CN-550000-ASA19-W0030000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

725-090-04B

RAIL

OGC – 03/15

RAILROAD CHANGE ORDER NO. 3

Financial Project Number Road Name or Number County Name Parcel & R/W Number FAP Number

428953-1-57-01 I-75 (SR 93A) Hillsborough 1 (10000) N/A

A. 1. The CSX Transportation, Inc. Company is hereby authorized to observe the following changes in the plans and or specifications to the subject Railroad Agreement, and to perform such work accordingly, further described as:

Additional funds to cover Flagging and CEI during construction. This includes any other railroad work deemed necessary during this project.

NGCN: 627922-B, RRMP: S 837.28

2. Exhibit A is attached to the Railroad Change Order and made a part of the Original Railroad Agreement.

3. The items of work covered by this Change Order are referenced to an Master Agreement of record dated 08/07/1972 and no supplemental Agreement is required.

Master Type: Crossing Surface Signals Preliminary Engineering

B. 1. The Railroad Relocation Work is to conform to that shown by the railroad adjustment plans as:

a. X ATTACHED

b. INCLUDED IN THE HIGHWAY CONTRACT PLANS

2. Reimbursement for the cost of this Railroad Work is to be in accord with the provisions set forth in Administrative Rule

Chapter 14-57 as:

a. NONREIMBURSABLE – Section .011(2)

b. X REIMBURSABLE – Section .011(2)

(1) X Force Account Method

(2) Lump Sum Method

(3) Third Party Contract Method

C. ESTIMATED COST OF WORK DUE TO THIS CHANGE ORDER

ITEM

NO.

ITEM UNIT UNIT

PRICE

WORK ELIMINATED (-)

QTY AMOUNT

ADDITIONAL WORK (+)

QTY AMOUNT

1 Flagging and CEI 592,961.00 688,245.80

Sub-Totals ………………………………………………………………… $592,961.00 $688,245.80 Net Cost of Construction Changes, this order ………………………... $ $95,284.80 Cost of Construction Changes, previously ordered ………………….. $ $592,961.00 Net Total Cost of Construction Changes, to date…………………………………………….. $688,245.80 Contract Amount ………………………………………………………………………………… $0.00 Estimated Cost of Work Authorized, to date………………………………………………….. $688,245.80

Examined as to provisions and participating items of cost:

Recommended: Approved: Approved:

Date

Steve C. Love

District Rail Administrator Director of Transportation

Development Division Administrator N/A Federal Highway Administration

725-090-04B

RAIL OFFICE

OGC – 03/15

EXHIBIT A

The Company shall:

1. utilize the U.S. Department of Homeland Security’s E-Verify system to verify the employment eligibility of all new employees hired by the Company during the term of the contract; and

2. include an express requirement in any subcontract that subcontractors performing work or providing services pursuant to the state contract utilize the U.S. Department of Homeland Security’s E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term.

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASA19

7/22/2020

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 7/22/2020

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55074010706

Expansion Option: A5

Object Code: 563000

Amount: $95,284.80

Financial Project: 42895315701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2021

Budget Entity: 55150200

Category/Category Year: 088716/21

Amendment ID: W003

Sequence: 00

User Assigned ID: CO#3

Enc Line (6s)/Status: 0003/04

Total Amount: $95,284.80

Contract: ASA19

Contract Type: AC - RR CROSSING-PE/INSTAL (RR-XING/PE)

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 05/09/2018

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: Preliminary Engineering and Flagging Services for Construction of Interstate Bridges over CSX R/W.

Page1 of 1

To: Ta'rika.Green@dot.state.fl.us

DocuSign Envelope ID: 664FEB97-7D4F-453E-B73B-A42841788791

ACCT. CODE : 709 - FL2359 Form Revision

12/11/18

ESTIMATE SUBJECT TO REVISION AFTER: 6/24/2021 DOT NO.: 627922B

CITY: COUNTY: Hillsborough STATE: FL

REGION: Jacksonville SUB-DIV: Yeoman MILE POST: S 837.28

AGENCY PROJECT NUMBER: FDOT: 428953-1-57-01

PRELIMINARY ENGINEERING:

212 Contracted & Administrative Engineering Services -$

Subtotal -$

CONSTRUCTION ENGINEERING/INSPECTION:

212 Contracted & Administrative Engineering Services 320,870$

Subtotal 320,870$

FLAGGING SERVICE: (Contract Labor)

70 Labor (Conductor-Flagman) 0 Days @ 350.00$ -$

50 Labor (Foreman/Inspector) 225 Days @ 504.00$ 113,400$

70 Additive 150.40% (Transportation Department) -$

50 Additive 149.50% (Engineering Department) 169,533$

230 Expenses (Engineering Department) 225 Days @ 75.00$ 16,875$

230 Expenses (Transportation Department) 0 Days @ 45.00$ -$

Subtotal 299,808$

SIGNAL & COMMUNICATIONS WORK: 5,000$

TRACK WORK: -$

PROJECT SUBTOTAL: 625,678.00$

900 CONTINGENCIES: 10.00% 62,567.80$

PROJECT TOTAL: ***************************************************** 688,245.80$

CURRENT AUTHORIZED BUDGET: ***************************************************** 592,961.00$

TOTAL SUPPLEMENT REQUESTED: ***************************************************** 95,284.80$

DIVISION OF COST:

Agency 100.00% 95,285$

Railroad 0.00% -$

NOTE: Estimate is based on FULL CROSSING CLOSURE during work by Railroad Forces.

Office of Chief Engineer Public Projects--Jacksonville, Florida

C. Showman J. Shaw Approved by: KSWCSXT Public Project Group

DATE: 05/08/18 REVISED: 06/24/20 DATE: 07/10/20

Estimated prepared by:

This estimate has been prepared based on site conditions, anticipated work duration periods, material prices, labor rates, manpower and resource availability, and other factors known as of the date prepared. The actual cost for CSXT work may differ based upon the agency's requirements, their contractor's work procedures, and/or other conditions that become apparent once construction commences or during the progress of the work

Brandon

DESCRIPTION: I-75 OH Bridge: New on-ramp construction over CSXT ROW; Redecking of existing I-75 Northbound OH

Bridge.

DocuSign Envelope ID: 664FEB97-7D4F-453E-B73B-A42841788791

_____ Other

*By signing this form you are authorizing CSXT to incur costs and bill against this project. Should the project be canceled, CSXT will bill the Project Sponsor for the incurred costs. In the event the Project Sponsor is unresponsive for 90 days or more, the project will be closed;

and the Project Sponsor will be final billed for all project costs incurred.

Project Location:

Sponsor Project Ref.

Number (If applicable)

Signature of Applicant Date:

Project Description:

Signature of Applicant* Please sign, and e‐mail this form to the authorized CSX representative.

Only complete this section if this project is associated with

Federal and/or State funds.

CSX is subject to a state single audit as a recipient or subrecipient of funds (The only states that should apply here are FL or NC. FL must provide completed form DFS-A2-NS.)

If you selected Other, please describe below.

Name and Title of

Applicant

Please describe the funding source for this project (i.e. INFRA, Section 130, State, County, Private, etc.).

Contact Name:

Phone:

E-mail:

State Suspended and Debarred (Note - All federally funded projects are already monitored against the federal sus/deb listings)

Davis-Bacon (Please only check this box if this is a construction project that may be performed by an outside party)

Project Sponsor Bill To Information

Agency - Sponsor:

BillingAddress:

Project Requirements:

CSX TRANSPORTATION – NEW PROJECT INITIATION FORM

Please provide the following information so that CSXT is able to accurately and appropriately process the project setup and billing.

Is this project associated with

Federal funds?

Is this project associated with

State funds?

Additional procurement restrictions (Please describe below)

Buy America

Form Revision 9/6/19

NO

YES

Florida Department of Transportation District 7

11201 N. NcKinley Drive MS 7-500, Tampa, Fl 32612-6456

Steve C. Love, District Rail Administrator

813-975-6402

Steve.love@dot.state.fl.us

I-75 (SR 93A) FM WB SR 60 ENTRANCE RAMP TO S OF CSX RR/CR 574

I-75 Overhead Bridge - New On Ramp Bridge construction over CSX ROW - Redecking of existing bridge

428953-1-57-01

Steve C. Love, District Rail Administrator

Steve C. Love Digitally signed by Steve C. Love Date: 2020.07.22 16:44:05 -04'00'