CN-550000-ASR76-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

448429-1-57-01 Various POLK Various D122003B

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:

Upgrade incandescent bulbs to LED inserts at the following crossings: Interlachen Parkway (624155S, A 849.39); Ronald Reagan Parkway (622957K, A 819.4); New Tampa Highway (624301V, A 855.2);

Airport Road (624300N, A 854.75); and South Wabash Avenue (624298P, A 852.96). Materials only, all work to be done by CSX forces.

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

LED Upgrades Materials Only 0.00 57,646.00

Sub-Totals ………………………………………………………………… $ $57,646.00 Net Cost of Construction Changes, this order ………………………... $ $57,646.00 Cost of Construction Changes, previously ordered ………………….. $ $0.00 Net Total Cost of Construction Changes, to date…………………………………………….. $0.00 Contract Amount ………………………………………………………………………………… $0.00 Estimated Cost of Work Authorized, to date………………………………………………….. $57,646.00

Examined as to provisions and participating items of cost:

Recommended: Approved: Approved: N/A

Date

Exempt From FHWA Review Wendy Sands

District Rail Administrator

Paul A. Simmons Modal Development Administrator

Division Administrator

N/A

Federal Highway Administration

DocuSign Envelope ID: DD613156-86A6-485D-A257-97F29A714C67

4/7/2022 | 11:45 AM EDT 4/7/2022 | 11:59 AM EDT

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.

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASR76

3/16/2022

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 3/16/2022

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55012020129

Expansion Option: A9

Object Code: 563000

Amount: $57,646.00

Financial Project: 44842915701

Work Activity (FCT): 675

CFDA:

Fiscal Year: 2022

Budget Entity: 55100100

Category/Category Year: 088808/22

Amendment ID: W001

Sequence: 00

User Assigned ID: CO1

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

Total Amount: $57,646.00

Contract: ASR76

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 03/14/2022

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: Districtwide LED Upgrades

Page1 of 1

To: Kyle.Green@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

YES

NO

Section 130 (RHP)

E-Verify

Florida Department of Transportation

801 North Broadway Avenue, Bartow, FL 33830

W. Kyle Green

863-519-2386 kyle.green@dot.state.fl.us

Crossings 624155S, 622957K, 624301V, 624300N, 624298P

Districtwide LED Upgrades (materials only)

FPID 448429-1-57-01 // ASR76

W. Kyle Green, Rail Projects Coordinator, Atkins on behalf of FDOT D1

4/6/2022

ACCT. CODE : 709 - TBD Form Revision

10/07/19

ESTIMATE SUBJECT TO REVISION AFTER: 12/30/1900 DOT NO.: 624155S / 622957K / 624301V / 624300N / 624298P

CITY: COUNTY: Various STATE: FL

ZONE: Florida SUB-DIV: Various MILE POST: Various

AGENCY PROJECT NUMBER: 0

PRELIMINARY ENGINEERING:

212 Contracted & Administrative Engineering Services 1,500$

Subtotal 1,500$

CONSTRUCTION ENGINEERING/INSPECTION:

212 Contracted & Administrative Engineering Services 1,500$

Subtotal 1,500$

FLAGGING SERVICE: (Contract Labor)

70 Labor (Conductor-Flagman) 0 Days @ 350.00$ -$

50 Labor (Foreman/Inspector) 0 Days @ 504.00$ -$

70 Additive 150.40% (Transportation Department) -$

50 Additive 149.50% (Engineering Department) -$

230 Expenses (Engineering Department) 0 Days @ 75.00$ -$

230 Expenses (Transportation Department) 0 Days @ 45.00$ -$

Subtotal -$

SIGNAL & COMMUNICATIONS WORK: 37,312$

TRACK WORK: -$

PROJECT SUBTOTAL: 40,311.97$

900 CONTINGENCIES: 30.00% 12,093.59$

PROJECT TOTAL: ***************************************************** 52,405.56$

CURRENT AUTHORIZED BUDGET: ***************************************************** -$

TOTAL SUPPLEMENT REQUESTED: ***************************************************** 52,405.56$

DIVISION OF COST:

Agency 100.00% 52,406$

Railroad 0.00% -$

NOTE: Estimate is based on FULL CROSSING CLOSURE during work by Railroad Forces.

Office of Chief Engineer Public Projects--Jacksonville, Florida

0 Approved by: 0 CSXT Public Project Group

DATE: 01/00/00 REVISED: 01/00/00 DATE: 01/00/00

Various

DESCRIPTION: Interlachen Parkway / Ronald Reagan Parkway / New Tampa HWY / Airport Road / S Walbash Ave -

OOM estimate to install 12" LED upgrade inserts to replace incedescent bulbs. Estimate includes

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

Estimated prepared by:

OOM Included for reference, FAE needed for accuracy