Fort Walton Beach Resolution — 2022-26 Confirming Authorization up to $142,300 for FDOT Utility Work — reading text

07/ 14 IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective the day and year first written. UTILITY: CITY OF FORT WALTON BEACH BY: ( Signature) ( ; L C DATE: Irgiki - Typed Name: Dick Rynearson) Typed Title: Mayor) Recommend Approval by the District Utility Office DocuSigned by: BY:( Signature) 12/ 14/ 2022 1 11: 22 AM EST 4bob. W 1rr 1442[... DATE: FDOT Legal review e— DocuSigned by: 04" r4, BY:( Signature) 12/ 14/ 2022 1 11: 52 AM EST t t, aeorttuuor, goL, DATE: District Counsel STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION DDocuSigned by: BY:( Signature) I m Smtg DATE: 12/ 15/ 2022 1 8: 01 AM EST 00EA910BEA3D404... Typed Name: Tim Smith, P. E.) Typed Title: Director of Transportation Development) FEDERAL HIGHWAY ADMINISTRATION ( if applicable) BY: DATE: Typed Name: Typed Title: Page 5 of 5 DocuSign Envelope ID: 0D7249D2- 199B- 42A2- 96A2- DB9246661 FDE Florida Department of Transportation Office of the Comptroller Wire and ACH Instructions kc ac c• a+ o: c; 4; t 1; ; Wire and ACH Instructions for Local Funds Being Deposited into the Treasury Cash Deposit Trust Fund K 11- 78 with Department of Financial Services Please wire or ACH funds to: Department of Financial Services c/ o Wells Fargo Bank, N. A. 1 Independent Drive Jacksonville, Florida 32202 Phone: ( 813) 225- 4338 ESCROW WIRING and ACH INSTRUCTIONS Wells Fargo Bank, N. A. Account# 4834783896 ABA # 121000248 Chief Financial Officer of Florida Re: DOT— K 11- 78, Financial project# In order for FDOT to receive credit for the funds due to the Department, the reference line must contain - FDOT" and an abbreviated purpose, financial project number or LFA account number. Once the wire transfer is complete, please contact Charmaine Small at 850-414- 4885 with the following information: Financial Project Number, Dollar amount of transfer, Name of Participant It is critical that the above information be provided to the LFA accountants to properly process the deposit. SUBSTITUTE FORM W9: The Department of Financial Services now requires all entities who receive payments from the State of Florida to have a Substitute Form W- 9 on file. All cash disbursements ( return of cash collateral or earned income) will he subject to this requirement. The Substitute Form W- 9 can be completed online through the State of Florida Vendor Portal Website ( Imps. 11‘ endor. m\ tloridacto.com.). DocuSign Envelope ID: OD7249D2- 199B- 42A2- 96A2- DB9246661 FDE STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 350- 020- 03 AGREEMENT SUMMARY SHEET COMPTROLLER 9118 Attach this completed form to the agreement and forward to the LFA Section in the OOC, General Accounting Office, M. S. 42B. If you have have any questions, please call 850- 414-4867 or 850- 414- 4889. 1. Participants Name: CITY OF FORT WALTON BEACH Participants Address: 107 Miracle Strip Parkway City, State, Zip: Ft. Walton Beach, FL 32548 Contact: Daniel Payne Phone Number: 850- 833- 9613 E- Mail Address: dpayne@fwb. org Fax Number: Federal Employer ID# and address sequence: F596000323005 FEID# has a verified W-9 registered with the Department of Financial Services: ® Yes No DIn Process 2. Refund Address: same as above 3. District Contact Person: rb Kathy Ozmore Phone Number: 850-466- 4122 District Number: 3- Chiplpy Fax Number: 4. Agreement Date: 12/ 15/ LU22 T s: ui AM Es! 5. Date Form Modified: 12/ 15/ 2022 I 8: 01 AM EST 6. Agreement Amount: 142, 300. 00 7. Escrow Deposit Due Date: 12- 22- 2022 Amount Due: $ 142, 300. 00 Additional Deposit Due Date: Amount Due: $ Additional Deposit Due Date: Amount Due: $ 8. County Name: OKALOOSA 9. FDOT County Number: 57 10. If fund type is LFR/ LFRF ( Yes No), what is the anticipated start date of the payback: Is payback to be made in: [' Scheduled Payments Quarterly [' Lump Sum 11. Participant is responsible for( check one): 0100% [' Other Percentage ( Bid Items ® Lump Sum If participant is responsible for bid items, please complete the attached spreadsheet. 12. Description of work: 30 manholes& 16 valve boxes to be adjusted by the Highway Contractor 13. Financial Project# 15. Work 16. Federal Part or 14. Amount Program Fund Non- Federal Part. Including 6x Phases 17. Contract# 18. % to Bill Code 437366- 1- 52- 02 142, 300. 00 LF 1 19. Has WP been updated to reflect the changes on this form? ® Yes No 20. Comments: This is a Lump Sum Agreement and includes an additional 10% in the cost. Rule 14- 46.001 F. A C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 710-010..06 UTILITY WORK ESTIMATE UTILITIES 12/16 FDOT PROJECT INFORMATION Financial Project ID: 437366- 1- 52- 02 Federal Project ID: N/ A State Road Number: 30 County: Okaloosa FDOT Plans Dated: 10- 10-2022 District Document No.: UTILITY AGENCY/ OWNER( UAO) Utility Company: City of Ft. Walton Beach Job No. or Work Order No.: UAO Project Rep: Dick Rynearson Phone: 850- 833- 9500 E- mail: drynearson@fwb. org UAO Field Rep: Daniel Payne, P. E. Phone: 850-833- 9613 E- mail: dpayne@fwb. org SECTION A: ITEMIZED COST ESTIMATE Item Cost($) Overhead(%) Item Cost+ Overhead($) Item Must use•%" or'." Lo. 10% or. 10) Preliminary Engineering 0 Right of Way Acquisition 0 Construction Engineering 0 Construction Labor 142, 300. 00 142, 300. 00 Materials and Supplies 0 Transportation& Equipment 0 Contract Construction 0 Miscellaneous Expenses