Backup Documents 08/26/2025 Item #16F 1 (Absentia 08/12/2025 Item #16A16) ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 A 1 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. ,Attach 10 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. AU completed routing slips and original documents must be received in the County Attorney
Office no later than 1londay 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. County Attorney Office County Attorney Office
, AT/Mh 'WV
2. BCC Office Board of County
Commissioners , iy f'/57 of-S
3. Minutes and Records Clerk of Court's Office / 16 2t
4ti.) � s �s
4. Procurement Services Procurement Services
l
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 stall for additional or missing information.
Name of Primary Staff Khatuna Chkuaseli Contact Information 239-252-2480
Contact/Department
Agenda Date Item was August 12,2025 Agenda Item Number 16.A.16
Approved by the BCC
Type of Document Change Order#1 Number of Original I
Attached Documents Attached
PO number or account 4500232444 Change Order#1 Metro Forecasting
number if document is 4500232444 Models,LLC
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)
I. 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 KC
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 KC
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 KC
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 August 26,2025,and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County ( / an optionfor
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 Ce( j an option for
Chairman's signature. J l this line.
16A
Procurement Services
C Co ter ni�ittty Change Order Form
❑Contract Modification ❑Work Order Modification
Contract#; 20-046-NS Change#: 1 Purchase Order#: 4500232444 Project#: N/A
Contractor/Firm Name: Metro Forecasting Models, LLC Contract/Project: Update CIGM Model
Pro ect Mana er Name: Michael Bosi Growth Management-Zoning
j 9 Division Name:
Original Contract/Work Order Amount $ 30,000.00 7/14/2016A26 Original BCC Approval Date; Agenda Item #
Current BCC Approved Amount $ 30,000.011 Last BCC Approval Date; Agenda Item #
Current Contract/Work Order Amount $ 30,000.00 1/9/2026 SAP Contract Expiration Date (Master)
Dollar Amount of this Change 0.00% Total Change from Original Amount
Revised Contract/Work Order Total $ 30,000.00 0.00% 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 07/29/2024 Original 07/29/2025 Last Approved 07/29/2025 Revised Date 10/10/2025
Date Completion Date Date Includes this change)
#of Days Added 73 Select Tasks ❑Add new task(s) ❑ 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. The change order will add 73 days to the work schedule to all the land use modeling expected within the past year to be
available for the upcoming 73-day period,with presentations to the Planning Commission and Board expected within that
time frame. The new completion date will be considered to October 10,2025.
2. The change requested is due to delays in scheduling the contractor before both bodies due to time availability and hearing
schedules. These issues are outside the control of the vendor.
3. With the increase of 73 days,no additional funding is needed to compensate for the additional time needed to fully complete
the tasks associated with the scope of work.
4. If this change order is not approved the County will not be able to model potential land use changes to the Growth
Management Plan and Land Development Code,which is a necessary part of the data and analysis required of GMP and
LDC amendments.
Digitally signed by
BosiMichael Bosi Michael
Prepared by: Dale.2o250r.2s Date:
(Michael Bosi, Dirdet`)9r4A- Aing,Growth Management Department)
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.
Digitally signed by David
Accepted by: David FaffTle[-0aetrmer�e7026 Date:
07.96
(David Farmer,Metoeeremlasting Models, LLC.)
Accepted by: Date:
(Design Professional and Name of Firm,if project applicable)
Digitally signed by
Approved by: Bosi Michael
9"itslichael
Dato.2025.0 7.25 Date:
( Ichaei B si, Dir edPZ PRng,Growtb10o r gal29% 5Ben tephanie
Approved by: 11Do W rye n to p ante Date:2025.07.25 12:06:10-04'00' Date:
(Procurement Professional)
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Ain 'dm BC �CC ES
717
1 6 A 1 e
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal K. Kinzel,Clerk of Courts COLLIER COUNTY, FLORIDA
Comptroller
By:
Burt L. Saunders. Chairman
,y '`F
Dated:- tett t
(SE LAIlisatastst airman's
,...signature only
Appr ed s to form an lity:
B
R. Teach
Deputy County Attorney
'=z.
I 6 A 1 6
Change Order/Amendment Summary
COST TIME
CO# AMO# Description Days New Justification
Additive(+) Deductive(-) Added Amount
The time extension is due to staff
not being able to schedule the
vendor in front of the CCPC or BCC
due to time conflicts and hearing
1 Time Extension 73 schedules,beyond the control of
the vendor,as such we are
requesting additional 73 days to
allow for the presentations to
happen.
Revised:01/14/2021 (Divisions who may require additional signatures may include on separate sheet.) PROCUREMENT USE ONLY
Admin RA! BCC ES
Ion --.
a 16A16
AFFIDAVIT REGARDING LABOR AND SERVICES
ANT)CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED
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.
Effective January 1,2024,a governmental entity may not accept a bid on,a proposal for,or a reply to,or enter into,a contract with
an entity which would grant the entity access to an individual's personal identifying information unless the entity provides the
government with an affidavit signed by an officer or representative under penalty of perjury attesting that the entity does not meet
any of the following criteria: (a)the entity is owned by the government of a foreign country of concern; (b)the government of a
foreign country of concern has a controlling interest in the entity;or(c)the entity is organized under the laws of or has its principal
place of business in a foreign country of concern.
Effective July 1,2025,when an entity extends or renews a contract with a governmental entity which would grant the entity access
to an individual's personal identifying information,the entity must provide the governmental entity with an affidavit signed by an
officer or representative of the entity under penalty of perjury attesting that the entity does not meet any of the criteria in paragraphs
(2)(a)-(e),§287.138,Florida Statutes.
Nongovernmental Entity's Name: 11111 e t"R o ff- ,,., 'nod f[S
Address; c.41 o FG; otat I'y -111 t�(i'ca7 C h "t v 3 )?)cm!'ta_ Z.134.4.4.
raq s./FL 3 LiI 3 4--
Phone Number: , , q— g 13 — 6 q L{ c V
Authorized Representative's Name: )a 1'1, -Fcx,z/nvik,
Authorized Representative's Title: C C9
Email Address: °l a v e -yyu o Luc Gr • c vYY L
I, LQu•cC Fetivram, (Name of Authorized Representative), as authorized representative attest under
penalty of perjury that'm,L tt.v Fyi< 1'n od e I S (Name of Nongovernmental Entity) does not: (I) use
coercion for labor or services as defined in§787. 1,Florida Statutes,and(2)the nongovernmental entity is not(a)owned by
a government of a foreign country of concern,(b)that a foreign country of concern does not have a controlling interest in the
entity,and(c)that the entity is not organized under the laws of or has its principal place of business in a foreign country of
concern,all as prohibited under§ 287.138,Florida Statutes.
Under penalty of perjury,I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
(Signature of authorized representative) Date
STATE OF r tCov 01 Q
COUNTY OF
Sworn to(or affirmed)and subscr ed before me,by means of CErphysical presence or 0 online notarization this
A day of .J u.J ,202 ti ,by j virl rouvwvir (Name of Affiant),who produced his Florida Driver's License as
identification.
Notary Public 4 Notary Public State of Florida I
Adsis Zimtnskt
i QI 10/ 8 OD °u My
Commission
sion1011 oiesea2Exp I
Commission Expires
Personally Known_I$'6R Produced Identification 0
Type of Identification Produced: _
CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1