HomeMy WebLinkAboutItem 09 Approval of Amendment No. 1 to the Cost-Share Agreement Contract No. 35349 with St. Johns River Water Management District for Bid ITB 20-007 The Hammocks Reclaimed Water Retrofit Project it$01AP
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AGENDA ITEM COVER SHEET
Meeting Date: December 1, 2020
Item # 9
Reviewed By: AlbA
Contact Name: T'Jean Tomlinson Department Director: Jamie Cif -�j,!�/
Contact Number: 407-905-3159 City Manager: Robert Frank 7( 7 '>
Subject: Approval to Append Amendment No. 1 to the Cost-Share Agreement Contract No. 35349
with St. Johns River Water Management District for Bid ITB20-007 The Hammocks Reclaimed
Water Retrofit Project; District 2: Commissioner Wilson
Background Summary:
On February 13, 2020, The City of Ocoee and The St. Johns River Water Management District
(SJRWMD) entered into Cost-Share Agreement No. 35349 to provide $131,238 in funding for The
Hammocks Reclaimed Water Retrofit Project(City Commission Meeting February 4, 2020). This original
agreement states a contract expiration date on December 30, 2020, but due to the COVID-19 virus
delaying the start of construction, the City reached out to SJRWMD and requested a four-month
extension to the contract expiration date.
SJRWMD approved the request for an extension and is requesting to append Amendment No. 1 to
Cost-Share Agreement No. 35349. Amendment No. 1 will replace Paragraph 1(a) Term: Withdrawal of
Offer with a new term of Agreement from February 13, 2020 through April 30, 2021.
The Utilities Department is recommending the approval of appending Amendment No. 1 to Cost-Share
Agreement No. 35349 to reflect the new agreement term.
The Utilities Department shall be available for questions.
Issue:
Should the Mayor and Commission accept and approve appending Amendment No. 1 to the Cost-Share
Agreement Between the St. Johns River Water Management District and City of Ocoee for The
Hammocks Reclaimed Water Retrofit Project?
Recommendations:
Staff recommends that the Mayor and City Commission approve of Amendment No. 1 to the Cost-Share
Agreement Between the St. Johns River Water Management District and City of Ocoee and authorize
the Mayor to execute Amendment No. 1.
Attachments:
(1) Executed Cost-Share Agreement Between the St. Johns River Water Management District and
City of Ocoee.
(2) Amendment No. 1.
Financial Impact:
No Financial Impact.
Type of Item: (please mark with an `x')
Public Hearing For Clerk's Dept Use:
Ordinance First Reading X Consent Agenda
Ordinance Second Reading Public Hearing
Resolution Regular Agenda
Commission Approval
Discussion&Direction
X Original Document/Contract Attached for Execution by City Clerk
Original Document/Contract Held by Department for Execution
Reviewed by City Attorney N/A
Reviewed by Finance Dept. N/A
Reviewed by () N/A
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Contract#35349
COST-SHARE AGREEMENT
BETWEEN THE
ST.JOHNS RIVER WATER MANAGEMENT DISTRICT
AND CITY OF OCOEE
THIS AGREEMENT("Agreement")is entered into by and between the GOVERNING BOARD of
the ST.JOHNS RIVER WATER MANAGEMENT DISTRICT(the"District"),whose address is 4049 Reid
Street, Palatka,Florida 32177,and CITY OF OCOEE("Recipient"), 150 North Lakeshore Drive,Ocoee.
Florida 34761.All references to the parties hereto include the parties,their officers,employees,agents,
successors,and assigns.
RECITALS
The waters of the state of Florida are among its basic resources,and it has been declared to
be the policy of the Legislature to promote the conservation,development,and proper
utilization of surface and ground water. Pursuant to chapter 373, Fla. Stat..the District is
responsible for the management of the water resources within its geographical area.
The District's cost-share funding program is designed to fund the construction of local
stormwater management and alternative water supply projects as well as conservation
implementation projects. Its goals are to contribute to:(I)reduction in water demand
through indoor and outdoor conservation measures;(2)development of alternative or non-
traditional water supply sources;such as reclaimed water,surface water,or seawater;
(3)water quality improvements(for example, nutrient-loading reduction in springsheds or
other surface-water systems);and(4)water resource development opportunities(for
instance, increasing available source water through expansion or development of surface-
water storage).The current cost-share funding program also recognizes the importance of
providing funding opportunities for construction of flood protection and natural-systems
restoration projects,which are important components of the District's core mission focus.
The District has determined that providing cost-share funding to Recipient for the purposes
provided for herein will benefit the water resources and one or more of the District's
missions and initiatives.
At its April 10,2018 meeting,the Governing Board selected Recipient's proposal for cost-
share funding.The parties have agreed to jointly fund the following project in accordance
with the funding formula further described in the Statement of Work,Attachment A
(hereafter the"Project"):
The Hammocks Reclaimed Water Retrofit Project
In consideration of the above recitals,and the funding assistance described below,
Recipient agrees to perform and complete the activities provided for in the Statement of Work,
Attachment A. Recipient shall complete the Project in conformity with the contract documents and
all attachments and other items incorporated by reference herein.This Agreement consists of all of
the following documents:(1)Agreement,(2)Attachment A—Statement of Work;and(3)all other
attachments. if any.The parties hereby agree to the following terms and conditions.
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Contract#35349
1. TERM;WITHDRAWAL OF OFFER
(a) The term of this Agreement is from the date upon which the last party has dated and executed the
same("Effective Date")until December 30,2020("Completion Date"). Recipient shall not
commence the Project until any required submittals are received and approved.Time is of the
essence for every aspect of this Agreement, including any time extensions.Any request for an
extension of time beyond the Completion Date must be made before October 1,2020.Timely
requests to extend,for longer than six months,the Completion Date of the Agreement for projects
whose District contribution exceeds$100,000 may only be approved by the District's Governing
Board.Notwithstanding specific mention that certain provisions survive termination or expiration of
this Agreement,all provisions of this Agreement that by their nature extend beyond the Completion
Date survive termination or expiration hereof(e.g.,delivery of a final report, will remain in full force
and effect after the Completion Date as necessary to effect performance).
(b) This Agreement constitutes an offer until authorized,signed and returned to the District by
Recipient.This offer terminates 45 days after receipt by Recipient;provided, however,that Recipient
may submit a written request for extension of this time limit to the District's Project Manager,stating
the reason(s)therefor.Request for extension of time after the 45 days will be denied.The Project
Manager shall notify Recipient in writing if an extension is granted or denied. If granted,this
Agreement shall be deemed modified accordingly without any further action by the parties.
(c) If the construction project,or the conservation project,which is eligible for District reimbursement,
does not begin before June 30,2020,the cost-share agreement will be subject to termination and the
funds subject to reallocation.
2. DELIVERABLES. Recipient shall fully implement the Project,as described in the Statement of Work,
Attachment A. Recipient is responsible for the professional quality,technical accuracy,and timely
completion of the Project.Both workmanship and materials shall be of good quality. Unless otherwise
specifically provided for herein, Recipient shall provide and pay for all materials,labor,and other
facilities and equipment necessary to complete the Project.The District's Project Manager shall make a
final acceptance inspection of the Project when completed and finished in all respects. Upon satisfactory
completion of the Project,the District will provide Recipient a written statement indicating that the
Project has been completed in accordance with this Agreement. Acceptance of the final payment by
Recipient shall constitute a release in full of all claims against the District arising from or by reason of
this Agreement.
3. OWNERSHIP OF DELIVERABLES. Unless otherwise provided herein,the District does not assert an
ownership interest in any of the deliverables under this Agreement.
4. AMOUNT OF FUNDING.
(a) For satisfactory completion of the Project,the District shall pay Recipient 33%of the total estimated
construction cost of the Project,but in no event shall the District cost-share exceed$131,238. The
District cost-share is not subject to modification based upon price escalation in implementing the
Project during the term of this Agreement. Recipient shall be responsible for payment of all costs
necessary to ensure completion of the Project. Recipient shall notify the District's Project Manager
in writing upon receipt of any additional external funding for the Project not disclosed prior to
execution of this Agreement.
(b) "Construction cost" is defined to include actual costs of constructing Project facilities, including
construction management. Land acquisition,engineering design,permitting,and solicitation costs
are excluded. Construction cost does not include any costs incurred prior to the Effective Date,
unless expressly authorized by the Statement of Work. Costs that are excluded will not be credited
toward Recipient's cost-share.
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Contract#35349
(c) Cooperative funding shall not be provided for expenses incurred after the Completion Date.
5. PAYMENT OF INVOICES
(a) Recipient shall submit itemized invoices quarterly as per the Statement of Work,Attachment A for
reimbursable expenses by one of the following two methods:(1)by email to acctpay@sjrwmd.com
(preferred)or(2)by mail to the St.Johns River Water Management District, Finance Director,4049
Reid Street. Palatka, Florida 32177-2571.The invoices shall be submitted in detail sufficient for
proper pre-audit and post-audit review. Invoices shall include a copy of contractor and supplier
invoices to Recipient and proof of payment. Recipient shall be reimbursed for 100%of approved
cost or the not-to-exceed sum of$131,238, whichever is less.The District shall not withhold any
retainage from this reimbursement.District reimbursement is subject to annual budgetary limitation,
if applicable,as provided in subsection(g). If necessary for audit purposes. Recipient shall provide
additional supporting information as required to document invoices.
(b) End of District Fiscal Year Reporting.The District's fiscal year ends on September 30.
Irrespective of the invoicing frequency,the District is required to account for all encumbered funds
at that time. When authorized under the Agreement,submittal of an invoice as of September 30
satisfies this requirement.The invoice shall be submitted no later than October 30. If the Agreement
does not authorize submittal of an invoice as of September 30, Recipient shall submit,prior to
October 30,a description of the additional work on the Project completed between the last invoice
and September 30,and an estimate of the additional amount due as of September 30 for such Work.
If there have been no prior invoices. Recipient shall submit a description of the work completed on
the Project through September 30 and a statement estimating the dollar value of that work as of
September 30.
(c) Final Invoice.The final invoice must be submitted no later than 45 days after the Completion Date;
provided,however,that when the Completion Date corresponds with the end of the District's fiscal
year(September 30),the final invoice must be submitted no later than 30 days after the Completion
Date. Final invoices that are submitted after the requisite date shall be subject to a penalty of
ten percent of the invoice.This penalty may be waived by the District,in its sole judgment and
discretion,upon a showing of special circumstances that prevent the timely submittal of the
final invoice.Recipient must request approval for delayed submittal of the final invoice not
later than ten days prior to the due date and state the basis for the delay.
(d) All invoices shall include the following information:(1) District contract number;(2) Recipient's
name,address,and authorization to directly deposit payment into Recipient's account(if Recipient
has not yet provided the District with a completed Direct Deposit Authorization form);
(3)Recipient's invoice number and date of invoice;(4)District Project Manager;(5)Recipient's
Project Manager;(6)supporting documentation as to cost and/or Project completion(as per the cost
schedule and other requirements of the Statement of Work), in addition,see Attachment D,
"CONTRACT PAYMENT REQUIREMENTS FOR STATE FUNDED COST REIMBURSEMENT
CONTRACT";(7)Progress Report(if required); (8)Diversity Report(if otherwise required herein).
Invoices that do not correspond with this paragraph shall be returned without action within 20
business days of receipt,stating the basis for rejection.Payments shall be made within 45 days of
receipt of an approved invoice.
(e) Travel expenses. If the cost schedule for this Agreement includes a line item for travel expenses,
travel expenses shall be drawn from the project budget and are not otherwise compensable. If travel
expenses are not included in the cost schedule,they are a cost of providing the service that is borne
by Recipient and are only compensable when specifically approved by the District as an authorized
District traveler. In such instance,travel expenses must be submitted on District or State of Florida
travel forms and shall be paid pursuant to District Administrative Directive 2000-02.
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Contract#35349
(f) Payments withheld.The District may withhold or,on account of subsequently discovered evidence.
nullify, in whole or in part,any payment to such an extent as may be necessary to protect the District
from loss as a result of:(I)defective work not remedied;(2)failure to maintain adequate progress in
the Project;(3)any other material breach of this Agreement.Amounts withheld shall not be
considered due and shall not be paid until the ground(s)for withholding payment have been
remedied.
(g) Annual budgetary limitation. For multi-fiscal year agreements,the District must budget the
amount of funds that will be expended during each fiscal year as accurately as possible.The
Statement of Work.Attachment A, includes the parties' current schedule for completion of the Work
and projection of expenditures on a fiscal year basis(October 1 —September 30)("Annual Spending
Plan"). If Recipient anticipates that expenditures will exceed the budgeted amount during any fiscal
year, Recipient shall promptly notify the District's Project Manager and provide a proposed revised
work schedule and Annual Spending Plan that provides for completion of the Work without
increasing the Total Compensation.The last date for the District to receive this request is August 1
of the then-current fiscal year.The District may in its sole discretion prepare a District Supplemental
Instruction Form incorporating the revised work schedule and Annual Spending Plan during the
then-current fiscal year or subsequent fiscal year(s).
6. LIABILITY AND INSURANCE. Each party is responsible for all personal injury and property damage
attributable to the negligent acts or omissions of that party, its officers,employees and agents. Recipient
accepts all risks arising from construction or operation of the Project.Nothing contained herein shall be
construed or interpreted as denying to any party any remedy or defense available under the laws of the
state of Florida,nor as a waiver of sovereign immunity of the state of Florida beyond the waiver
provided for in§768.28, Fla. Stat.,as amended. Each party shall acquire and maintain throughout the
term of this Agreement such liability,workers' compensation.and automobile insurance as required by
their current rules and regulations. If Florida Department of Environmental Protection("FDEP")funds
will be used to fund all or a portion of the Agreement,additional FDEP insurance requirements
applicable to the Recipient are included in the insurance attachment to the Agreement.
7. FUNDING CONTINGENCY.This Agreement is at all times contingent upon funding availability.
which may include a single source or multiple sources, including,but not limited to:(1)ad valorem tax
revenues appropriated by the District's Governing Board;(2)annual appropriations by the Florida
Legislature,or(3)appropriations from other agencies or funding sources.Agreements that extend for a
period of more than one Fiscal Year are subject to annual appropriation of funds in the sole discretion
and judgment of the District's Governing Board for each succeeding Fiscal Year. Should the Project not
be funded, in whole or in part, in the current Fiscal Year or succeeding Fiscal Years,the District shall so
notify Recipient and this Agreement shall be deemed terminated for convenience five days after receipt
of such notice,or within such additional time as the District may allow. For the purpose of this
Agreement,"Fiscal Year"is defined as the period beginning on October I and ending on September 30.
8. PROJECT MANAGEMENT
(a) The Project Managers listed below shall be responsible for overall coordination and management of
the Project. Either party may change its Project Manager upon three business days' prior written
notice to the other party. Written notice of change of address shall be provided within five business
days. All notices shall be in writing to the Project Managers at the addresses below and shall be sent
by one of the following methods:(1)hand delivery;(2)U.S.certified mail;(3)national overnight
courier;or(4)email.Notices via certified mail are deemed delivered upon receipt.Notices via
overnight courier are deemed delivered one business day after having been deposited with the
courier.Notices via e-mail are deemed delivered on the date transmitted and received.
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Contract#35349
DISTRICT RECIPIENT
Mark E. Brandenburg,MS,CSE.PWS Charles K. Smith P.E.
Project Manager Project Manager
St.Johns River Water Management District City of Ocoee
601 South Lake Destiny Road, Suite 200 1800 A D Mims Road
Maitland, Florida 32751 Ocoee,Florida 34761
Phone:407-659-0915 Phone:407-905-3159
Email:mbrandenburg@sjrwmd.com Email:csmith@ocoee.org
(b) The District's Project Manager shall have sole responsibility for transmitting instructions,receiving
information,and communicating District policies and decisions regarding all matters pertinent to
performance of the Project.The District's Project Manager may issue a District Supplemental
Instruction(DSI)form,Attachment C.to authorize minor adjustments to the Project that are
consistent with the purpose of the Project.Both parties must sign the DSI. A DSI may not be used to
change the District cost-share or percentage,quantity,quality or the Completion Date of the Project,
or to change or modify the Agreement.
9. PROGRESS REPORTS AND PERFORMANCE MONITORING.
(a) Progress Reports.Recipient shall provide to the District quarterly Project update/status reports as
provided in the Statement of Work. Reports will provide detail on progress of the Project and outline
any potential issues affecting completion or the overall schedule. Recipient shall use the District's
Project Progress Report form,Attachment B. Recipient shall submit the Project Progress Reports to
the District's Project Manager and District's Budget Analyst within 15 days after the closing date of
each calendar quarter(March 31,June 30,September 30 and December 31).
(b) Performance Monitoring. For as long as the Project is operational,the District shall have the right
to inspect the operation of the Project during normal business hours upon reasonable prior notice.
Recipient shall make available to the District any data that is requested pertaining to performance of
the Project.
10. WAIVER.The delay or failure by the District to exercise or enforce any of its rights under this Contract
shall not constitute or be deemed a waiver of the District's right thereafter to enforce those rights,nor
shall any single or partial exercise of any such right preclude any other or further exercise thereof or the
exercise of any other right.
11. FAILURE TO COMPLETE PROJECT
(a) Should Recipient fail to complete the Project.Recipient shall refund to the District all of the funds
provided to Recipient pursuant to this Agreement. However,the District, in its sole judgment and
discretion,may determine that Recipient has failed to complete the Project due to circumstances that
are beyond Recipient's control,or due to a good faith determination that the Project is no longer
environmentally or economically feasible. In such event,the District may excuse Recipient from the
obligation to return funds provided hereunder. If the Project has not been completed within 30 days
after the Completion Date,Recipient shall provide the District with notice regarding its intention as
to completion of the Project.The parties shall discuss the status of the Project and may mutually
agree to revise the time for Project completion or the scope of the Project. Failure to complete the
Project within 90 days after the Completion Date shall be deemed to constitute failure to complete
the Project for the purposes of this provision.
(b) In the event the Project constitutes a portion of the total functional project,this paragraph shall apply
in the event the total functional project is not completed. In such event,the 90-day timeframe
provided herein shall commence upon the date scheduled for completion of the total functional
project at the time of execution of this Agreement, unless extended by mutual agreement of the
parties. Paragraphs 11(a)and 11(b)shall survive the termination or expiration of this Agreement.
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Contract#35349
12. TERMINATION. If Recipient materially fails to fulfill its obligations under this Agreement. including
any specific milestones established herein,the District may provide Recipient written notice of the
deficiency by forwarding a Notice to Cure,citing the specific nature of the breach. Recipient shall have
30 days following receipt of the notice to cure the breach. If Recipient fails to cure the breach within the
30-day period,the District shall issue a Termination for Default Notice terminating this Agreement
without further notice. In such event,Recipient shall refund to the District all funds provided to
Recipient pursuant to this Agreement within 30 days of such termination.The District may also
terminate this Agreement upon ten days' written notice in the event of any material misrepresentations in
the Project Proposal.
Delay or failure by the District to enforce any right,remedy or deadline hereunder shall not impair,or be
deemed a waiver of.any such right,remedy or deadline,or impair the District's rights or remedies for
any subsequent breach or continued breach of this Agreement.
ADDITIONAL PROVISIONS(Alphabetical)
13. ASSIGNMENT. Recipient shall not assign this Agreement,or any monies due hereunder,without the
District's prior written consent. Recipient is solely responsible for fulfilling all work elements in any
contracts awarded by Recipient and payment of all monies due.No provision of this Agreement shall
create a contractual relationship between the District and any of Recipient's contractors or
subcontractors.
14. AUDIT; ACCESS TO RECORDS; REPAYMENT OF FUNDS
(a) Maintenance of Records. Recipient shall maintain its books and records such that receipt and
expenditure of the funds provided hereunder are shown separately from other expenditures in a
format that can be easily reviewed. Recipient shall keep the records of receipts and expenditures,
copies of all reports submitted to the District.and copies of all invoices and supporting
documentation for at least five years after expiration of this Agreement. In accordance with generally
accepted governmental auditing standards,the District shall have access to and the right to examine
any directly pertinent books and other records involving transactions related to this Agreement. In
the event of an audit, Recipient shall maintain all required records until the audit is completed and all
questions are resolved. Recipient will provide proper facilities for access to and inspection of all
required records.
(b) Repayment of Funds. District funding shall be subject to repayment after expiration of this
Agreement if,upon audit examination.the District finds any of the following:(1) Recipient has spent
funds for purposes other than as provided for herein, including but not limited to construction
materials not used in the Project;(2) Recipient has failed to perform a continuing obligation of this
Agreement;(3)Recipient has received duplicate funds from the District for the same purpose;
(4)Recipient has been advanced or paid unobligated funds;(5) Recipient has been paid funds in
excess of the amount Recipient is entitled to receive under the Agreement;and/or(6) Recipient has
received more than 100%contributions through cumulative public agency cost-share funding.
15. CIVIL RIGHTS. Pursuant to chapter 760, Fla. Stat.,Recipient shall not discriminate against any
employee or applicant for employment because of race,color,religion,sex.or national origin,age,
handicap,or marital status.
16. COOPERATION WITH THE INSPECTOR GENERAL,PURSUANT TO§20.055(5)FLA.STAT.
Recipient and any subcontractors understand and will comply with their duty, pursuant to§20.055(5),
Fla. Stat.,to cooperate with the inspector general in any investigation,audit, inspection,review,or
hearing.
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Contract#35349
17. DISPUTE RESOLUTION. Recipient is under a duty to seek clarification and resolution of any issue,
discrepancy,or dispute involving performance of this Agreement by submitting a written statement to
the District's Project Manager no later than ten business days after the precipitating event. If not resolved
by the Project Manager,the Project Manager shall forward the request to the District's Office of General
Counsel,which shall issue a written decision within ten business days of receipt.This determination
shall constitute final action of the District and shall then be subject to judicial review upon completion of
the Project.
18. DIVERSITY REPORTING.The District is committed to the opportunity for diversity in the
performance of all cost-sharing agreements, and encourages Recipient to make a good faith effort to
ensure that women and minority-owned business enterprises(W/MBE)are given the opportunity for
maximum participation as contractors. The District will assist Recipient by sharing information on
W/MBEs. Recipient shall provide with each invoice a report describing:(I)the company names for all
W/MBEs;(2)the type of minority,and(3)the amounts spent with each during the invoicing period.The
report will also denote if there were no W/MBE expenditures.
19. FLORIDA SINGLE AUDIT ACT
(a)Applicability.The Florida Single Audit Act(FSAA), §215.97, Fla. Stat.,applies to all sub-recipients
of state financial assistance,as defined in §2 15.97(I)(q), Fla.Stat.,awarded by the District through a
project or program that is funded,in whole or in part,through state financial assistance to the
District. In the event Recipient expends a total amount of state financial assistance equal to or in
excess of$750,000 in any fiscal year of such Recipient,Recipient must have a state single or project-
specific audit for such fiscal year in accordance with§215.97,Fla. Stat.;applicable rules of the
Department of Financial Services;and chapters 10.550(local governmental entities)or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General. In determining the state
financial assistance expended in its fiscal year,Recipient shall consider all sources of state financial
assistance,including state financial assistance received from the District,other state agencies,and
other non-state entities. State financial assistance does not include Federal direct or pass-through
awards and resources received by a non-state entity for Federal program matching requirements.
Recipient is solely responsible for complying with the FSAA.
If Recipient expends less than$750,000 in state financial assistance in its fiscal year,an audit
conducted in accordance with the provisions of§215.97, Fla. Stat., is not required. In such event,
should Recipient elect to have an audit conducted in accordance with §215.97, Fla.Stat.,the cost of
the audit must be paid from the non-state entity's resources(i.e.,Recipient's resources obtained from
other than State entities).
(b) Program Information.This Agreement involves the disbursement of state funding by the Florida
Department of Environmental Protection(FDEP). Funding is provided under the State of Florida,
Florida Springs Grant Program in the amount of$131,238.The Florida Catalog of State Financial
Assistance(CSFA)number for this program is CSFA No. 37.052.
(c) Additional Information. For information regarding the state program under the above CSFA
number, Recipient should access the Florida Single Audit Act website located at
https://apps.fldfs.com/fsaa/catalog.aspx for assistance.The following websites may be accessed for
additional information: Legislature's Website at http://www.leg.state.fl.us/,State of Florida's website
at http://myflorida.com, District of Financial Services' website at http://www.fldfs.com/and the
Auditor General's Website at http://www.myflorida.com/audgen/.
(d) Allowable Costs. Recipient may only charge allowable costs to this Agreement,as otherwise
provided herein.Any balance of unobligated cash that have been advanced or paid that is not
authorized to be retained for direct program costs in a subsequent period must be returned to the
District.
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Contract#35349
(e) Audit Requirements. Recipient shall ensure that the audit complies with the requirements of
§215.97(7), Fla.Stat.This includes submission of a financial reporting package as defined by
§215.97(2), Fla.Stat.,and chapters 10.550(local governmental entities)or 10.650(nonprofit and
for-profit organizations), Rules of the Auditor General. Recipient shall comply with the program
requirements described in the Florida Catalog of State Financial Assistance(CSFA)
[https://apps.fldfs.com/fsaa/catalog.aspx].The services/purposes for which the funds are to be used
are included in the Statement of Work.
(f) Financial Reporting.Recipient shall provide the District with a copy of any reports,management
letters,or other information required to be submitted in accordance with chapters 10.550(local
governmental entities)or 10.650(nonprofit and for-profit organizations).Rules of the Auditor
General,as applicable,no more than 20 days after its preparation. Recipient shall indicate the date
the reporting package was delivered to Recipient in correspondence accompanying the reporting
package.This information shall be directed to: St.Johns River Water Management District, Finance
Director,Office of Financial Services,4049 Reid Street. Palatka, FL 32177.A copy of the report
shall also be provided to the Auditor General's Office at the following address:State of Florida
Auditor General.Room 401,Claude Pepper Building, Ill West Madison Street,Tallahassee. Florida
32399-1450.
(g) Monitoring. In addition to reviews of audits conducted in accordance with §215.97, Fla. Stat.,as
revised,monitoring procedures may include.but not be limited to.on-site visits by District staff,
limited scope audits,and/or other procedures. Recipient agrees to comply and cooperate with any
monitoring procedures/processes deemed appropriate by the District.In the event the District
determines that a limited scope audit of Recipient is appropriate, Recipient agrees to comply with
any additional instructions provided by the District to Recipient regarding such audit.Recipient
agrees to comply and cooperate with any inspections,reviews, investigations.or audits deemed
necessary by the District's Inspector General or the state Chief Financial Officer or Auditor General.
(h) Examination of Records. In addition to the District's audit rights otherwise provided for herein,
Recipient shall permit the District or its designated agent,the state awarding agency.the Department
of Financial Services,the state's Chief Financial Officer and the state's Auditor General to examine
Recipient's financial and non-financial records to the extent necessary to monitor Recipient's use of
state financial assistance and to determine whether timely and appropriate corrective actions have
been taken with respect to audit findings and recommendations,which may include onsite visits and
limited scope audits.
(i) Records Retention. Notwithstanding any other provision of this Agreement to the contrary.
Recipient shall retain sufficient records demonstrating its compliance with the terms of this
Agreement for a period of five years from the date the audit report is issued,and shall allow the
District,or its designee,state Chief Financial Officer,or Auditor General access to such records
upon request. Recipient shall ensure that audit working papers are made available for such access for
a period of three years from the date the audit report is issued. unless extended in writing by the
District.
20. GOVERNING LAW,VENUE,ATTORNEY'S FEES,WAIVER OF RIGHT TO JURY TRIAL.
This Agreement shall be construed according to the laws of Florida and shall not be construed more
strictly against one party than against the other because it may have been drafted by one of the parties.
As used herein,`'shall"is always mandatory. In the event of any legal proceedings arising from or related
to this Agreement: (1)venue for any state or federal legal proceedings shall be in Orange County;
(2)each party shall bear its own attorney's fees,including appeals;(3)for civil proceedings,the parties
hereby consent to trial by the court and waive the right to jury trial.
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Contract#35349
21. INDEPENDENT CONTRACTORS. The parties to this Agreement,their employees and agents,are
independent contractors and not employees or agents of each other.Nothing in this Agreement shall be
interpreted to establish any relationship other than that of independent contractors during and after the
term of this Agreement. Recipient is not a contractor of the District.The District is providing cost-share
funding as a cooperating governmental entity to assist Recipient in accomplishing the Project.Recipient
is solely responsible for accomplishing the Project and directs the means and methods by which the
Project is accomplished. Recipient is solely responsible for compliance with all labor,health care.and
tax laws pertaining to Recipient,its officers,agents, and employees.
22. CONFLICTING INTEREST IN RECIPIENT. Recipient certifies that no officer,agent.or employee
of the District has any material interest,as defined in §112.312,Fla. Stat.,either directly or indirectly,in
the business of Recipient to be conducted hereby,and that no such person shall have any such interest at
any time during the term of this Agreement.
23. NON-LOBBYING. Pursuant to§216.347,Fla. Stat.,as amended,Recipient agrees that funds received
from the District under this Agreement shall not be used for the purpose of lobbying the Legislature or
any other state agency.
24. PERMITS.Recipient shall comply with all applicable federal,state and local laws and regulations in
implementing the Project and shall include this requirement in all subcontracts pertaining to the Project.
Recipient shall obtain any and all governmental permits necessary to implement the Project.Any activity
not properly permitted prior to implementation or completed without proper permits does not comply
with this Agreement and shall not be approved for cost-share funding.
25. PUBLIC ENTITY CRIME.A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid,proposal,or reply on a contract to
provide any goods or services to a public entity; may not submit a bid.proposal,or reply on a contract
with a public entity for the construction or repair of a public building or public work;may not submit
bids,proposals,or replies on leases of real property to a public entity;may not be awarded or perform
work as a contractor,supplier,subcontractor,or consultant under a contract with any public entity;and
may not transact business with any public entity in excess of the threshold amount provided in §287.017,
Fla. Stat.,for CATEGORY TWO($35,000)for a period of 36 months following the date of being placed
on the convicted vendor list.
26. PUBLIC RECORDS. Records of Recipient that are made or received in the course of performance of
the Project may be public records that are subject to the requirements of chapter 119, Fla.Stat. If
Recipient receives a public records request, Recipient shall promptly notify the District's Project
Manager. Each party reserves the right to cancel this Agreement for refusal by the other party to allow
public access to all documents,papers,letters.or other materials related hereto and subject to the
provisions of chapter 119,Fla. Stat.,as amended.
27. ROYALTIES AND PATENTS. Recipient certifies that the Project does not,to the best of its
information and belief, infringe on any patent rights. Recipient shall pay all royalties and patent and
license fees necessary for performance of the Project and shall defend all suits or claims for infringement
of any patent rights and save and hold the District harmless from loss to the extent allowed by Florida
law.
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Contract#35349
IN WITNESS WHEREOF,the St.Johns River Water Management District has caused this
Agreement to be executed on the day and year written below in its name by its Executive Director,or duly
authorized designee,and Recipient has caused this Agreement to be executed on the day and year written below
in its name by its duly authorized representatives,and,if appropriate,has caused the seal of the corporation to
be attached.This Agreement may be executed in separate counterparts,which shall not affect its validity.
Upon execution,this Agreement constitutes the entire agreement of the parties,notwithstanding any
stipulations,representations,agreements,or promises,oral or otherwise, not printed or inserted herein.This
Agreement cannot be changed by any means other than written amendments referencing this Agreement and
signed by all parties.
ST.JOHNS RIVER WATER CITY OF OCOEE,a Florida municipal corporation
MANAGEMENT DISTRICT
aft W6J4- -
By: By: —
Ann B.Shortelle,Ph.D.,Executive Director(or designee) Rusty Johnson,May
Date: 2/13/20 Date: S rl,,d,rN -1 .�6,0
'------)1
Attest: \], �AMbL
Melanie Sibbitt,City Clerk
FOR USE AND RELIANCE ONLY BY
THE CITY OF OCOEE,FLORIDA;
APPROVED AS TO FORM AND LEGALITY
thiIday of ,2020.
SI IUFFIELD.LOWMAN& ILSON
By: `-- _
City A , 1+��—
Attachments:
Attachment A—Statement of Work
Attachment B—Project Progress Report Form
Attachment C—District Supplemental Instructions Form
Attachment D—Contract Payment Requirements for State-Funded Cost Reimbursement Contracts
Attachment E—Insurance Requirements
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Contract#35349
ATTACHMENT A-STATEMENT OF WORK
THE HAMMOCKS RECLAIMED WATER RETROFIT PROJECT
I. INTRODUCTION/BACKGROUND
The St.Johns River Water Management District(District)Cooperative Cost Share Initiative Program strives
to develop and implement resource and water supply development projects and promote conservation.On
April 10,2018,the District's Governing Board approved funding for Cooperative Cost Share projects. Each
project selected for funding will have a positive benefit to one or more of the District's core missions;
including water supply,water quality, natural systems or flood mitigation.
The City of Ocoee(Recipient)requested funding for The Hammocks Reclaimed Water Retrofit project for
the not to exceed amount of$131.238.towards the estimated construction cost of$397.692.This request was
approved by the Governing Board.The Florida Department of Environmental Protection(FDEP)is
providing funding in the not-to-exceed amount of$131.238.The Recipient is located in Orange County.
II. OBJECTIVES
The objective of this contract is to provide cost share dollars that will enable the Recipient to extend
reclaimed water capacity to The Hammocks neighborhood by retrofitting the neighborhood with reclaimed
water mains for irrigation and non-domestic uses instead of potable(ground)water.
III. SCOPE OF WORK
The project will include the extension of the reclaimed water lines to The Hammocks,an existing 125-home
neighborhood,to replace the current use of potable water for irrigation and non-domestic with reclaimed
water.
IV. PROJECT ADMINISTRATION AND DELIVERABLES
The Recipient shall be responsible for the following:
• Complete and obtain final project design,construction plans,and specifications;
• Obtain all required permits, including right of access to the project sites, related to project
construction and subsequent operation and maintenance of the completed work;
• Assure compliance with all permits and permit conditions;
• Provide procurement for project construction;
• Perform supervision and inspection of construction;
• Perform construction contract administration;
• Assure compliance with cost accounting practices and procedures required for reimbursement of cost
share funds expended.
The Recipient shall provide the following to the District's Project Manager:
• Timely invoices for actual construction costs in accordance with this cost share agreement(i.e.
quarterly,with appropriate substantiation that demonstrates that the applicant has paid for the total
work cost and is seeking reimbursement up to the match amount)to enable proper review by the
District's Project Manager prior to payment authorization. Deliverables to be submitted with
invoices include(as applicable):
o Interim progress status summaries including inspections,meeting minutes and field notes
and dated color photographs of the construction completed to include on-going work that
represents the time-period being invoiced;
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Contract#35349
o Final invoice submittals for completed construction including inspections and dated color
photographs of the construction site prior to,during and immediately following completion
of the construction task.
o Construction plans,specifications, and contract documents for the site work must be made
available upon request;
o Written verification that the record drawings and any required final inspection reports for the
project are received.
• Quarterly progress reports identifying project progress to date, key milestones reached,overall
project schedule versus time for project completion,an updated spend-down plan,key issues to be
resolved, project construction photos. Quarterly reports shall also be emailed to the District's
Budget Analyst at hnbarber@sjrwmd.com.
• Certification of construction completion by a Professional Engineer registered in the state of Florida.
The Recipient shall ensure the task in the Task Identification section below is completed.
V. TASK IDENTIFICATION AND TIME FRAMES
The expiration date of this cost share agreement is December 30. 2020. The projected schedule is as follows:
Anticipated Anticipated
Task Description Start Date Completion Date
Construction of The Hammocks Reclaimed Water Retrofit 4/1/20 12/30/20
VI. BUDGET/COST SCHEDULE
For satisfactory completion of the Project,the District shall pay Recipient 33%of the total construction cost
of the Project,but in no event shall the District's cost-share exceed$131,238. It is anticipated that the FY
breakdown will be$87,709 for FY I9-20 and$43,529 for FY20-21.
Recipient shall invoice the District quarterly with appropriate documentation.The District's Project Manager
shall provide an invoice template that will be used. Invoices shall include a copy of the contractor's invoices
submitted to the Recipient,proof of payment by Recipient,and other required supporting documentation for
reimbursement up to match amount. For in-house expenses, Recipient shall provide copies of all receipts for
materials and a system report showing documentation of staff time or other proof of staff time expenses for
the Project.The final invoice shall be submitted with the final project report. If the total actual cost of this
project is less than originally estimated,the District's cost-share amount shall be reduced accordingly.
Recipient may invoice more frequently submitting all required documentation and include general status
information. Recipient may invoice the District for Project construction work beginning January 1,2020.
The District will not reimburse for any expenses prior to January 1.2020.
Recipient shall submit quarterly progress reports to the District's Project Manager and the District's Budget
Analyst within 15 days of the end of quarter for work accomplished during each quarter.The email address
for the District's Budget Analyst is hnbarber@sjrwmd.com.The Recipient shall submit a final project report
within 15 days of Final Completion and acceptance by City of Ocoee detailing the Project's
accomplishments and any issues resolved during the course of the work.
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Contract#35349
Estimated Cost Schedule for Reimbursement per fiscal year(all dollar amounts are approximate and may be
reallocated between the construction task for the two FYs).
FY 19-20(10/1/2019—9/30/2020)
Estimated
Estimated Reimbursement
Description Task Amount Amount
Construction of The Hammocks Reclaimed Water Retrofit $265,785 $87,709
FY20-21 (10/1/2020—9/30/2021)
Estimated
Estimated Task Reimbursement
Description Amount Amount
Construction of The Hammocks Reclaimed Water Retrofit $131,907 $43,529
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Contract#35349
ATTACHMENT B
PROJECT PROGRESS REPORT
St.Johns River Water Management District Date:
Project Progress Report
Report Number:
Contract/Project Identification
Project Name: The Hammocks Reclaimed Water Retrofit Project
Recipient: City of Ocoee
SJRWMD Contract Number: 35349 SJRWMD Project Manager: Charles K.Smith,P.E.
Recipient's Project Manager: Mark E.Brandenburg,MS,CSE,PWS
Construction Schedule Reporting Period
Construction Start Date: Beginning Date:
Construction Completion Date: Ending Date:
Contract Expiration Date:
Cost-Share Budget
Total Cost-Share Budget: Cost-Share Amount Expended This Period:
Cost-Share Amount Expended To-date: Percent Cost-Share Budget Expended:
Spend-Down Plan
Fiscal Year 1 Fiscal Year 2
Reimbursement# Anticipated Amount Anticipated Date Reimbursement# Anticipated Amount Anticipated Date
1 1
2 2
3 3
4 4
Project Readiness and Schedule Tracking
%Complete Start Date Completion Current
shown In %Complete Shown In Date Shown in Current Start Completion
Project Phase Application Currently Application Application Date Date Notes:Explain anticipated deviations from schedule
Planning
Design
Permitting
Bidding&Award
SOW Construction Tasks/Milestones/Deliverables
Total
Construction Start Date Shown Completion Date Current Completion
Task Number Tasks/Milestones/Deliverables %Complete inSOW Shown in SOW Current Start Date Date
1
Project update including problems,Issues and solutions. Explain in detail.
Include digital photographs of work accomplished during reporting peroid. Attach an additional page of notes if necessary to explain reasons for lateness or
unusual events or circumstances.
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Contract#35349
ATTACHMENT C—DISTRICT'S SUPPLEMENTAL INSTRUCTIONS(sample)
DISTRICT SUPPLEMENTAL INSTRUCTIONS#
DATE:
TO: Charles K.Smith.P.E.• Project Manager
City of Ocoee
1800 A D Mims Road
Ocoee,FL 34761
FROM: Mark E. Brandenburg, MS,CSE. PWS.Project Manager
CONTRACT NUMBER: 35349
CONTRACT TITLE: The Hammocks Reclaimed Water Retrofit ' oject
,„,,, ,
The Work shall be carried out in accordance with the following supple ,- •tal instruc '•• ued in accordance
with the Contract Documents without change in the Contract Sum or Co ct Time ` . • proceeding in
accordance with these instructions,indicate your acceptance of these instr ••ns fo i . ..justments to the
work as consistent with the Contract Documents and return to the District's ' ' ect •-
I. RECIPIENT'S SUPPLEMENTAL INSTRUCTIONS:
2. DESCRIPTION OF WORK TO BE CHANG
3. DESCRIPTION OF SUPPLEMENT' L, t+ , ON ' •UIR‘ EN .
Recipient's a , , house o ,.ei e, i�
Approved: IN ate:
(It is agreed that th- - • tions s . I not - ,It in . \an11'n the Total C. '): sation or the Completion
Date.)
Approved: Date:
NI
(Recipient agrees to imp - •ent the pplemental Instructions as requested.but reserves the right to seek a
Change Order in accordan - - •. requirements of the Agreement.)
Approved: Date:
Mark E. Brandenburg, MS.CSE, PWS,District Project Manager
Acknowledged: Date:
Carol Taylor Miller,District Senior Procurement Specialist
c: Contract file
Financial Services
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Contract#35349
ATTACHMENT D—CONTRACT PAYMENT REQUIREMENTS
FOR STATE-FUNDED COST REIMBURSEMENT CONTRACTS
Invoices for state-funded cost reimbursement contracts must be supported by an itemized listing of
expenditures by category(salary,travel,expenses.etc.). Supporting documentation must be provided for
each amount for which reimbursement is being claimed,indicating that the item has been paid.Check
numbers may be provided in lieu of copies of actual checks.Each piece of documentation shall clearly reflect
the dates of service.Only expenditures for categories in the approved contract budget will be reimbursed.
Listed below are examples of the types of documentation representing the minimum requirements by cost
category:
Salaries: Submit a payroll register or similar documentation showing gross salary charges,fringe benefits,
other deductions,and net pay. If an individual is paid by the hour.a document reflecting the hours worked
times the rate of pay is acceptable.
Fringe Benefits:Fringe benefits should be supported by invoices showing the amount paid on behalf of the
employee(e.g.,insurance premiums paid). If the contract specifically states that fringe benefits will be based
on a specified percentage.rather than the actual cost of fringe benefits,then the calculation for the fringe
benefits amount must be shown.
Exception: Governmental entities are not required to provide check numbers or copies of checks for fringe
benefits.
Travel:Reimbursement for travel must be in accordance with §112.061, Fla.Stat.,which includes
submission of the claim on the approved State of Florida (State)or District travel voucher.
Other direct costs: Reimbursement is based upon paid invoices/receipts. If nonexpendable property is
purchased using State funds, the contract should include a provision for the transfer of the property to the
State when services are terminated. Documentation must be provided to show compliance with Department
of Management Services Rule 60A-1.017, F.A.C., regarding the requirements for contracts which include
services and that provide for the contractor to purchase tangible personal property as defined in§273.02.Fla.
Stat.,for subsequent transfer to the State.
In-house charges:Charges which may be of an internal nature (e.g., postage, copies, etc.) may be
reimbursed on a usage log which shows the units, times the rate being charged. The rates must be
reasonable.
Indirect costs: If the contract specifies that indirect costs will be paid based on a specified rate, then the
calculation should be shown.
The"Reference Guide for State Expenditures"prepared by the Florida Department of Financial Services can
be found at this web address: http:/www.fldfs.com/aadir/reference,guide.htm
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Contract#35349
ATTACHMENT E-INSURANCE REQUIREMENTS
Including Florida Department of Environmental Protection Insurance Requirements
Recipient shall acquire and maintain,and ensure that any sub-recipients,contractors,and subcontractors.
similarly acquire and maintain, until completion of the Work the insurance coverage listed below,which
constitutes primary coverage. Recipient shall not commence the Work until the District receives and
approves Certificates of Insurance documenting required coverage. Recipient's General Liability policy
shall include Endorsement CG 20101185,or equivalent,naming the St.Johns River Water Management
District("District")as Additional Insured. All required policies shall include:(1)endorsement that waives
any right of subrogation against the District for any policy of insurance provided under this requirement or
under any state or federal worker's compensation or employer's liability act;(2)endorsement to give the
District no less than thirty(30)days written notice(with the exception of non-payment of premium which
requires a 10-calendar-day notice)in the event of cancellation or material change. Certificates of Insurance
must be accompanied by copies of the requested endorsements. In addition,Recipient's General Liability
insurance and Automobile Liability insurance shall include the State of Florida,the Florida Department of
Environmental Protection,and the State of Florida Board of Trustees of the Internal Improvement Trust
Fund,as Additional Insureds for the entire length of the Agreement. If the Recipient is self-funded for any
category of insurance,then the Recipient shall provide documentation that warrants and represents that it is
self-funded for said insurance,appropriate and allowable under Florida law,and that such self-insurance
offers protection applicable to the Recipient's officers,employees,servants and agents while acting within
the scope of their employment with the Recipient for the entire length of the Agreement.
Any deductibles or self-insured retentions above$100,000 must be declared to and approved by the District.
Approval will not be unreasonably withheld. Recipient is responsible for any deductible or self-insured
retention. All insurance policies shall be with insurers licensed or eligible to do business in the State of
Florida and having an A.M. Best rating of A-V or greater. If any work proceeds over or adjacent to water.
the Recipient shall secure and maintain,as applicable,any other type of required insurance,including but not
limited to,Jones Act,Longshoreman's and Harbormaster's,or the inclusion of any applicable rider to
worker's compensation insurance,and any necessary watercraft insurance,with limits not less than$300,000
each. District receipt of insurance certificates providing less than the required coverage does not waive these
insurance requirements.
(a) Workers' Compensation Insurance. Workers' compensation and employer's liability coverage,
including maritime workers compensation,if applicable.in not less than the minimum limits required by
Florida law. If Recipient claims an exemption from workers' compensation coverage, Recipient must
provide a copy of the Certificate of Exemption from the Florida Division of Workers' Compensation for
all officers or members of an LLC claiming exemption who will be participating in the Work. In
addition,Recipient must provide a completed District"Affidavit(Non-Construction)"for non-
construction contracts. Recipient is solely responsible for compliance with any Federal workers'
compensation laws such as Jones Act and USL&H Act, including any benefits available to any workers
performing work on this project. In case any class of employees engaged in hazardous work under this
Agreement is not protected under Worker's Compensation statutes,the Recipient shall provide,and
cause each sub-recipient,contractor,or subcontractor,to provide,adequate insurance satisfactory to the
District and the Florida Department of Environmental Protection,for the protection of its employees not
otherwise protected.
(b) General Liability.Commercial General Liability Insurance on an"Occurrence Basis,"with limits of
liability not less than$1,000,000/$2,000,000,for personal injury,bodily injury.and property damage.
Coverage shall include:(I)contractual liability,(2)products and completed operations.(3)independent
contractors,and(4)property in the care,control,or custody of the Recipient. Extensions shall be added
or exclusions deleted to provide the necessary coverage.
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Contract#35349
(c) Automobile Liability.Minimum limits of liability shall be as follows:
$300,000 Automobile Liability Combined Single Limit for Company-Owned Vehicles,if applicable
$300.000 Hired and Non-owned Automobile Liability Coverage
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Contract#35349
Amendment#1
AMENDMENT 1 TO THE COST SHARE AGREEMENT BETWEEN
THE ST.JOHNS RIVER WATER MANAGEMENT DISTRICT
AND CITY OF OCOEE
FOR THE HAMMOCKS RECLAIMED WATER RETROFIT PROJECT
THIS AMENDMENT is entered into by and between the GOVERNING BOARD of the ST.JOHNS
RIVER WATER MANAGEMENT DISTRICT(the"District"),whose mailing address is 4049 Reid Street,
Palatka,Florida 32177-2571,and CITY OF OCOEE("Recipient")whose address is 150 North Lakeshore
Drive,Ocoee,Florida 34761,and is effective on the date the last party has executed same.
PREMISES:
The parties entered into Agreement No. 35349 on February 13,2020 to provide funding for the Recipient's
The Hammocks Reclaimed Water Retrofit Project("Agreement").The parties desire to amend the
Agreement.
NOW,THEREFORE,in consideration of the above premises,which are hereby made a part of this
amendment,the mutual covenants contained herein,and other good and valuable consideration,the parties
hereby agree to amend the Agreement as follows:
1. Paragraph 1(a)TERM;WITHDRAWAL OF OFFER: delete this paragraph and replace it with the
following paragraph:
(a) The term of this Agreement is from February 13,2020("Effective Date")through April 30,2021
("Completion Date"). Time is of the essence for every aspect of this Agreement,including any time
extensions.Any request for an extension of time beyond the Completion Date must be made in
writing before February 1,2021. For projects whose District contribution exceeds$100,000,timely
requests to extend the Completion Date more than six months beyond the original Completion date,
December 30,2020,may only be approved by the District's Governing Board. Notwithstanding
specific mention that certain provisions survive termination or expiration of this Agreement,all
provisions of this Agreement that by their nature extend beyond the Completion Date survive
termination or expiration hereof(e.g.,delivery of a final report,will remain in full force and effect
after the Completion Date as necessary to effect performance).
2. All other terms and conditions of the Agreement,including any subsequent amendments,are hereby
ratified and continue in full force and effect.
IN WITNESS WHEREOF,the parties hereto have duly executed this amendment on the date set forth
below.
ST.JOHNS RIVER WATER CITY OF OCOEE,a Florida municipal corporation
MANAGEMENT DISTRICT
By: By:
Louis J. Donnangelo,Bureau Chief
Bureau of Project Management,or designee
Typed Name and Title
Date: Date:
Attest:
Typed Name and Title
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