Backup Documents 08/26/2025 Item #16F11 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 1 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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. County Attorney Office County Attorney Office
1P-4 32Y)
2. BCC Office Board of County
Commissioners Chairman U6 /r}j// 6115
fik)
/Olol$tta
K
3. Minutes and Records Clerk of Court's Office a 6'
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 Sara Schneeberger, Facilities Division Phone 239-252-5013
Contact/ Department Number Sara.Schneeberger@colliercountyfl.gov
Email
Agenda Date Item was August 26, 2025 Agenda
Approved by the BCC Item 16.F.11
Number
Type of Document Recommendation to approve Change Number of
Attached Order No.2, adding 60 days to the project Original 1
time under Agreement No. 24-8250 with Documents
South Florida Excavation, Inc.,to Attached
construct approximately 2,400 linear feet
of a 35-foot-wide lined swale and a 300
linear foot outfall pipe at the Golden Gate
Golf Course, and authorize the Chairman
to sign the attached Change Order.
(Project No. 80412)
PO number or account Facilities Division is requesting a
number if document is completed copy
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 original signature? 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
signed by the Chairman,with the exception of most letters, must be reviewed and signed SS
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 SS
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
signature and initials are required. 012
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!
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
8. The document was approved by the BCC on August 26,2025 l . I6 Fsndt 1 ;. 1
and all changes made during the meeting have been incorporated in the attached an option for
document. The County Attorney's Office has reviewed the changes, if applicable. s�r//h� 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 ' 4 an option for
Chairman's signature. r1 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 1 I/30/12
16F11
„... 11.1..,,. Procurement Services Change Order Form
Contract# 24-8250 CO#02 PO# 4500234938 Project#: 80412.1
Project Name: Golden Gate Golf Course Outfall Swale
Contraotor/Consuitant Name: South Florida Excavation, Inc.
Select One: 0 Contract Modification(Construction or Project Specific) ❑Work Order Modification
Project Manager Name:1James Morton Division Name: Facilities Management
Original Contract/Work Order Amount j $1,a77.712.0o 00t24/2024 18f11 Original BCC Approval Date;Agenda Item#
Current BCC Approved Amount $1,877,712.00 00r24r2024 16F11 Last BCC Approval Date;Agenda Item#
Current- My�2025 SAP Contract Expiration Date(MASTER)
I Contract/Work Order Amount $1.877,712.00 __..._._. Date
os ---. -...— --- -- o.00 Total%Change from Original Amount
Dollar Amount of this Change '
_c.._...
j Revised ContractlWork Order Total $i sn,712.00 0.00% %Change from Current BCC Approved Amount
Total Cumulative Changes $0.00 I 0.00% %Change from Current Amount
j Original NTP Original Final i Last Final5/19/2025
Notice to Proceed 12/10/2024 120 4/9/2025 Date —
Date �_ ♦__.�. #of Days _— Completion Date _ Approved
#of Days Added Revised Final Date TBD Current Substantial Completion Date 4/19/2025
60 (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;funds;0 Other(must be explained funds;Add n detail Allowance;Use of w
0 ModifylDelete existing Task(s); 0Reallocate
Add new Task(s);0
)
1.) Detail of change/s to be made through this Change Order.
This change order will add 60 days to the project to allow the contractor to complete the scope of the
project.
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.
This project is currently on a Stop Work Notice dated 4/18/25 with 31 days remaining.
3.) Explain why this change was not included in the original contract/Work Order.
The additional time is being provided to account for the adjusted construction schedule associated to
include the remaining work under the recently approved South Florida Water Management District
(SFWMD) permit for the final phase of the project. This work, which would have been completed
concurrent to the other work on the project if the permit was approved earlier, must now be completed
at the end of the construction schedule. Additionally, this time gives the contractor the ability to haul
any excess fill to the Collier County Landfill for the County's use.
4.) Describe the impact if this change is not processed.
If this change order is not processed, there would be limited time to complete the scope of work and
i address the requirements of the SFWMD permit.
.___ _____ _, Page 1 of 4
Change Order Form(2023_ver.1)
1 6 F 1 1
Co " * ,0' -1 tly Procurement Services Change Order Form
Contract# 24-8250 CO#02 _ Po# 450023493$ Project#: 80412.1
Project Name: Golden Gate Golf Course (Nitta; Swale
Contractor/Consultant Name: South Florida Excavation, Inc.
Change Order/Amendment Summary i
(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 -------i
i..._. ` _ __.`._..—. ___.._.___� -- "_-- 1 The additional time Is being provided to ',
Adds 24 days to ! I support account for the timeline
1 I the project. I 24 144 1 associated with obtaining South Florida
Water Management District(SFWMD)
I permits for the final phase of the project.
---i-.. -^ The additional time is being provided to
Adds 60 days to i account for the timeline associated with
the project. 60 204 1 obtaining South Florida Water
2 Management District(SFWMD)permits
for the final phase of the project.
I
I
I i
I i
Check here if additional summary pagels are attached to this Change Order
Page 2 of 4
Change Order Form(2023_ver.1)
16F1 1
Co .. - a. . Procurement Services Change Order Form
Contract* 24-8250 CO#02 PO# 4500234938 Protect#: 80412.1
Project Name: Golden Gate Golf Course Outfall Swale
Contractor/Consultant Name: South Florida Excavation, 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) websife(imps:/1dos.myttorida.com/surrbi?JsearcU.
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 MortonJames
Prepared by. Date:2025.05.28 14:48:00.04'00' Date:
Signature-Division Project Manager
James Morton P.E., Project Manager III, Facilities Management
Punted Name
Log Digitally signed by Jeff Davidson
Accepted by: --- Date:2025.05.28 15:04:25-04'00' Date: 5/28/2025
Signature-DesigntEirigine,n Professional (if applicable)
Jeff Davidson, President, Davidson Engineering, Inc.
Printed elTiti ;Com-pan Name
Accepted by: i �_.._._�_ Date: C: 2 1 -
Signature-ContractortCansuttantiVendor
Russell Anderson,President, South Florida Excavation, Inc.
Printed Name/Title/Company Name
Approved by: __ _ — Date:.
Signature-Dlvlslon Manager or Designee(Optional)
Printed Name
Approved by: DelonyBr)an
Digitally signed by DelonyBrian
Date:2025.05.2814:40;13-04'00' Date:
Signature-Dlvlslon Director or Designee(Optional)
Brian DeLony P.E., Division Director, Facilities Management
Printed Name
Approved by: Date:
Signature-Dlvlslon Administrator or Designee(Optional)
Printed Name
Page 3 of 4
Change Order Form (2023_ver.1)
1 6 F 1 1
Procurement Services Change Order Form
Contract# 24-8250 CO#2 PO# 4500234938 Project#: 80412.1
Project Name: Golden Gate Golf Course Outfall Swale
Contractor/Consultant Name: South Florida Excavation, Inc.
FOR PROCURMENT USE ONLY
FY 25 CHO Request# 683
BoWdenStephanie Date:Digitally signed 2025.06.03 by16:37:Bow10-den04Step'00h'anie
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, Ciprif the Circuit Court BOARD OF COUNTY COMMISSIONERS
and ComptroB.r.., ....,. .;',. COLLIER COUNTY, FLORIDA
By. . — By
atI9S— Burt L. Saunders Chairman
Dated:
Attest ' its ' -e.''' /
- signs 'diniyr . :`:' Date: 8/Z61 ZS
(SEAL) Agenda# I[Fl I
pproved to r and a ity:
Depu C my Attorney
,..,,Th p
Print Name
Page 4 of 4
Change Order Form (2023_ver.1) 1 ,�
`1 `1-•