CN-550000-ASL06-W0010000.pdf

Florida Department of Transportation

RON DESANTIS

GOVERNOR

801 N Broadway Avenue

Bartow, FL 33830

KEVIN J. THIBAULT, P.E.

SECRETARY

Safety, Innovation, Mobility, Attract, Retain & Train www.fdot.gov

January 21, 2021

Mr. Scott Willis

CSX Public Projects Manager

500 Water Street J-301

Jacksonville, FL 32202

RE: FPID: 448771-1-57-01, SR 600 (US 17) Signal Preemption for

FPID: 440791-1-52-01, Design Build Push Button Task 34

Crossing 622968X, RR MP A 827.29

Change Order 1 and Plans Submittal

Mr. Willis, Enclosed is Change Order 1 for Bates Road which crosses at grade crossing 622968X. As part of an upcoming Design Build Push Button (DBPB) task, FDOT is constructing a new traffic signal east of this crossing at the intersection of SR 600 (US 17). As such we wish to connect for preemption at crossing 622968X. The project would install a pull box outside of CSX right of way for connection by CSX Signal Forces.

Included with the change order is a copy of the plans for review and comment prior to construction.

If you have any questions or concerns, feel free to contact me at 863-519-2836.

Sincerely, W. Kyle Green

Design/Construction Coordinator GEC

ATKINS on behalf of FDOT

Enclosure cc: Arlene Barnes, District Rail Administrator, FDOT

DocuSign Envelope ID: C4900960-A38A-4278-A024-5A8152869B22

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

725-090-04A

RAIL

OGC – 03/15

RAILROAD CHANGE ORDER NO. 1

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

448771-1-57-01 SR 600 (US 17) Polk 1 (SIGW) N/A

A. 1. The CSXT, 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 and flagging coverage for crossing 622968X (RR MP A 827.29) to provide signal pre-emption connection in coordination for new traffic signal installation on SR 600 (US 17) and Bates Road.

This change order includes any other work deemed necessary to complete 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 Original Agreement of record dated 10/18/1977 and no supplemental Agreement is required.

Original Type: Crossing Surface Signals Flagging

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

PE review, signals and flagging 80,000.00

Sub-Totals ………………………………………………………………… $ $80,000.00

Net Cost of Construction Changes, this order ………………………... $ $80,000.00

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

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

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

Estimated Cost of Work Authorized, to date………………………………………………….. $80,000.00

Examined as to provisions and participating items of cost:

Recommended: Approved: Approved: N/A Date Date Date

Exempt From FHWA Review Arlene Barnes

District Rail Administrator Paul A. Simmons

Modal Development Administrator Division Administrator

N/A

Federal Highway Administration

1/22/2021 | 2:44 PM EST 1/22/2021 | 4:04 PM EST

725-090-04A

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

ASL06

1/22/2021

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 1/22/2021

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55014010106

Expansion Option: A5

Object Code: 563000

Amount: $80,000.00

Financial Project: 44877115701

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

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

Total Amount: $80,000.00

Contract: ASL06

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 01/19/2021

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: Signal Preemption Connection for DBPB Task 34, PE and Install

Page1 of 1

To: Kyle.Green@dot.state.fl.us

Revised 1-11-16 Page 1 of 2

CSX TRANSPORTATION – GOVERNMENT COMPLIANCE DEPT

NEW PROJECT FORM

Haines City, Polk County, FL Bates Road at US 17 Signal Improvements, 622968X, A 827.29

Agency Project Number 448771-1-57-01, contract ASL06 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 W. Kyle Green Phone 863-519-2386

Address 801 N. Broadway Avenue Email Kyle.Green@dot.state.fl.us

Bartow, FL 33803 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: