Backup Documents 05/27/2025 Item #16C 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C 1
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2. (Enter your Dept here)
3. County Attorney Office County Attorney Office
0/g3
4. BCC Office Board of County BS by MB
Commissioners [s]
5. Minutes and Records Clerk of Court's Office
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 Madison Bird Phone Number 2939
Contact/Department
Agenda Date Item was / I Agenda Item Number
,�
Approved by the BCC 2?(/ZS 4 C
Type of Document(s) Number of Original
Attached CS41-e Orc .v 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)
1. Does the document require the chairman's signature?(stamped unless otherwise stated) MB
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 MB
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 MB
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 MB
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 MB
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 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 5 Z7 and all changes made during 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 /A is not
BCC,all changes directed by the BCC have been made, and the document is ready for the an option fa
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
16Ci
Coder Coup , Procurement Services
Change Order Form
®Contract Modification ❑Work Order Modification
Contract#: 21-7938 Change#: 7 Purchase Order#: 4500217774 Project#: 70215.2
Contractor/Firm Name: R2T, Inc. Contract/Project: Master Pump Station 302.00 Site Improvements
Project Mana er Name: Lourdes Santiago Engineering and Project Management
g Division Name:
Original Contract/Work Order Amount $ 2,404,514.00 4/26/2022, 11C Original BCC Approval Date; Agenda Item#
Current BCC Approved Amount 11/12/24 16C8 Last BCC Approval Date; Agenda Item#
Current Contract/Work Order Amount $ 2,404,514.00 03/05/2025 SAP Contract Expiration Date (Master)
Dollar Amount of this Change $ 0.00 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 2,404,514.00 #VALUE! Change from Current BCC Approved Amount
Cumulative Changes $ 0.00 0.00% Change from Current Amount
Completion Date,Description of the Task(s)Change,and Rationale for the Change
Notice to Proceed 1/4/2023 Original 6/27/2024 Last Approved 3/5/2025 Revised Date TBD
Date Completion Date Date (Includes this change)
#of Days Added 90 Select Tasks ❑Add new task(s) El Delete task(s) ❑Change task(s) ®Other
Provide a response to the following: 1.)detailed and specific explanation/rationale of the requested change(s)to the task(s)and/or
the additional days added(if requested);2.)why this change was not included in the original contract;and,3.) describe the impact
if this change is not processed. Attach additional information from the Design Professional and/or Contractor if needed.
1.Detailed and specific explanation/rationale of the requested change(s)to the task(s)and/or the additional days added(if
requested)This is a zero-dollar change order.Stop-work order issued on 1/15/2025 with 49 days remaining.The purpose of this
Change Order is to authorize the use of Owner Directed Work Allowance(Pay item#28)and extends substantial and final completion
by 90 days.This change order addresses changes specified in Design Change Notice(DCN)#2 due to unexpected conditions as
follows:
A. DCN#2—CEM Extreme-2P Moisture Trap:To authorize the Contractor to purchase a CEM—Extreme-2P moisture trap and
install it on the H2S analyzer at the pump station. All work associated with furnishing and installing the CEM—Extreme -2P
moisture trap shall be billed on a time and material basis.After installation of the CEM Extreme—2P moisture trap,increase the
Odor Control Unit Airflow to 1,200 CFM and wait for the necessary acclimation period before proceeding with the Performance
Testing.
2.Why this change was not included in the original contract?the H2S analyzer specified for the project stopped working because
too much moisture had been entrained in the sample tubing. This condition was not expected during design, however,we understand
Collier County has had similar experiences with the same H2S analyzer at other locations throughout the County.
3.Describe the impact if this change is not processed.If this change is not processed,the specified H2S analyzer will not function
with excessive moisture entrained in the sample tubing. Without these changes,the specified H2S analyzer and OCU will not function
as intended and the Contractor will not be able to commence the performance testing required for the project's Substantial
Completion.
Approved Owner Directed Allowance $313,800.00
CO#1 -$6,450.59
CO#2 -$3,253.58
CO#3 -$18,307.33
CO#4 -$3,815.81
CO#5 -$54,203.53
CO#6 -$27,877.50
CO#7 -$19,209.00
Remaining General Allowance $180,682.66
This change does not increase the contract amount.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin a BCC ES
16C1
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.
SantiagoLou rdes Digitally signed by SantiagoLourdes
Prepared by: Date:2025.02.26 14:02:07-05'00' Date:
Lourdes Santiago, El, Project Manager III, EPMD KLA 3/3/2 5
uw•r w..V Gana kf
0 C•u5 E•p ..ive :or O'J•RZT
Accepted by: George Ajy.,. roq Mrc
app.a,.�M,.. 2 26 2025
Date:
George Ajy, PE, V. President, R2T, Inc.
Approved by: -yA /4.� Date: 2/26/2025
Migu�E,Assoc, Stantec, Inc.
Approved by: FandrichShOn ra^�
Date:
Shon Fandrich, PE, Supervisor Project Management,EPMD
h Digitally signed by BelloneJoseph BelloneJose
Approved by: p Date:2025.03.04 08:45:09-05'00' Date:
Matthew McLean, PE, Director, EPMD
B owd e n Ste p h a n i•e Digitally signed by BowdenStephanie
'
Approved by: Date:2025.03.05 16:11:16 05'00 Date:
(Procurement Professional)
r'AO
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin �� BCC ES
603
16C1
Change Order/Amendment Summary
COST TIME
CO# AMD# Description Days New Justification
Additive(+) Deductive(-) Added Amount
This Change Order
is to authorize the
use of Owner
Directed Work
Allowance(Pay The installation of a new FDOT
item#28).This Type C storm structure. If this
1 change order N/A N/A N/A N/A change is not processed, then the
addresses new stormwater system will not
changes specified function as intended.
in Work Directive
(WD)#2 due to
unexpected
conditions.
This Change Order
is to authorize the
use of Owner
Directed Work
Allowance(Pay Additional Surveying Works. If this
item#28).This change is not processed,the
2 change order N/A N/A N/A N/A proposed stormwater drainage
addresses system and pond cannot be
changes specified completed.
in Work Directive
(WD)#3 due to
unexpected
conditions.
This Change Order
is to authorize the
use of Owner
Directed Work
Allowance(Pay Odor Control Unit Drain Piping item#28).This P 9
3 change order N/A N/A 4 544 Alignment Modifications. If this
addresses change is not processed,the odor
changes specified control unit will not work properly.
in Work Directive
(WD)#4 due to
unexpected
conditions.
This Change Order
is to authorize the
use of Approved
Original Electrical Relocation of Electrical Transformer
Service Allowance
and Owner Relocation and Electrical Meter.If
Directed Allowance this change is not processed,the
4 for Electrical N/A N/A N/A N/A contractor will not be able to
Transformer and perform the task required in the
Meter Relocation. contract documents,which will
This Change Order prevent the completion of the
addresses project.
changes specified
in Work Directives
#5 and#5A.
This Change Order Encasement of both the 4-inch
is to authorize the drain pipe and the 12-inch Sch 40
use of Owner PVC suction air pipe in concrete
5 Directed Work N/A N/A 10 554 per RFI#52 and Supplemental
Allowance(Pay Drawing#1. If this change is not
item#28).This processed,the new pipe will be
change order exposed to traffic loadings,and will
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin 41610 BCC ES
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i6C1
addresses break. This will cause the odor
changes specified control to not work properly.
in Work Directive
(WD)#6 due to
unexpected
conditions.
This Change Order
is to authorize the
use of Owner
Directed Work
Allowance(Pay
item#28).This Installation of 144 LF of 7-foot high
change order chain link fence and two(2)5-foot
6 addresses N/A N/A N/A N/A wide chain link gates. If this change
changes specified is not processed. the site will
in Design Change remain open to the public which is a
Notice(DCN)#1 safety and security risk.
due to changes in
the design due to
different site
conditions.
This Change Order
is to authorize the
use of Owner
Directed Work
Allowance(Pay
item#28). This
change order
7 addresses N/A N/A 90 644 Purchase and installation of a CEM
changes specified —Extreme-2P moisture trap.
in Design Change
Notice(DCN)#2
related to
purchasing a CEM
—Extreme-2P
moisture trap.
CAO
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Atlmm ; Rpc ' BCC ES
Colt County
16C1 .1
Procurement Services Change Order Form
Contract# CO# PO# Project#:
Project Name:
Contractor/Consultant Name:
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 603
Approved by:
Signature-Procurement Professional Signature/Date
Approved by:
Signature-Procurement Manager/Director(OPTIONAL)
APPROVAL TYPE:
❑ Administrative 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, FLORIDA
ttest as to Chairman's
o� 6.- 2 UZt signature only Burt L. Saunders Chairman
-, Dated
Date: 5/27/Z-5
. bit ihtU�r (SEAL) Agenda# 16 C I
1
pproved a to F r12Leg7y:
y County Atto
5.,,,/ a 7,
Print Name
Page 4 of 4
Change Order Form(2023_ver.1)
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16Cl
VvOQUA PROJECT CHANGE ORDER
WAl FR I f rHNC�I OUII
PROPOSAL FORM
PROJECT NAME: CC Naples MPS 302,FL CHANGE PROPOSAL NO.: 003 0
CUSTOMER: R2T INC SALES ORDER NO.: 0
PO/CONTRACT: F0300005 PROJECT NO.: 2500/000053(2033/001865)
DATE: Februa 10 2025
SCOPE OF SUPPLY
ITEM NO. DESCRIPTION OF CHANGE AND STATEMENT OF REASON AMOUNT
1 CEM Extreme upgrade for CEM 2 point includes 2 water traps with 4 fasteners,1 12VDC AC/DC convertor, $ 11,730
pump assembly/harness/cable/cable gland,connecting tubes&fittings,2 rolls 1/4 ID x 5/16 OD fep(includes
engineering revisions to system design).
Sales Tax: $ 938
TOTAL: $ 12,668
FINANCIALS
$ 634,232 =INITIAL CONTRACT AMOUNT NOTES:
1.Acceptance of this Change Order proposal will impact the financial values listed on
$ 22,575 =PREV APP'VD CHANGE ORDERS AMOUNT any additional outstanding Change Order proposals.
$ 656,807 =CURRENT CONTRACT AMOUNT 2.All values in US dollars,unless noted otherwise.
$ 12,668 =THIS CHANGE ORDER AMOUNT
$ 669,476 =NEW CONTRACT AMOUNT
SCHEDULING/TIMING
1)Both parties must sign this form within three business days;and EWT must receive an amended Purchase Order reflecting this Change within ten business days,in
order to make this Change Order valid.
2)Delivery of the proposed equipment is estimated three to six weeks after design approval.
3)The Parties agree that as a result of this Change Order,in the event the project schedule is amended and as a result of such project schedule changes,the Buyer
agrees that all references to Liquidated Damages,to the extent set forth in the Contract Documents,shall be adjusted accordingly. Seller shall strive to full in full the
revised project schedule,however,as the project schedule milestones are approximates only and Seller shall not be liable for any loss or expense(consequential or
otherwise)incurred by Buyer or Buyer's customer,if Seller fails to meet the revised delivery dates.
4)Billing Milestone(s)will be created in accordance with original agreed to contract terms.
SIGNATURES
THE EXISTING TERMS AND CONDITIONS SHALL REMAIN FULL FORCE AND EFFECT UNLESS MODIFIED SPECIFICALLY IN THIS CHANGE ORDER.
Eran Wasserman
Customer Name(Print) EWT Project Manager Name(Print)
ErGin WG/SSCYVnsi 0,
Customer Signature EWT Project Manager Signature
February 10,2025
Date Date
cc: Project Controller,Contract Manager,Project File
PM994 Change Order Costing and Pricing Form F00130-ISS V2.00(12/16/2019)