Backup Documents 04/22/2025 Item #16F1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6F1
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. Risk Risk Management
2. County Attorney Office County Attorney Office
/40 y
1 l
4. BCC Office Board of County
Commissioners 4, /,/ VZS
4. Minutes and Records Clerk of Court's Office tz512s--
5. Procurement Services Procurement Services
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 Osmanis Nieves Borjas-Procurement Contact Information 239-252-2220
Contact/Department
Agenda Date Item was April 22,2025 Agenda Item Number AGENDA # 16.F.1
Approved by the BCC
Type of Document treen> - aa J Number of Original 1
Attached l7/'') OP.L I ' Documents Attached
PO number or account N/A 20-7753 Schenkel & Shultz,
number if document is Schenkel & Shultz, Inc
to be recorded
Inc
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 STAMP OK N/A
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 ONB
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 ONB
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 ONB
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 April 22, 2025,and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County JAq an option for
Attorney's Office has reviewed the changes,if applicable. l ry 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 sAkai an option for
Chairman's signature. this line.
16F 1
SECOND AMENDMENT TO AGREEMENT #20-7753
FOR
DESIGN SERVICES FOR COLLIER COUNTY EMS STATIONS
THIS SECOND AMENDMENT made and entered into on this / )-
(date), by and between Schenkel & Shultz, Inc. (the "Contractor/Consultant") and Collier County, a
political subdivision of the State of Florida, (the "County") (collectively, the "Parties"):
WHEREAS,on March 23,2021,(Agenda Item 16.C.7),the County entered into Agreement
#20-7753 "Design Services for Collier County EMS Stations" (the "Agreement") with Contractor for
professional engineering and design services for two new Collier County Emergency Medical Services
("EMS") Stations for a total amount of$713,680; and
WHEREAS,on March 30,2023,the Parties agreed to a First Amendment to the Agreement
to recognize total design cost for each EMS Stations: (1) Golden Gate Estates EMS Station 74
($454,769), and (2) Old 41/North Naples EMS Station 412 ($258,911); and
WHEREAS, the Parties desire to amend the Agreement to revise Schedule C — Task 7.0
Construction Administration for Golden Gate Estates EMS Station 74 project by adding an additional
180 days to include additional time for Construction Administration services to cover the completion
of the project.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
1. The above recitals are hereby incorporated into this Second Amendment as if fully set forth
herein.
2. Schedule C, Task 7.0 of the Project Milestone Schedule, of the Agreement, which pertains to
the Golden Gate Estates EMS Station 74 project, is enlarged by an additional 180 days so as
to insure that Construction Administration services will be provided by the Consultant for the
duration of the construction project.
3. All other terms and conditions of the Agreement, as previously amended, shall remain the
same.
]Signature page to follow]
**********Remainder of page intentionally left blank**********
Page 1 of 2
Second Amendment to Agreement#20-7753
Cq
16F1
IN WITNESS WHEREOF, the Parties have executed this Second Amendment by an authorized
person or agent on the date and year first written above.
ATTEST.
Crystal K. Kinzel, Clerk of the Circuit BOARD OF COUNTY COMMISSIONERS
Court and Comptr.,ller COLLIER COUNTY, FLORIDA
rR M1 nA K r'v1 "
By: "dot " B�
.eaf)1%.. ,e4#1411.40--
urt L. Saunders. Chairman
Dated 1= �':�� ^ �r«r`;�`. •
(SEAL) sit wort
''��
Contractor's Witnesses: CONTRACTOR:
SCHENKEL & SHULTZ, INC.
•lie/dideete
First Witness Signa ure
Blakely Jones Daniel C. Laggan, President
Type/print witness name *"I pe:'print signature and title^
Se
4/3/2025,Dnd 1ti'itness
Iris Zayas Date
T"I ype,'print tiff imess name?'
Approv o• o iu d legalit):
Jeffrey h atzk V. C mty Attorney
Page 2 of 2
Second Amendment to Agreement i20-7-753
.16F1
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: Schenkel&Shultz, Inc.
Address: 834 Orange Avenue, Winter Park, FL 32789
Phone Number: 407-872-3322
Authorized Representative's Name: J. David Torbert
Authorized Representative's Title: Vice President
Email Address: jdtorbert@schenkelshultz.com
AFFIDAVIT
1 J. David Torbert (Name of Authorized Representative), as authorized representative attest
that Schenkel&Shultz, Inc. (Name of Nongovernmental Entity)does not use coercion for labor or
services as defined in §787.06, Florida Statutes.
C•.
Unde of per' ry, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
3/27/25
(Sig ature of authorized representative) Date
STATE OF Florida
COUNTY OF Orange
Sworn to (or affirmed)and subscribed before me, by means of physical presence or❑online notarization this
27 day of March 20 215 by J. David Torbert (Name of Affiant), who produced their
as identification or are personally known to me.
I i:144"•. IRIS ELIZABETH ZAYAS
Notar Public(not re t when digital) =° 1x ' Notary Public-State of Florida
rzi Commission N HH 630561
Cprt. My Comm.Expires Apr 20,2029 F
4/20/29 I Bonded through National Notary Assn. p
Commission Expires
Personally Known t OR Produced Identification a
Type of Identification Produced:
CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1