#20-7745 (JSFM, Inc.) 1st Amendment ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management
2. County Attorney Office County Attorney Office
4. BCC Office Board of County 3
Commissioners17r1
4. Minutes and Records Clerk of Court's Office rr
5. Procurement Services Procurement Services
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 Ashley Borgia/Procurement Contact Information 239-252-8950
Contact/Department
Agenda Date Item was March 24th,2026 Agenda Item Number 16.F.4
Approved by the BCC
Type of Document First Amendment Number of Original 1
Attached _ Documents Attached
PO number or account N/A 20-7745 20-7745
number if document is HVAC Parts,Supplies JSFM,Inc.dba
to be recorded and Customized Parts Johnstone Supply
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 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 ab
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 ab
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 ab
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 March 24th,2026,and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County / an option for
llh4 Attorney's Office has reviewed the changes,if applicable. 5 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 / b an option for
Chairman's signature. ..ter(4 this line.
FIRST AMENDMENT TO AGREEMENT No. 20-7745
FOR
HVAC Parts, Supplies and Customized Parts c�
THIS FIRST AMENDMENT, is made and entered into on this 2,9 day of
ck 2026, by and between JSFM, Inc. dba Johnstone Supply. (the "Contractor") and
Collier County, a political subdivision of the State of Florida, (the "County" or "Owner")
(collectively,the"Parties"):
WHEREAS, on October 27, 2020 (Agenda Item No. 16.C.2), the County entered into an
Agreement No. 20-7745, "HVAC Supplies and Customized Parts" (the "Agreement"), with the
Contractor to provide parts and equipment; and
WHEREAS,the Parties wish to amend the Agreement by extending the award term for one
additional year starting April 26, 2026, and ending April 25, 2027, to allow continued purchases of
HVAC parts and equipment while the County completes a new solicitation; and
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
1. The above recitals are hereby incorporated into this First Amendment as if fully set forth
herein.
2. Upon execution of this First Amendment, the Parties agreed to extend the agreement for one
additional year starting April 26, 2026, and ending April 25, 2027.
3. All other terms and conditions of the Agreement, as previously amended, shall remain the
same.
SIGNATURE PAGE TO FOLLOW
**Remainder of this page left blank intentionally**
Page 1 of 2
First Amendment to Agreement No. 20-7745
P.O
IN WITNESS WHEREOF, the Parties have executed this First Amendment on the date and
year first written above by an authorized person or agent.
ATTEST:
Crystal K. Kinzel, Clerk of the Circuit BOARD OF COUNTY COMMISSIONERS
Court and Comptroller COLLIER COUNTY, FLORIDA
BY By: 7
c Attests to Chairman's Dan Kowal, Chair an
Dated. 3 ; . 2- :_ si nature only
(SRAL) ;4J.i4; .•',tt
CONTRACTOR:
JSFM, In dba John n Supply
By. I
Signature
r
5tpA90 411 ene5 We,it-
TType/print signattre and titleT
3)32 &
Date
Ap roved as to F a Le ality:
ir
S tt R. each, Deputy County Attorney
Page 2 of 2 c")°111:,
First Amendment to Agreement No. 20-7745 ,u)
AFFIDAVIT REGARDING LABOR AND SERVICES
AND 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)-(c),§287.138,Florida Statutes. T 1
Nongovernmental Entity's Name: 7.5ff Inc D13 TA. irS) ' Sip p)y
Address: 311 P y Dons!t?S C i C Ave AV , S, F- 3YW t Y
Phone Number: -23g-61)3-- .3 /#'L
Authorized Representative's Name: Stc p ie.7 K,;,a
Authorized Representative's Title: Pll"�osii de,',t- !
Email Address: ��// S)—epk"" - xi.,ct '� ,Di1►15i2HPs pjJy. co—,
I, Si?pier) /C1✓1 (Name
9 of Authorized Representative),J as authorized representative attest under
penalty of perjury that ,T'Ff'I j r►C, (Name of Nongovernmental Entity) does not: (1) use
coercion for labor or services as defined in§ 787.06,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•arty ••Y erjury,,, .- . - tat I have re.• •. egoing A davi and that the facts stated in it are true.
e
;9; _ r...�'' 3 ' ab
(Signature o authorized representative) Date
STATE OF j,in�fi g4
COUNTY OF �V?r.If
Sworn to(or affi med)a d subscribed before e,by means of(•$'physical presence or 0 online notarization this
04 day of ,20 ' by ame of Affiant),who produced his Florida Driver's License as
identificati n.
Nota lic , t*rYP YARISLENI PUPO SARMIENTO
IJ " `4'{
1 ,� �, �; Notary Public-State of=;oriCa
4 ,ram .+�W4? Commission;iH 4339'0
f 1Q ' 2 3✓ ' ".. My Comm.Expires Aug 16.2027
Commissi•t xpires _ _ _ _ _ _ _ _ _ _ _
Personally Known 0 OR Produced Identification
%Type of Identification Produced: PL �
' 1r1 fly1-10 L
(C:-5D)