Backup Documents 05/13/2025 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST&ROUTING SLIP 1 C F 7TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO V
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 Dat
1. County Attorney's Office County Attorney Office )a
2. BCC Office Board of County Commissioners ChairmanJ(�/
3. Minutes and Records Clerk of Court's Office S
_ /0/ 8
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 May 13,2025 Agenda
Approved by the BCC Item 16.F.7
Number
Type of Document Attached Recommendation to ratify administratively approved Number of
Change Order No.7,adding 365 days to the project Original 1
time under Agreement No. 19-7650,Golden Gate Documents
Golf Course Redevelopment Planning and Attached
Engineering,to provide continued planning and
engineering services to the overall project,and
authorize the Chairman to sign the attached Change
Order.(Project No.80412)
PO number or account The Facilities Division is requesting a co eted 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 Attorney'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 Attomey'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 May 13,2025,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 '�i option for this
changes,if applicable. 5r",{ line.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes N/A is not an
directed by the BCC have been made,and the document is ready for the Chairman's signature. 5R(f jh�+ 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
16F7
Cotie
-r County Procurement Services Change Order Form
Contract# 19-7650 CO# 07 PO# 4500202044 Project#: 80412.3
Project Name: Golden Gate Golf Course Redevelopment Planning and Engineering
Contractor/Consultant Name: Davidson Engineering, Inc.
Select One:Q Contract Modification (Construction or Project Specific) ❑Work Order Modification
Project Manager Name: James Morton P.E. Division Name: Facilities Management
Original Contract/Work Order Amount $684,666.50 12/10/2019 16F11 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $2,527,985.10 12/12/2023 16F9 Last BCC Approval Date;Agenda Item#
Current Contract/Work Order Amount $2,527,985.10 3/2/2025 SAP Contract Expiration Date(MASTER)
Dollar Amount of this Change 269.23% Total%Change from Original Amount
Revised Contractlork Order Total $2,527,985.10 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes $1,843,318.60 0.00% %Change from Current Amount
I - _
Notice to Proceed 2/24/2020 Original NTP 1 095 lOriginal Final 2/23/2023 Last Final 3/2/2025
Date #of Days Completion Date Approved Date
#of Days Added Revised Final Date Current Substantial Completion Date
365 (includes this change) 3/2/2026 (if applicable) NA
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:lii Add Time;❑Add funds;0 Use of Allowance;
❑ Modify/Delete existing Task(s); ❑Add new Task(s); 0 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 365 days to the project to allow the EOR to continue providing planning and
engineering services through project close out.
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.
Additional time is required to support the extended timeline associated with South Florida Water
Management permitting as well as potential adjustments to the construction schedule.
4.) Describe the impact if this change is not processed.
If this change order is not processed, the EOR will not be available to provide services through the end
of construction as required.
Page 1 of 4
Change Order Form(2023_ver.1)
16F 7
ot.le--r Jaunty Procurement Services Change Order Form
Contract# 19-7650 CO# 07 PO# 4500202044 Project#: 80412,3
Project Name: Golden Gate Golf Course Redevelopment Planning and Engineering
Contractor/Consultant Name: Davidson Engineering, 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
Increase Phase 1-Golf Provide necessary
Course Redevelopment
(task 7-Survey Design) surveying related to
utilizing allowance for zero property leases.
•
dollar change.
•
Replace Schedule Update Key personnel
1 F, Key schedule
Personnel
Add additional funding Provide necessary Golf
and reallocate existing
2 funding for Phase 1-Golf $178,273.40 Course Redevelopment
Course Redevelopment tasks.
tasks.
Add tasks 11&12(to Phase 1 Provide for necessary Golf Course
Golf Course Redevelopment),add
Phase 2 tasks 1.1 thru 1.9(Site Redevelopment, Site Design and
2 Design/Permitting),add Phase 3 $1,179,786.20 permitting and services during
tasks 1 thru 3(Services During
Construction). construction tasks.
Reallocate existing Provide for necessary Site Design
funding from Phase 2 and Permitting as required to
3 (Site Design and accommodate unforeseen
Permitting)task 5, 1.5,to conditions impacting permitting
Phase 2 task 3. tasks.
Add additional days for impact of Provide additional contract time to accommodate
unforeseen site,regulatory and permitting adjustment to approach,unforeseen conditions,
requirements and realign task budget from permitting requirements and services during construction.
4 Phase I Task I and from Phase I Task 410 730 1,825 Funding reallocation required to accommodate additional
Increase Phase 1 Task 5 SFWMD work associated with unforeseen conditions and revisions
Conceptual ERP Permitting. to project approach.
To provide the revisions to the Golden Gate
is
Utilizing $17,812.25 of Golf Course MPUD and the Golden Gate City
Task 10 Phase 1 Sub-Element of the Golden Gate Area Master
5 Plan to accommodate the relocation of the
Allowance. Leaving a
proposed State Veteran's home within the
balance of$25,742.55 PUD,which Is part of Phase 1,Task 3.
Adds $485,259 to Without the critical information
Phase 1 Task 2 gained from the assessment, it would
6 $485,259 be challenging to plan and execute
the site's rehabilitation effectively.
❑✓ Check here if additional summary page/s are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
CAO
16 F '7
Co ier Coittnty
Procurement Services Change Order Form
Contract# 19-7650 CO# 07 PO# 4500202044 Project#: 80412.3
Project Name: Golden Gate Golf Course Redevelopment Planning and Engineering
Contractor/Consultant Name: Davidson Engineering, 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
• Adds 365 days to This change order provides
7 the project. 365 2 190 additional time to ensure the
FOR is available through the
end of construction.
•
•
•
❑ Check here if additional summary page/s are attached to this Change Order
•
Page 2 of 4
Change Order Form(2023_ver.1)
CAO
16F 7
Colte-r County
Procurement Services Change Order Form
Contract# 19-7650 CO# 07 PO# 4500202044 Project#: 80412.3
Project Name: Golden Gate Golf Course Redevelopment Planning and Engineering
Contractor/Consultant Name: Davidson Engineering, 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://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.
MortonJames Digitally signed by MononJames
Prepared by: Date:2025.02.18 14:10:15-05'00' Date:
Signature-Division Project Manager
James Morton P.E.,Project Manager III (Licensed) Facilities Management
Printed Name
Tilt, cn=Jell Davidson,o•Davidson Englnaenng,ou=0nglneenng,
am all^jeff®devldsonenginaedng.com,
- c=US 2i24/2025
Accepted by: ' '" 2025.02,2410:29.26•05'00'
Date:
Signature-Design/Engineer Professional(if applicable)
Jeff Davidson, Davidson Engineering, Inc.
Printed Name/Title/Company Name
Accepted by: Date:
Signature-Contractor/Consultant/Vendor
Printed Name/Title/Company Name
Approved by: Date:
Signature-Division Manager or Designee(Optional)
I'.
Printed Name
Approved by: Delon Brian Digitally signed by Delonyarian
Y Date:2025.02.18 11:34:45-05'00' Date:
Signature-Division Director or Designee (Optional)
Brian DeLony P.E., 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)
C AO
1 16F7
collier County
Procurement Services Change Order Form
Contract# 19-7650 CO# 7 PO# 4500202044 Project#: 80412.3
Project Name: Golden Gate Golf Course Redevelopment Planning and Engineering
Contractor/Consultant Name: Davidson Engineering, Inc.
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 596
Bowden Stephanie Digitally signed2025.02.25 by Bow13:33:37de-05nStephanie'00'
Approved by:
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative /4 Administrative-BCC Report ❑ BCC Stand-Alone ES (BCC Approval Required)
BCC APPROVAL
ATTEST:
Crystal K. Kinzel,p-r of the Circuit Court BOARD OF COUNTY COMMISSIONERS
and Comp a 4er,� * 0, COLLIER COUNTY, FLORIDA
r �, �f /
By: , ,a _Abt By:f4‘4%...,e4(410 -
.:, 7�dff �` Burt L. Saunders
, Chairman
Dated: ' i i_ 6
'At44t 0, tp)C4iairman's Date: 5113/2S
L. ,signature only C
(SEAL) Agenda# 16 f 7
pproved - • F„P:n Legality:
�, /� L.
ty County Attorney
Se Q Tad-L,
Print Name
1r(1.11)
Page 4of4
Change Order Form(2023_ver.1)
CA 0
11
16F 7
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: Davidson Engineering, Inc.
Address: 4365 Radio Road Suite 201,Naples, FL 34104
Phone Number: 239-434-6060
Authorized Representative's Name: Jeff Davidson
Authorized Representative's Title: President
Email Address: jeff@davidsonengineering.com
AFFIDAVIT
Jeff Davidson (Name of Authorized Representative), as authorized representative attest
that Davidson Engineering,Inc. (Name of Nongovernmental Entity) does not use coercion for labor or
services as defined in §787,06, Florida Statutes.
Under penalty of perjury);declare that I have read the foregoing Affidavit and that the facts stated in it are true.
—; ,/ 2/25/25
(Sign attire of authorized representative) Date
STATE OF FLORIDA
COUNTY OF COLLIER
Sworn to (or affirmed) and subscribed before me, by means of 0 physical presence or El online notarization this
25th day of Februan 20 by Jeff Davidson (Name of Affiant),who produced their
as identification or are personally known to me.
ff''i ) r_:',6ti C Lih� oG�PHAMLlN.�ps/..1 o�PY PU��
Notary Public i•
•
7/7/27 = MY COMMISSION
• EXPIRES 7-7-2027
Commission Expires `•
,
OF
Personally Known a OR Produced Identification sss/ NUMBr c„. "
Type of Identification Produced:
•
CONTRACT,RENEWAL,OR EXTENSION REQUEST FORM Version:2025.1