CN-550000-ASY80-W0010000.pdf

725-090-04

RAIL

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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

RAILROAD CHANGE ORDER NUMBER 1

Financial Project ID Roadway Description County Roadway ID Contract ID

450879-1-57-01 SR 17 Polk 16090000 ASY80

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 review, CEI services, and flagging coverage for roadway resurfacing project at crossing 627563M, RR MP SX 851.64. This change order includes any other work deemed necessary to complete the project.

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 Master Agreement of record dated 8/7/1972 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

1 PE, CEI, flagging $0.00 $30,000.00

Total amount of work previously authorized………………………………………………………… $0.00

Total amount of new work authorized by this change order…………………………………………………………………… $30,000.00

Total amount of work authorized under agreement for this Financial Project ID……………………………………… $0.00

PROJECT TOTAL AMOUNT OF WORK AUTHORIZED TO DATE……………………………………………………………………… $30,000.00

Examined as to provisions and participating items of cost:

Recommended: ____________________ Approved: ____________________ Date Date

Wendy Sands Paul Simmons

District Rail Administrator Modal Development Administrator

DocuSign Envelope ID: E4460C93-3C1A-44AB-A219-0C496390B84C

05/29/2024 | 2:20 PM EDT 05/30/2024 | 9:27 AM EDT

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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.

FLORIDA DEPARTMENT OF TRANSPORTATION

FUNDS APPROVAL

ASY80

2/5/2024

CONTRACT INFORMATION

FUNDS APPROVAL INFORMATION

FUNDS APPROVED/REVIEWED FOR JASON ADANK, CPA, COMPTROLLER ON 2/5/2024

Action: Task Work Order

Reviewed or Approved: APPROVED

Organization Code: 55014010106

Expansion Option: A5

Object Code: 563000

Amount: $30,000.00

Financial Project: 45087915701

Work Activity (FCT): 127

CFDA:

Fiscal Year: 2024

Budget Entity: 55150200

Category/Category Year: 088716/24

Amendment ID: W001

Sequence: 00

User Assigned ID: CO# 1

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

Total Amount: $30,000.00

Contract: ASY80

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

Vendor Name: CSX TRANSPORTATION, INC.

Vendor ID: F546000720022

Beginning Date of This Agreement: 02/02/2024

Ending Date of This Agreement: 12/31/2050

Contract Total/Budgetary Ceiling:

Method of Procurement: R - RAILROAD/UTILITIES AGREEMENT

Description: PE and Flagging at crossing 627563M in Frostproof for POP project

Page1 of 1

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

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?

Please describe the funding source for this project (i.e. INFRA, Section 130, State, County, Private, etc.).

Project Requirements:

Buy America

Additional procurement restrictions (Please describe below)

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)

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.)

Other If you selected Other, please describe below. Only complete this section if this project is associated with

Federal and/or State funds.

Project Sponsor - "Bill To" Information

Agency - Sponsor:

Billing Address:

Contact Name:

Phone:

E-mail:

Invoice Delivery Method:

Project Location:

Project Description:

Sponsor Project Ref.

Number (If applicable)

Signature of Applicant* Please sign, and e‐mail this form to the authorized CSX representative.

Name and Title of

Applicant

Signature of Applicant Date:

*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.

Form Revision 7/18/23

If Email or Mail & Email is selected, please enter Email address(es) here:

Note: this is the agency that will be paying the invoice.

Note: this is the address to send the invoice for payment.

State funds, DDR

E-Verify

Florida Department of Transportation 801 N Broadway Avenue, Bartow, FL 33830

J.J. Wren 863-519-2437 JJ.Wren@dot.state.fl.us

JJ.Wren@dot.state.fl.us

Crossing 627563M, RR MP SX 851.64

SR 17 FROM US 37 TO 5TH AVE

450879-1-57-01 (ASY80)

J.J. Wren, Rail Project Manager

No

Yes

Email

05/29/2024 | 1:08 PM EDT