CN-550000-ASQ75-W0010000.pdf

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

RAILROAD CHANGE ORDER NO. 1

725-090-04B

RAIL

OGC – 1/21

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

FAP

Number

439829-9-57-01 SR 674/E COLLEGE AVE HILLSBOROUGH 10120-2150 D 721 021

A. 1. The CSX Transportation 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:

Right Of Entry Review and Flagging Services for Lighting Project. This change order covers all other work deemed necessary to complete the project.

Crossing # 624767N, RRMP: 897.31

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 08/07/1972 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. 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

1 Right of Entry & Flagging 1 5,000.00

Sub-Totals ………………………………………………………………… $ $5,000.00 Net Cost of Construction Changes, this order ………………………... $ $5,000.00 Cost of Construction Changes, previously ordered ………………….. $ $ Net Total Cost of Construction Changes, to date…………………………………………….. $5,000.00 Contract Amount ………………………………………………………………………………… $ Estimated Cost of Work Authorized, to date………………………………………………….. $5,000.00

Examined as to provisions and participating items of cost:

Recommended: Approved: Approved:

Date Date Date

Kenneth Madden District 7 Rail Administrator

Richard Moss PE Director of Transportation

Development

Division Administrator N/A

Federal Highway Administration

725-090-04B

RAIL

OGC 1/21

EXHIBIT A

The Company shall:

1. utilize the U.S. Department of Homeland 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 E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term.

OGC 1/21

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 c delivery date.

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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

ASQ75

12/21/2021

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 12/21/2021

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55072020727

Expansion Option: AG

Object Code: 242059

Amount: $5,000.00

Financial Project: 43982995701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2022

Budget Entity: 55150200

Category/Category Year: 088796/22

Amendment ID: W001

Sequence: 00

User Assigned ID: CO#1

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

Total Amount: $5,000.00

Contract: ASQ75

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 11/22/2021

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: Right of Entry Review & Flagging Services

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To: Stephen.Anderson@dot.state.fl.us

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:

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