CN-550000-ASE25-W0020000.pdf

District Rail Administrator Steve Love

Director of Transportation Development Richard Moss

DocuSign Envelope ID: 84AD852B-0EF0-4741-9EAE-B71FB5767C0E

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

RAILROAD CHANGE ORDER NO. 2

7 2 5 - 0 9 0 - 0 4 B R A I L O G C –

0 3 / 1 5 P a g e 1 o f 2

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

441098-2-57-01 SR 580 (Busch Blvd) Hillsborough Parallel Line 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:

Preliminary Engineering review of plans and flagging services for pedestrian crossings, sidewalk, crosswalks at railroad crossing 626895D at Brooks St and railroad crossing 626894W at 12th St along Busch Blvd, This change order shall cover any other work deemed necessary for the completion of the project.

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 09/15/1998 and no supplemental Agreement is required.

Master Type: Crossing Surface Signals X Preliminary Engineering

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

a. ATTACHED

. X INCLUDED IN THE HIGHWAY CONTRACT PLANS

C.

ITEM

NO.

ITEM UNIT UNIT

PRICE

WORK ELIMINATED (-)

QTY AMOUNT

ADDITIONAL WORK (+)

QTY

1 Preliminary Engineering Review Flagging Services

20,000.00 43,323.28

Sub-Totals Net Cost of Construction Changes, this order Cost of Construction Changes, previously ordered Net Total Cost of Construction Changes, to date Contract Amount Estimated Cost of Work Authorized, to date

$20,000.00 $43,323.00 $0.00 $23,323.00

$20,000.00 $20,000.00 $43,323.00

$0.00 $43,323.28

Examined as to provisions and participating items of cost:

9/25/2020 | 2:33 PM EDT 9/28/2020 | 8:12 AM EDT

Recommended: __________________________ Approved: ________________________ Approved: _________________________

Date Date Date

Division Administrator N/A

Federal Highway Administration

2. Reimbursement for the cost of this Railroad Work is to be In accord with the provisions set forth in Adminlslralive Rule Chapler 14-57 as:

a. __ NONREIMBURSABLE -Section .011(2)

b. .....!_ REIMBURSABLE - Section .011 (2)

(1) _!_ Force Account Method

(2) _ Lump Sum Method

(3) __ Third Party Contract Method

ESTIMATED COST OF WORK DUE TO THIS CHANGE ORDER

DocuSign Envelope ID: 84AD852B-0EF0-4741-9EAE-B71FB5767C0E

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.

ACCT. CODE : 709 - FL2520 Form Revision

12/11/18

ESTIMATE SUBJECT TO REVISION AFTER: 9/2/2021 DOT NO.: 626895D ; 626894W

CITY: COUNTY: Hillsborough STATE: FL

REGION: Florida SUB-DIV: Clearwater MILE POST: SY 848.95;SY 849.05

AGENCY PROJECT NUMBER: FDOT - 441098-1-52-01

PRELIMINARY ENGINEERING:

212 Contracted & Administrative Engineering Services 11,580$

Subtotal 11,580$

CONSTRUCTION ENGINEERING/INSPECTION:

212 Contracted & Administrative Engineering Services 14,480$

Subtotal 14,480$

FLAGGING SERVICE: (Contract Labor)

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

50 Labor (Foreman/Inspector) 10 Days @ 504.00$ 5,040$

70 Additive 150.40% (Transportation Department) -$

50 Additive 149.50% (Engineering Department) 7,535$

230 Expenses (Engineering Department) 10 Days @ 75.00$ 750$

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

Subtotal 13,325$

SIGNAL & COMMUNICATIONS WORK: -$

TRACK WORK: -$

PROJECT SUBTOTAL: 39,384.80$

900 CONTINGENCIES: 10.00% 3,938.48$

PROJECT TOTAL: ***************************************************** 43,323.28$

CURRENT AUTHORIZED BUDGET: ***************************************************** 20,000.00$

TOTAL SUPPLEMENT REQUESTED: ***************************************************** 23,323.28$

DIVISION OF COST:

Agency 100.00% 23,323$

Railroad 0.00% -$

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

Office of Chief Engineer Public Projects--Jacksonville, Florida

Benesch - JES Approved by: KSW CSXT Public Project Group

DATE: 09/02/20 REVISED: DATE: 09/03/20

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

Tampa

DESCRIPTION: Roadway Modifications at Brooks Street and 12th Street, including PE, CEI and Flagging services

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASE25

9/22/2020

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 9/22/2020

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55074010706

Expansion Option: A5

Object Code: 563000

Amount: $23,323.00

Financial Project: 44109825701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2021

Budget Entity: 55150200

Category/Category Year: 088716/21

Amendment ID: W002

Sequence: 00

User Assigned ID: CO#2

Enc Line (6s)/Status: 0002/04

Total Amount: $23,323.00

Contract: ASE25

Contract Type: AA - RR SIGNALS-PE/INSTAL (RR-SIG/PE)

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 05/20/2019

Ending Date of This Agreement: 12/30/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: Proposed ped crossing improvements adjacent to the RR crossings at Brooks St & 12th St along Busch Blvd.

Page1 of 1

To: David.Grillo@dot.state.fl.us

_____ 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:

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:

Billing Address:

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

DPTO - State - PTO

Florida Department of Transportation District 7

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

Steve Love, District Rail Administrator

813-975-6402

Steve.Love@dot.state.fl.us

Brooks Street & N 12th Street - Adjacent to Busch Boulevard

Additional funds for CEI, Flagging Services & Project Closeout for: 626895D, N Brooks Street and 626894W, N 12th Street, Contract #ASE25

441098-2-57-01

Steve Love, District Rail Administrator

DocuSign Envelope ID: 84AD852B-0EF0-4741-9EAE-B71FB5767C0E

9/25/2020 | 2:33 PM EDT