CN-550000-ASL21-W0010000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

RAILROAD CHANGE ORDER NO. 1

725-090-04B

RAIL

OGC – 10/20

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

Number

FAP

Number

445362-2-57-01 I-75, SR 574 & US 92 HILLSBOROUGH See Exhibit D 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, CEI & Flagging Services for work adjacent to and within CSX Right of Way.

See Exhibit D for Location Details.

2. Exhibit A, Exhibit B, and Exhibit C are attached to the Railroad Change Order and made 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 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 Preliminary Engineering 1 $50,000.00 CEI & Flagging Services

Sub-Totals ………………………………………………………………… $ $50,000.00 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: N/A

Date

Exempt From FHWA Review

District Rail Administrator Steve Love

Director of Transportation Development Richard Moss

Division Administrator N/A

Federal Highway Administration

DocuSign Envelope ID: 6F9C2F50-7D1E-40B2-A357-643FBC4E02DB

2/1/2021 | 3:36 PM EST 2/1/2021 | 3:59 PM EST

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.

EXHIBIT B

The Company shall:

1. adhere to all Buy America requirements (23 CFR 635.410) to ensure that all manufacturing processes of steel and iron occur in the United States; and

2. ensure that prefabricated items that contain steel must also comply with Buy America; and

3. provide Buy America certifications that include correct language, project information, and the material’s delivery date.

EXHIBIT C

The Company understands:

1. that while FHWA1273 does not apply to force account work performed by rail companies, FHWA-assistance is subject to Title VI (42 U.S.C. § 2000d et seq); and

2. requires appropriate assurances by providing an executed Title VI / Nondiscrimination Assurance, including Appendices A and E.

Exhibit D Crossing Number

Road County Milepost Parcel Number

621453G I-75

(SR 93A)

Hillsborough 874.10

10075-

ROPA

624344N McIntosh Rd

Hillsborough 868.84 10518-

XNGL

624342A N Dover Rd Hillsborough 867.30 10090-

X&SL

624340L Sydney Dover Rd

Hillsborough 866.52 10000-

X&SL

624336W S Forbes Rd Hillsborough 865.22 10000-

MISC

624313P Park Rd Hillsborough 860.09 10740-

624350S Kingsway Rd

Hillsborough 870.95 10000-

MISC

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASL21

1/29/2021

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 1/29/2021

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55074010706

Expansion Option: A5

Object Code: 563000

Amount: $50,000.00

Financial Project: 44536225701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2021

Budget Entity: 55150200

Category/Category Year: 088716/21

Amendment ID: W001

Sequence: 00

User Assigned ID: CO#1

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

Total Amount: $50,000.00

Contract: ASL21

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 01/26/2021

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: PE Review for ATMS Installation

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

District Dedicated Revenue (DDR) - State

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-4 Frame from Downtown Tampa to Polk County Line

Preliminary Engineering Review, CEI & Flagging Services. This Project involves Camera Installations and wiring that may occur within CSX ROW.

445362-2-57-01

Steve C. Love, District Rail Administrator

2/1/2021 | 3:36 PM EST