0046
L w....hnsonenginecring.arnn Cry,
1 C3
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: Johnson Engineering,LLC
Address: 2122 Johnson Street,Ft.Myers, Florida 33901
Phone Number: 1239-334-0046
_.i
Authorized Representative's Name: Lonnie V.Howard
Authorized Representative's Title: President
IEmail Address: I Lhoward@johnsoneng,com
AFFIDAVIT
I, Lonnie V.Howard __ _(Name of Authorized Representative),as authorized representative attest
that Johnson Engineering,LLC _(Name of Nongovernmental Entity)does not use coercion for labor or
services as defined in§ 787.06, Florida Statutes.
Und penalty per ury,I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
�1 2/13/25
(Signature of authorized representative) Date
STATE OF Florida
COUNTY OF Lee
Sworn to(or affirmed)and subscribed before me,by means of physical presence or❑online notarization this
y`''day of V.21` tY ,20 r-c,by I.t»r„t •- hoti atr..(Name of Affiant),who produced their
as identification or are personally known to me.
1 �4.`ffrf �.
Notary��rrbilc a "",?., FAVIQLA LUNA
Notary Public-State o! Florida
6/11/27 '+��11ir - Commission N HH a0$917
My Commission Expires
June 11,2027
Commission Expires ----- ___.._.
Personally Known ! OR Produced Identification CI
Type of Identification Produced:
CONTRACT,RENEWAL,OR EXTENSION REQUEST FORM Version:2025.1
C