Backup Documents 04/22/2025 Item #16C7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C7
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management
2. County Attorney Office County Attorney Office 7/a-5)a3
4. BCC Office Board of County
Commissioners P5 /ON tf ZS
4. Minutes and Records Clerk of Court's Office
St4 `(f?5/ZS
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,mai 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.C.7
Approved by the BCC
Type of Document ,Q,ge —.4 L Number of Original 1
Attached n/al&, i t-C 1 T Documents Attached
PO number or account N/A 24-029-NS Xylem Water
number if document is Xylem Water Solutions USA, Inc
to be recorded Solutions USA, 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 iplob 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 N/A is not
BCC,all changes directed by the BCC have been made, and the document is ready for the I rlj an option for
Chairman's signature. �(`� this line.
16 C7
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SECOND AMENDMENT TO AGREEMENT NO.24-029-NS
FOR
XYLEM MIXERS,PUMPS AND RELATED EQUIPMENT,PRODUCTS,AND SERVICES
THIS SECOND AMENDMENT made and entered into on this il I)1
(date), by and between Xylem Water Solutions U.S.A, Inc. (the "Contractor") and Collier County,
a political subdivision of the State of Florida, (the "County")(collectively,the"Parties"):
WHEREAS, on August 13, 2024 (Agenda Item 16.C.9), the County entered into
Agreement No. 24-029-NS "Xylem Mixers, Pumps and Related Equipment, Products,and Services"
(the"Agreement")with the Contractor to provide equipment,products,and services; and
WHEREAS, on December 20, 2024, the Parties agreed to a First Amendment to the
Agreement to revise Exhibit A—Scope of Services;and
WHEREAS,due to the continued growth of the County and rising maintenance and repair
needs, the Parties wish to further amend the Agreement to revise Section 4—Agreement Sum, with
the new estimated maximum amount for the Agreement as $2,360,000.00, and to strike verbiage
regarding shipping costs from Exhibit A of the Agreement.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
Words Struck—Tlweugh are deleted; Words Underlined are added
1. The above recitals are hereby incorporated into this Second Amendment as if fully set forth
herein.
2. The Parties agree that Section 4 — the Agreement Sum shall be revised such that the new
maximum amount for the Agreement is$2,360,000.00
3. The Parties agree that Exhibit A — Scope of Services, to Agreement No. 24-029-NS shall be
amended as follows: Shipping charges shall be paid at-eeat.
4. All other terms and conditions of the Agreement, as previously amended, shall remain the
same.
[Signature page to follow this page]
Page 1 of 2
Second Amendment to Agreement No.24-029-NS
C
16C7
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 Cpin WoIlei COLLIER COUNTY, FLORIDA
n Wy,y f
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By: '� ' By: �
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Burt L. Saunders,Chairman
Dated
SEAL '`
(SEAL) � ci81m1aniS
signature only.
Contractor's Witnesses: CONTRACTOR:
XYLEM WATER SOLUTIONS U.S.A, INC.
First Witness By:
`_ Signature
`r\ (1` c)
TType/print w�itness ameT Richard Pangrazzi,Sr. Director, Sales
//j? tType/print signature and title1
Second Witness
March 14,2025
l
l4 11 t o\ He"(e(6\ Date
TType/print witness nameT
A proved as o 'or 1 Le ity:
Scott R.T a h
Deputy County Attorney
Page 2 of 2 J
Second Amendment to Agreement No.24-029-NS
107
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: Xy l4 ram. IN.+ar S c 1i.+ ij^S IA S A 2EC.
Address: I5I3Z. P.rk of Cof►sv1`r'L 131'J It 10X du();ids F4 33'17g
Phone Number: (S(,I) aMS • 31 IX
Authorized Representative's Name: Eric Jai►A 5o r
Authorized Representative's Title: P•.-t;olkl Setts Mft.4.3e5-
Email Address: brit. .S0 6nSon e, xjIe.M• LOTs%
AFFIDAVIT
J
I, 'r i�— O , S c'Z (Name of Authorized Representative), as authorized representative attest
that 7`y I LV 4/: im,ror.=z 454 (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.
•
/yam 3 / 3 / a� 5
(Signature of authorized representative) Date
STATE OF Flor:,(‘‘
COUNTY OF Qh
Sworn to(or affirmed)and subscribed before me, by means of jphysical presence or❑online notarization this
.1",-( day of CIAO, ,2(05 , by rr;st JrhhSQ (Name of Affiant),who produced their 0/.-.
as identification or are personally known to me.
Notary Public(not required when digital) �n
/ / KORREQ W STBROOK
C.7/3 r /�0)2 {'• ~' Notify Pupli{ _Stitt of Riotldi
!!! ' CommiyiidF E aH owe ,I
Commission Expires 4 MY COMM, JW 31,2027
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Personally Known O OR Produced Identification
Type of Identification Produced: �L
CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1