Backup Documents 07/12/2016 Item #16C4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 4
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 Date
1.
2.
3. County Attorney Office County Attorney Office 4 7117/1)1
4. BCC Office Board of County
Commissioners \ / / I.t1Z.\Ve7
5. Minutes and Records Clerk of Court's Office . -/"y 4113/(‘ 3 + I5
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 John Eick Phone Number 252-5345
Contact/ Department
Agenda Date Item was July 12,2016 Agenda Item Number 16C-4 V
Approved by the BCC
Type of Document Work Order ..\tc.o.r s Number of Original I
Attached 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. (I Applicable)
1. Does the document require the chairman's original signature?
rillfr
2. Does the document need to be sent to another agency for additional signatures? If yes, '�(�
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. �1'
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
by the Office of the County Attorney. iii"
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board 41-"/
5. The Chairman's signature line date has been entered as the date of BCC approval of the
if17
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.
7. In most cases(some contracts are an exception),the original document and this routing slip i
should be provided to the County Attorney Office at the time the item is input into SIRE. ��lt
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-712. )L- and all changes made during
the meeting have been incorporated in the att ch�d document. The County
Attorney's Office has reviewed the changes, if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the ;IPA BCC, all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature. I
\.... ...2
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
1 C
7
MEMORANDUM
Date: July 13, 2016
To: John Eick, Senior Project Manager
Public Utilities Engineering
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Work Order for Contract #14-6213 w/Douglas N. Higgins,
Inc.
Attached is a copy of the document as referenced above, (Item #16C4) approved
by Board of County Commissioners on Tuesday, July 12, 2016.
The original has been kept by the Minutes and Records Department
as part of the Board's Official Records.
If you need anything further, please feel free to contact me at 252-8411.
Thank you.
Attachment
I f,
J.
WORK OIR,DER/PURCHASE ORDER
Contract 14-6213 "Underground Utility Contracting"
Contract Expiration Date: July 7,2018
RFQ 14-6213-64 Pump Station 309.19
This Work Order is for underground construction services for work known as:
Project Name:Pump Station 309.19 Relocation/
Project No: 70046.37.3.1
The work is specified in the proposal dated May 20,2016 which is attached hereto and made a part of
this Work Order. In accordance with Terms and Conditions of the Agreement referenced above,this
Work Order/Purchase Order is assigned to:Douglas N.Higgins,Inc.
Scope of Work: As detailed in the attached proposal and the following:
* Task I Construction of Pump Station
* Task II Owner-Directed Allowance for Extension of FPL Power
* Task III Owner-Directed Allowance for Unforeseen Conditions
/
Schedule of Work: Complete work within 180 days from the date of the Notice to Proceed which is
accompanying this Work Order. The Contractor agrees that any Work Order that extends beyond the
expiration date of Agreement# 14-6213AGvill survive and remain subject to the terms and conditions of
that Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenyed above,the County will compensate the
Firm in accordance with following method(s): ►4Negoti!ited Lump Sum (NLS) CLump Sum Plus
Reimbursable Costs (LS+RC) ►/Time/&Material (T&M) (established hourly rate—Schedule A) ❑
Cost Plus Fixed Fee(CPFF),as provided in the attached proposal.
Task I $480,415.00(NLS)
Task II $ 10,000.00(T&M)/
Task III $ 25,000.00 (T&M),//
TOTAL FEE $515,415.00
PREPARED BY: ,1 Lei June 9,2016
hn H. Eick P E. Senior Project Manager Date
APPROVED BY: - - 6f 3
Crai: ' P.E., cipal Project Manager Date
APPROV:b B • �--~
Bet Johnsser, Wastewater Director Date
4a
y
Page 1 of 3
C?
I
1 C
APPROVED BY:
Tom Ilelik,P.E.,PPMD Director Date
4 O\`� APPROVED BY: — �---'� r � 'i I L
� George Yilmaz,Ph.D., ,Dept. Administrator Date
By the signature below, the Firm (including employees, officers and/or agents) certifies, and hereby
discloses, that, to the best of their knowledge and belief,all relevant facts concerning past,present, or
currently planned interest or activity(financial,contractual,organizational,or otherwise)which relates
to the proposed work; and bear on whether the Firm has a potential conflict have been fully disclosed.
Additionally,the Firm agrees to notify the Procurement Director,in writing within 48 hours of learning
of any actual or potential conflict of interest that arises during the Work Order and/or project duration.
ACCEPTED BY: k as lggins,In`c --- ..„,�
Lw /r ? UUP r'_ i f ,c? 617/7/‘
Name&Title of Authorized Officer Date
(Remainder of page intentionally left blank)
Page2of3
cri)
16C4
IN WITNESS WHEREOF,the parties hereto,have each,respectively,by an authorized person or
agent,have executed this Work Order on the date and year first written below.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Dwight E.Brock, Clerk of Courts COLLIER COUNTY, FLORIDA
44 i h Irl✓ ,1102 "o"
f _ - By.
Donna Fiala, Chairman
Dated: = �A I b
f�esras to, i
'Cha►rman s
(SEAL) 1113fure,t/4
DOUGLAS N. HIGGINS,INC.
, '''' ii I)
stif B — ,
Firs Witness il Signature
TType/print signature and titleT
TTyp /print witness namel
,) tke6.-
Seco d Witness
kte-r t &
TType/print witness nameI
Al .ro et• • 'and Legality:
)i
II LIFAI'‘-etti
' _ County Attorney
QG1:,
mit p. ,.1 .---
Print ame
On ,..,4111111A1
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16C4
COLLIER COUNTY WATER SEWER DISTRICT
PUMP STATION 309.19
COUNTY BID NO. 14-6213-64
Bid Item Description Units Bid Quantity Total
1 Mobilization/Demobilization Ea. 1 $17,974.00
2 Stormwater Pollution Prevention Ea. 1 $1,734.00
3 Maintenance of Traffic Ea. 1 $2,673.00
4 Preconstruction Video Ea. 1 $642.00
5 Record Drawings Ea. 1 $5,130.00
6 Temporary Bypass Provisions Ea. 1 $36,504.00
7 Miscellaneous Site Clearing Ea. 1 $9,104.00
8 Existing Pump Station Demolition&Site Restoration Ea. . 1 $22,555.00
9 Existing Gravity Sewer Main Grouting Ea. 1 $22,825.00
10 Lateral Connections(2 locations) Ea. 1 $5,579.00
11 Existing Sewer Lateral Grouting(3 locations) Ea. 1 $3,452.00
12 Existing Manhole Modifications(5 locations) Ea. 1 $40,714.00
13 New Pump Station Structure,Pumps,Piping&Valves Ea. 1 $221,142.00
14 New Pump Station Elecrric and Telemetry Ea. 1 $62,253.00
15 New Pump Station Site Work&Restoration Ea. 1 $18,214.00
16 Force Main Connections at New Pump Station Ea. 1 $6,93200
17 Valve(4")Cut in at Existing Pump Station Ea, 1 $2,981.00
ALLOWANCE FUND FOR EXTENSION OF FPL POWER FROM
HANDHOLE TO SITE This Fund will be used only at the Owner's Basis of Payment--Time $10,000
18 direction to accomplish the work.Inclusion of the Allowance Fund as and Materials
part of the Contract Price is not a guarantee that the Contractor will
be paid any portion or the full amount of the Allowance Fund.
ALLOWANCE FUND FOR OWNER'S USE AS DIRECTED(UNFORESEEN
CONDITIONS)This Fund will be used at the Owner's direction to
accomplish the work due to unforeseen conditions.Inclusion of the Basis of Payment--Time $25,000
19 Allowance Fund as part of the Contract Price Is not a guarantee that and Materials
the Contractor will be paid any or the full amount of the Allowance
Fund.
TOTAL PRICE FOR ITEMS 1 THROUGH 19 $515,415.00 V