CN-550000-ASQ73-00010000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

RAILROAD CHANGE ORDER NUMBER

725-090-04A

RAIL

OGC – 12/23

Financial Project ID Roadway Description County Roadway ID Contract ID

441661-1-57-01 SR 60 FROM E OF CLARENCE

GORDON JR RD TO POLK COUNTY

LINE

HILLSBOROUGH 10110000 ASQ73

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:

Construction, CEI & Flagging Services for a resurfacing project. This includes any other work deemed necessary for this project.

Crossing # 624572B - RRPM: 828.91

2. Exhibit A, Exhibit B, and Exhibit C are attached to the Railroad Change Order and made part of the below referenced Railroad Agreement.

3. The items of work covered by this Change Order are referenced to the Original Agreement of record dated 2/13/1980 and no Supplemental Agreement is required.

Agreement Type: Crossing Surface

B. 1. Reimbursement for the cost of this Railroad Work is to be in accord with the provisions set forth in Administrative Rule Chapter 14-57 Section .011(2) as:

a. ☐ NONREIMBURSABLE

b. ☒ REIMBURSABLE

(1) ☒ Force Account Method

(2) ☐ Lump Sum Method

(3) ☐ Third Party Contract Method

C. ESTIMATED COST OF WORK DUE TO THIS CHANGE ORDER

CHANGE

ORDER DESCRIPTION

PREVIOUSLY

AUTHORIZED WORK

AMOUNT(S)

NEW AUTHORIZED

WORK AMOUNT

Construction, Flagging & CEI Construction, Flagging & CEI

$52,254.00 $ $7,208.00

Total amount of work previously authorized………………………………………………………… $52,254.00 Total amount of new work authorized by this change order…………………………………………………………………… $7,208.00 Total amount of work authorized under agreement for this Financial Project ID……………………………………… $59,462.00 PROJECT TOTAL AMOUNT OF WORK AUTHORIZED TO DATE……………………………………………………………………… $59,462.00

Examined as to provisions and participating items of cost:

Recommended: ____________________ Approved: ____________________ Date Date

Kenneth Madden

District 7 Rail Administrator Justin Hall

Director of Transportation Development

Docusign Envelope ID: B1F09206-D80D-40E5-BED8-54B7D2B2AE40

08/09/2024 | 11:37 AM EDT 08/12/2024 | 9:03 AM EDT

725-090-04A

RAIL

OGC – 12/23

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.

OGC – 12/23

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.

OGC – 12/23

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.

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASQ73

8/5/2024

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR JASON ADANK, CPA, COMPTROLLER ON 8/5/2024

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55074010706

Expansion Option: A5

Object Code: 563000

Amount: $7,208.00

Financial Project: 44166115701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2025

Budget Entity: 55150200

Category/Category Year: 088716/25

Amendment ID: W003

Sequence: 00

User Assigned ID: CO#3

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

Total Amount: $7,208.00

Contract: ASQ73

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 11/15/2021

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: PE & Flagging Services for Resurfacing Project

Page1 of 1

To: Michael.Pokers@dot.state.fl.us

ACCT. CODE : 709 - FL2895 Form Revision 12/22/21

BUY AMERICA

ESTIMATE SUBJECT TO REVISION AFTER: 7/10/2025 DOT NO.: 624572B

CITY: COUNTY: Hillsborough STATE: FL

ZONE: Florida SUB-DIV: Plant City MILE POST: SV 828.91

AGENCY PROJECT NUMBER: FDOT 441661-1-57-01 (ASQ73)

PRELIMINARY ENGINEERING:

212 Contracted & Administrative Engineering Services 16,700$

Subtotal 16,700$

CONSTRUCTION ENGINEERING/INSPECTION:

212 Contracted & Administrative Engineering Services 17,700$

Subtotal 17,700$

FLAGGING SERVICE: (Contract Labor) 70 Labor (Conductor-Flagman) 0 Days @ 350.00$ -$ 50 Labor (Foreman/Inspector) 15 Days @ 504.00$ 7,560$ 70 Additive 137.00% (Transportation Department) -$

50 Additive 160.00% (Engineering Department) 12,096$

Subtotal 19,656$

SIGNAL & COMMUNICATIONS WORK: -$

TRACK WORK: -$

PROJECT SUBTOTAL: 54,056$

900 CONTINGENCIES: 10.00% 5,406$

PROJECT TOTAL: ***************************************************** 59,462$

CURRENT AUTHORIZED BUDGET: ***************************************************** 52,254$

TOTAL SUPPLEMENT REQUESTED: ***************************************************** 7,208$

DIVISION OF COST:

Agency 100.00% 7,208$

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 - TPT Approved by: KSW CSXT Public Project Group

DATE: 03/09/23 REVISED: 07/10/24 DATE: 07/26/24

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

Plant City DESCRIPTION: SR 60: Preliminary Engineering, Construction Engineering & Inspection, and Flagging covering sidewalk installation at crossing and within the CSXT ROW, and roadway resurfacing adjacent to the CSXT ROW by FDOT.

If ther please describe here:

Not Applicable _____ Florida Single Audit _____ CSX is not subject to the Single Audit.

Federal Audit _____ (Florida Statute 215.97)

Single Audit Status ¹ ² :

CSFA # ³

5) Agency

*Phone:

*Email

Date:

Recipient. The Federal Sub-Recipient and Vendor Determination Checklist is enclosed for reference.

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

³ CSFA Number: If CSX 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.

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

CSX TRANSPORTATION – GOVERNMENT BILLING DEPT

NEW PROJECT FORM

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

*1) Is the project Federally Funded?

*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.

*3) Project Requirements

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

Vendor (CFDA # Not Required)

Recipient (CFDA # )

Sub-Recipient (CFDA # )

Signature of Applicant:

Signature of Applicant Please sign, print , and e-mail this form to the authorized CSX representative

*Legal Address (1):

*Name: Federal Award #:

Date of Award:

Page of

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Has Been M/f W[TNESSETlI:

WHEREAS the ['F::·ARTMJ:t.;T is improving, re-eo11strncl..i11g or otherwisr chA.lif�iag a porlion of the State Iligh,vay S)··steni, ,-L�signa.te,l by the OEPART;-iE�:T :::s Jub N,,. _l.Q.LlQ-g_'tQ.2-al grndt tLc right of ·"·,iy a•!d b:.:ck(E} ,Jf t};c Of'>Jf'.-".:',/Y :i� Jrl)r;·;·,1 A.All Cr�18t:!i!'.� ;·'u11�:'.Jer .... £:::J�_g_, 1 ,, _l � Hoi:;e 1nE=;. I/ '"i1}-· �-·,·-�·. � �1-..,-. ..,,. ,1 ·�.:'i_.J .. \ f.i · � �f·'..-: P:1 ,.., .::.J· 1..::1 j'i1 :lnc. , nc.1tec nr,ar ··-----------··------------,, 0 .. J/<-c ,L � ,..,1.,1 '-!>,. . 1 .ar .1,c.1 ,, . (J::l,, _, ,i:.,t., J . .....>::..·.,.,:...-__ atta.::·hed herct'.:l a!) a pt1rt. hen�of, AND WHERFAS, th� D:ZFART.\IF:P.:T :rnd tlie COi\-IPANY have hc,P1ofore on the 79th rlay of June, � 9 4 4_. en!/�rr,d into a RAlLH.O,\D !·:lJ:\IBlJFtSEMET\T A.GREEME1\'T for conetruciion, :in1pro,.�u,ent J1,d n-,Hin1cna.c1cc of sai<l raiiroad grnclc cro,Eing.

NOW, TliEREFOR:S, in coas'id.eration of thr. rn!.1:va1 nndert;,kir,gs as haci11 sci forth, the partic,;

herclo 2.gree as follows:

l. Thf'; CO}''.'f��ANY l>ere�y i;rari1F to the D[PARTMENT the ri�hi to comiruci and m;,intafr,.

the sa.i2 E1g}:-.vay �t �rndc, 2wl n�ce;;sriry ::!pp1·0�chcs thereto, ,cross its '"ight of way and on:, it.;:

1.rael<(s) al th� he:reina.bovc referred tn lof:ft�iun.

2 The CO .'.\U·'A NY w:iU pr., ·1irl:�, �·ur,li:sh 0r h::\ c furr,it:hr>d, �ill nec:�:,c:ary m:tlt'ria!s rcq11ired for, a;irl will constrncl al· l)JiPARTMENT'.S C:.:J."ense a :iti:ndard Ilail:-oad ·cro2sing: Type_ ":-<.a ____ _ tH acf:,,rdan,:e wi:.i1 the DE.PARTi'1lE��T'S Sl .• rndard lnd,.:-.. No. GTI.H-OJ attu.chcd hereto .;.nd by this referent:!; mad(· a part hereof.

Fr1c11 c01nuietio!1 of ll1':! cros0:.Ui(!

t!tc COMPANY tha.H he resp<Jnsihle

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: