CN-550000-ASJ15-W0010000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

725-090-04B

RAIL

OGC – 03/15

RAILROAD CHANGE ORDER NO. 1

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

440338-2-57-01 SR 39A/Alexander St Hillsborough 9 (10090-2504) NA

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, CEI and Flagging services to review 3R roadway plans for SR 39A, Alexander St, Plant

City, Florida, for NGCN's: 624427C; RRMP: S 824.28; and 624326R; RRMP A 862.15. Project consists primarily upgrading ADA ramps and sidewalk. This Change Order to include any other related activities for this 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 9/15/1998 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. ATTACHED

b. X 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 PE, CEI and Flagging Services 50000.00

Sub-Totals ………………………………………………………………… $ $50000.00

Net Cost of Construction Changes, this order ………………………... $ $50,000.00

Cost of Construction Changes, previously ordered ………………….. $ $

Net Total Cost of Construction Changes, to date…………………………………………….. $50,000.00

Contract Amount ………………………………………………………………………………… $

Estimated Cost of Work Authorized, to date………………………………………………….. $50,000.00

Examined as to provisions and participating items of cost:

Recommended:

Approved:

Approved:

Date

Kenneth Madden District Rail Coordinator

Richard Moss, PE Director of Transportation

Development

Division Administrator N/A

Federal Highway Administration

DocuSign Envelope ID: 625BEA6C-1363-4114-88CE-36FE446324B2

7/29/2020 | 1:05 PM EDT 7/29/2020 | 1:28 PM EDT

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

ASJ15

7/23/2020

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 7/23/2020

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55074010706

Expansion Option: A5

Object Code: 563000

Amount: $50,000.00

Financial Project: 44033825701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2021

Budget Entity: 55150200

Category/Category Year: 088716/21

Amendment ID: W001

Sequence: 00

User Assigned ID: CO1 PE

Enc Line (6s)/Status: 0001/04

Total Amount: $50,000.00

Contract: ASJ15

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 07/22/2020

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: CO #1 PE and flagging

Page1 of 1

To: Kenneth.Madden@dot.state.fl.us

Revised 1-11-16 Page 1 of 2

CSX TRANSPORTATION – GOVERNMENT COMPLIANCE DEPT

NEW PROJECT FORM

Plant City, Hillsborough County, PE Review, CEI and flagging NGCN’s: 624427C; RRMP: S 824.28; 624326R; RRMP A 862.15

FDOT FPN: 440338-2-57-01

To ensure compliance with government reporting requirements, please provide the following information so that CSXT may accurately and appropriately setup and oversee the necessary accounting associated with the proposed project.

Please enter the below requested information and return this form to Eva Olsen (Eva_Olsen@csx.com) for handling with

CSXT:

1) Is the project Federally Funded? Yes No

2) Funding Source: If the project is funded by multiple sources please provide the approximate anticipated percentage of the total project cost to be paid by each source.

____ American Recovery and Reinvestment Act (ARRA)

____ Federal Emergency Management Agency (FEMA)

____ Federal Railroad Administration (FRA)

____ Federal Transit Administration (FTA)

____ Federal Highway Administration (FHWA)

____ Transportation Investment Generating Economic Recovery (TIGER)

____ Section 130

____ City ____ County __X__ State

____ Other (__________________________________)

3) Project Requirements ____ Procurement Restrictions (e.g. Buy America(n), Buy State, US Steel)

____ Procurement Restrictions Waiver

____ Suspended / Debarred

____ Davis-Bacon Act

_X__ E-Verify

____ Other (__________________________________)

4) Audit Type: Please advise if the project is subject to government audit requirements by completing the appropriate box below (complete only one box).

Not Applicable __X__ Federal Audit _____ Florida Single Audit _____

Please specify:

____ OMB Circular A-133 ____ Uniform Guidance

(Florida Statute 215.97)

CSXT is not subject to the OMB A- 133, Uniform Guidance, and Florida Single Audit.

Audit Status1, 2: CSFA# 3 __________

____ Vendor (CFDA# Not Required)

Note: This is not related to the project specific audit performed by your agency.

____ Recipient* (CFDA# Required _____)

____ Sub-Recipient* (CFDA# Required

1 Audit Status: If CSXT is subject to Federal Audit, please advise if CSXT is considered a Vendor (Contractor), Sub- Recipient or Recipient. The Federal Sub-Recipient and Vendor Determination Checklist is enclosed for reference.

2 CFDA Number: If CSXT is subject to Federal Audit, please provide the Catalog of Federal Domestic Assistance (CFDA) number.

3 CSFA Number: If CSXT is subject to the Florida Single Audit, please provide the Catalog of State Financial Assistance (CSFA) number.

*Please Note: Per 2 CFR 200.425(a), CSXT can recover Federal Audit costs directly through this project.

For Audit related questions, contact GBCompliance@csx.com.

5) Agency Contact and Federal Award Information

Name Kenneth Madden Phone 813-975-6407

Address 11201 N. McKinley Drive Email Kenneth.madden@dot.state.fl.us

Tampa, FL 33612 Fed Award # ___________________________

Date of Award ___________________________ mailto:Eva_Olsen@csx.com

Revised 1-11-16 Page 2 of 2

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: