CN-550000-ASV50-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

448936-1-57-01 SR 700 (US 98) Highlands 125 / 09510-2151 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:

Funding for preliminary engineering review, CEI, and design reviews for roadway work with a reconstruction of grade crossing located in Lorida, Florida, Highlands County, US 98 and Cowhouse Rd./ Bluff Hammock Rd., crossing 628045V, RRMP SX880.23. This change order includes any other work deemed necessary for the completion of this project.

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. 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.

Sub-Totals …………………………………………………………………

Net Cost of Construction Changes, this order ………………………...

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

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

Contract Amount ………………………………………………………………………………… Estimated Cost of Work Authorized, to date…………………………………………………..

Examined as to provisions and participating items of cost:

Recommended:

Date

Approved:

Date

Approved:

Date

Wendy Sands District Rail Administrator

Paul A. Simmons Modal Development Administrator Division Administrator

F ederal Highway Administration

N/A

ITEM UNIT UNIT

PRICE

WORK ELIMINATED (-)

QTY AMOUNT

ADDITIONAL WORK (+)

QTY AMOUNT

Preliminary Engineering Review 10,000.00

$ $10,000.00 $ $10,000.00 $ $0.00

$0.00 $0.00

$10,000.00

DocuSign Envelope ID: 40E63B6C-A900-4494-9D4E-6E21F7EF4FE8

02/13/2023 | 10:17 AM EST 02/13/2023 | 3:58 PM EST

725-090-04B

RAIL

OGC – 1/21

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.

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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.

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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.

To: Jennifer.Gaona@dot.state.fl.us

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASV50

2/10/2023

CONTRACT INFORMATION

Contract: ASV50

Contract Type:

Method of Procurement:

Vendor Name:

Vendor ID:

AC - RR CROSSING-PE/INSTAL (RR-XING/PE)

R - RAILROAD/UTILITIES AGREEMENT

CSX TRANSPORTATION, INC.

F546000720022

Beginning Date of This Agreement: 02/08/2023

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Description: Engineering review of FPID 448936-1 SR 700 (US 98) design plans for resurfacing/crossing reconstruction

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR ROBIN M. NAITOVE, CPA, COMPTROLLER ON 2/10/2023

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55014010106

Expansion Option: A9

Object Code: 563000

Amount: $10,000.00

Financial Project: 44893615701

Work Activity (FCT):

CFDA:

Fiscal Year: 2023

Budget Entity: 55150200

Category/Category Year: 088797/23

Amendment ID: W001

Sequence: 00

User Assigned ID: CO# 1

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

Total Amount: $10,000.00

Page1 of 1

_____ 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

State

E-Verify

Florida Department of Transportation

801 North Broadway Avenue Bartow, FL 33830

Jennifer Gaona

863-519-2730 jennifer.gaona@dot.state.fl.us

Crossing 628045V, RRMP SX880.23

SR 700 (US 98) RESURFACING AND RECONSTRUCT CROSSING 628045V

FPID 448936-1-57-01 / Contract ASV50

Jennifer Gaona, District One Rail Coordinator

02/13/2023 | 9:24 AM EST

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Rail Highway Crossing Inventory Search Crossing Reports Library Projects Reference

General Crossing Number: 628045V - US-98 / SR-700 Last Updated by Khaleda Hatim on 9/20/2022 3:58:22 PM

Railroad

Road

Signs

Railroad Operating Company: CSX TRANSPORTATION, INC.

Local Street Name: US-98 / SR-700

Crossing Status: OPEN--TRACK ACTIVE

Crossing General

Safety Index Rank: 283

Railroad Responsible FRA Field

RR Milepost: SX | 880.23 |

1 log entries available. View Log Signals

Gates

Vicinity

Data

Roadway Location

District County (I.3) City (I.4)

Highlands

LORIDA

IN CITY

NEAR CITY

Roadway Ownership

Crossing Status

OPEN--TRACK ACTIVE OPEN--

TRACK INACTIVE CLOSED--

TRACK REMOVED CLOSED--

ROADWAY REMOVED

Incident

Comments

Photos

Field Review

State Route Number (I.6)

County Route Number (I.6)

U.S. Route Number (I.6)

Local Street Name (I.5)

Railroad Local Street Name

SR-700

US-98

US-98 / SR-700

Crossing Type (I.17)

Public Access Allowed?

(I.20)

Crossing Purpose (I.18)

Crossing Position vs.

Highway (I.19)

Maintenance Responsibility

PUBLIC PRIVATE

YES NO UNKNOWN

Highway Vehicle

AT GRADE RR UNDER RR OVER

STATE COUNTY CITY PRIVATE

Block Number (I.5)

FDOT Bridge Number

Latitude (I.27)

Longitude (I.28)

Latitude/Longitude

27.4377467

-81.2402663 View location in Google Maps

ACTUAL ESTIMATED

State Annual Maintenance Percentage

Highway System (V.1)

INTERSTATE NHS

NATIONAL HIGHWAY SYSTEM

FED AID HIGHWAY, NOT NHS

NON FEDERAL AID

Functional Classification of Road at Crossing (V.2) Is Crossing ID Posted?

Roadway ID Number

Linear Referencing System (LRS Route ID) (V.5)

Highway Milepoint

LRS Milepost (V.6)

Railway ID Number

FDOT GIS RR Milepoint

Parcel Number

YES NO

09 / 11000 / 0

11.527

09 / 92900 / 1

878.595

Is the crossing on the State Highway System?

(V.3)

Rural

Urban

YES NO

INTERSTATE

PA-OTHER FREEWAY/EXPRESSWAY

PRINCIPAL ARTERIAL - OTHER

MINOR ARTERIAL

MAJOR COLLECTOR

MINOR COLLECTOR

LOCAL ACCESS

Railroad Ownership

Railroad Operating Company CSX TRANSPORTATION, INC.

Parent Company CSX TRANSPORTATION, INC.

Regularly used by Hazmat Vehicles?

Regular Emergency Services Route? (V.10)

Is the crossing on the Strategic Intermodal System (SIS)?

NO YES

NO YES

NO YES

Crossing Owner

Railroad Contact Phone Number 904-359-3100

Railroad Emergency Contact 800-232-0144 Number

Save | Cancel

Roadway Agency Contact 850-414-4907 Phone Number (I.35)

Source (I.29)

27°26'15.9"N 81°14'25.0"W

FPID 448936-1-57-01, Crossing 628045V, RRMP SX880.23

Map data ©2023 Google 200 ft

27°26'15.9"N 81°14'25.0 "W 27.437747, -81.240266

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Highlands County, FL 33857