Backup Documents 04/08/2025 Item #16F 6 ORIGINAL DOCUMENTS CHECKLIST&ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 F 6
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. County Attorney's Office County Attorney Office
Sew1irrk
2. BCC Office Board of County Commissioners Chairman cw� p; may_ _ t--
3. Minutes and Records Clerk of Court's Office 41/4/ 4111026 19:1
1 a„I
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
addresses above,may need to contact staff for additional or missing information.
Name of Primary Staff Bendisa E.Miller,Facilities Division Phone 239-252-8440
Contact/Department Number Bendisa.Miller@colliercountyfl.gov
Email
Agenda Date Item was April 08,2025 Agenda
Approved by the BCC r'eIattM J�: C�k. Item 16.F.6
"� Number
Type of Document Attached Recommendation to ratify administratively approved Number of
Change Order No.3 for a 120-day time extension for Original 1
the"Collier County Jail Fire Alarm Replacement" Documents
project under Agreement No.22-8018 with National Attached
Security Fire Alarm Systems,LLC. (Project No.
50237)
PO number or account The Facilities Division is requesting a completed copy
number if the document is to
be recorded
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. Does the document require the chairman's original signature? N/A
2. Does the document need to be sent to another agency for additional signatures? If yes,provide the Contact N/A
Information(Name,Agency,Address,Phone)on an attached sheet.
3. The original document has been signed/initialed for legal sufficiency. (All documents to be signed by the
Chairman,except for most letters,must be reviewed and signed by the Office of the County Attorney. BEM
4. All handwritten strikethroughs and revisions have been initialed by the County Attomey's Office and all N/A
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 BEM
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 N/A
provided to the County Attorney's 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 BCC approved the document on April 08,2025,and all changes made during the meeting have s •�
been incorporated in the attached document. The County Attorney's Office has reviewed the
changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes
directed by the BCC have been made,and the document is ready for the 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
ORIGINAL DOCUMENTS CHECKLIST&ROUTING SLIP 6`
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO r
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. County Attorney's Office County Attorney Office )/t gS
2. BCC Office Board of County Commissioners Chairman YQt�r' y f l o
3. Minutes and Records Clerk of Court's Office r I'' 4(0424 2S-1 0444
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
addresses above,may need to contact staff for additional or missing information.
Name of Primary Staff Bendisa E. Miller,Facilities Division Phone 23 -252-84
Contact/Department Number Bendisa i unty I •ov
Email
Agenda Date Item was April 08,2025 A.'ila,.
Approved by the BCC I -•. y1 16.F.6
0 udiraer
Type of Document Attached Recommendation to ra • ; f ' trati y a.! • • umber of
Change Order NW:. '.• :fiftee •. o the Original 1
Sub .nt'.. . 641. d. - . •urchase Order No. Documents
4501 ?' .,und- :reement No.21-7883-ST with Attached
f� dF • Inc.,d/b/a Owen-Ames-Kimball
6 -A
y,for the Main Campus Upgrades,and
authorize the Chairman to sign the attached Change
Order.(Project No.50214)
PO number or ount The Facilities Division is requesting a completed copy
number• • e document is to
.- -corded
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
I. Does the document require the chairman's original signature? N/A
2. Does the document need to be sent to another agency for additional signatures? If yes,provide the Contact N/A
Information(Name,Agency,Address,Phone)on an attached sheet.
3. The original document has been signed/initialed for legal sufficiency. (All documents to be signed by the
Chairman,except for most letters,must be reviewed and signed by the Office of the County Attorney. BEM
4. All handwritten strikethroughs and revisions have been initialed by the County Attomey's Office and all N/A
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 BEM
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 N/A
provided to the County Attorney's 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 BCC approved the document on April 08,2025,and all changes made during the meeting have N/A is not an
been incorporated in the attached document. The County Attorney's Office has reviewed the ()glob option for this
changes,if applicable. line.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes f N/A is not an
directed by the BCC have been made,and the document is ready for the Chairman's signature. C(1(Pt1 option for 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
16F 6
Co.tier CouVity
Procurement Services Change Order Form
Contract# 22-8018 CO# 03 PO# 4500223988 Project#: 50237.1
Project Name: Collier County Jail Fire Alarm Replacement
Contractor/Consultant Name: National Security Fire Alarm Systems, LLC
Select One: 0 Contract Modification(Construction or Project Specific) ❑Work Order Modification
Project Manager Name: Tim Rygiel, PMP CFM Division Name: Facilities Management
Original Contract/Work Order Amount $1,671,000.00 2/28/2023 16C3 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $1,671,000.00 3/26/2024 16F3 Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $1,671,000.00 4/23/2025 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change 0.00% Total%Change from Original Amount
Revised Contract/Work Order Total $1,671,000.00 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes $0.00 0.00% %Change from Current Amount
Notice to Proceed Original NTP 425 Original Final 6/1/2024 Last Final
4/3/2023 4/23/2025
Date #of Days Completion Date Approved Date
#of Days Added 120 Revised Final Date 8/21/2025 Current Substantial Completion Date 3/24/2025
(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: 0 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 will add 120 days to the contract time providing a new substantial completion date of
7/22/2025.
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.
This change is needed to allow time to complete additional separate projects at the Jail Facility. The
completion of the additional projects is required before the fire alarm project can obtain certification by
the Greater Naples Fire District .
4.) Describe the impact if this change is not processed.
If this change is not processed, the contractor will not be able to complete the project by the current
substantial completion date.
Page 1 of 4
Change Order Form(2023_ver.1)
16F 6
Co.lie-r County
Procurement Services Change Order Form
Contract# 22-8018 CO# 03 PO# 4500223988 Project#: 50237.1
Project Name: Collier County Jail Fire Alarm Replacement
Contractor/Consultant Name: National Security Fire Alarm Systems, 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
During shop drawing review,Greater Naples Fire
Adds 180 days Department alerted us to an egress issue at the Jail
providing a new Complex.This issue is indirectly related to the Fire
1 180 605 Alarm System and requires additional work that will
substantial completion need to be resolved prior to approval of the new Fire
Alarm System by the Greater Naples Fire inspector.
date of 10/29/2024.
Utilize $46,160 of the If this change is not approved,the
Fire Department inspections
2 Owner's Allowance required for the new alarm system
leaving a balance of will not be approved and the project
$53,840. will not be completed.
Adds 120 days This change is needed to allow time to
complete additional separate projects at the
providing a new 120 725 Jail Facility.The completion of the
3 substantial completion additional projects is required before the fire
alarm project can obtain certification by the
date of 7/22/2025. Greater Naples Fire District.
❑Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
16F 6
Co ter County
Procurement Services Change Order Form
Contract# 22-8018 Co# 03 Po# 4500223988 Project#: 50237.1
Project Name: Collier County Jail Fire Alarm Replacement
Contractor/Consultant Name: National Security Fire Alarm Systems, 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.
R ielTimoth Digitally signed by RygielTimothy
Prepared by: Y9 Date:2025.02.20 14:46:04-05'00' Date:
Signature-Division Project Manager
Tim Rygiel PMP, CFM, Project Manager III, Facilities Management
Printed Name
Victor J Latavish Digitally signed by Victor J Latavish
Accepted by: Date:2025.02.21 02:54:38-05'00' Date:
Signature-Design/Engineer Professional (if applicable)
Victor Latavish,AIA,Victor J. Latavish,Architect, P.A.
Printed Name/Title/Company Name
Christopher Morro Jr Digitally signed by Christopher Morra Jr
Accepted by: Date:2025.03.03 16:32:12-05'00' Date:
Signature-Contractor/Consultant/Vendor
Christopher Morra Jr., Vice-President, National Security Fire Alarm Systems, LLC
Printed Name/Title/Company Name
Approved by: Date:
Signature-Division Manager or Designee(Optional)
Printed Name
DelonyBrian Digitally signed by DelonyBrian
Approved by: Date:2025.02.20 13:58:28-05'00' Date:
Signature-Division Director or Designee(Optional)
Brian DeLony PE, Division Director, Facilities Management
Printed Name
Approved by: Date:
Signature-Division Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form(2023_ver.1)
16F 6
Co.[ier County--- Procurement Services Change Order Form
Contract# 22-8018 CO# 3 Po# 4500223988 Project#: 50237.1
Project Name: Collier County Jail Fire Alarm Replacement
Contractor/Consultant Name: National Security Fire Alarm Systems, LLC
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 607
BoAdenStephan•e DigitallyDate: signed byB
10:owdenSteph'anie
l 2025.03.10 22:56-0400
Approved by:
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative N Administrative-BCC Report [1 BCC Stand-Alone ES (BCC Approval Required)
BCC APPROVAL
ATTEST:
Crystal K.,,KinZ116,,ork of the Circuit Court BOARD OF COUNTY COMMISSIONERS
-and Coriidtroller•••.;,„1, COLLIER OUNTY, FLORIDA
By .
By:
/L
; Burt L. Saunders Chairman
Dated, Vil?. -0!'� �'
Atte t<<; tC C`aic f$ ZS
sv.
5ignatur "t5h y Date:
(SEAL) Agenda# j6 F 6
pprove• • t11,1
• and egalit
r/
D%
Deputy County Attorney
Print Name
Page 4 of 4
Change Order Form(2023_ver.1) . }l`
16F 6
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: National Security Fire Alarm Systems, LLC
Address: 13245 Tamiami Trail East
Phone Number: 239-302-5550
Authorized Representative's Name: Christopher Morra Jr
Authorized Representative's Title: Vice-President
Email Address: cmorrajr@nationalalarm.com
AFFIDAVIT
I, Christopher Morra Jr (Name of Authorized Representative),as authorized representative attest
that National Security Fire Alarm Systems(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.
-'} --' 3/7/25
(Signature of authorized representative) Date
STATE OF /, �,.I�G-/
COUNTY OFth-lid fr
Sworn to(or affirmed)and subscribed before me,by means of Ili-Physical presence or❑online notarization this
"7/17 day of1'/at(/',20266,b etfi. V, ', /4lJ/rria"me of Affiant),who produced their
as identification or are personally known to me.
• ' 10N F. �_
No ry Public 02 'Zol2prtp*(k 4-3
Commis ion Ex Tres •
Personally Known EN6R Produced Identification CI1 • ��c'
Type of Identification Produced:
CONTRACT,RENEWAL,OR EXTENSION REQUEST FORM Version:2025.1\