Backup Documents 09/09/2014 Item #16C2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must he received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 Through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office SRT by 9/17/14
4. BCC Office Board of County
Commissioners \AS/5/ %-z \4
5. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Oscar P.Martinez, Senior Project Manager, Phone Number 252-6214
Contact/ Department Public Uti ' ies
Agenda Date Item was 9/9/14 Agenda Item Number 16-C-2
Approved by the BCC
Type of Document Certification of Financial Responsibility Number of Original Two
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST •
Initial the Yes column or mark"N/A" in the Not Applicable column, whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? SRT
2. Does the document need to be sent to another agency for additional signatures? If yes, SRT
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be SRT h �
signed by the Chairman, with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's SRT
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the SRT
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's SRT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SRT
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/9/14 and all changes made during the SRT t i
meeting have been incorporated in the attached document. The County Attorney's t ail tot
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version a roved by the SNT
BCC, all changes directed by the BCC have been made, and the docu nt is ready for the ek7st
Chairman's signature
PLEASE INTEROFFICE ONE ORIGINAL TO OSCAR (ABO " • : ■ "I 'WARD IT TO THE
CONSULTANT
I'Fnrmc/Cniintv Fnrmc/RCC Forms/Original f)neuments Routine Slin WINS Original 9 01 04 Revised 1 2fi OS Revised 2 24 05.Revised 11/30/12
16C2
MEMORANDUM
Date: September 23, 2014
To: Oscar Martinez, Senior Project Manager
Public Utilities Engineering
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Certification of Financial Responsibility
Attached please find one (1) original of the document referenced above,
(Agenda Item #16C2) approved by the Collier County Board of County
Commissioners on Tuesday, September 9, 2014.
The Minutes and Records Department has retained the second original
document to be kept in the Board's Official Records.
If you have any questions, please call me at 252-8411.
Thank you.
16C2
CERTIFICATION OF FINANCIAL RESPONSIBILITY
The Collier County Board of County Commissioners
, a unit of local
government of the State of Florida, hereby certifies that it has
unconditionally obligated itself to have the financial resources
necessary to close, plug, and abandon its Class I underground
injection well (s) and rei.ated monitoring wells, as required by Chapter
62-528, Florida Administrative Code. It is further understood that
the cost estimate to conduct plugging and abandonment, established on
May 07, 2014 , shall be reviewed on an annual basis and this
obligation shall incorporate accumulated inflation costs. An annual
adjustment exceeding 10 percent in any one year shall require
submission of an updated certification form.
List of Injection Wells Covered By This Agreement:
(for each injection well list the following information)
Facility Name: South County Water Reclamation Facility
5600 Warren St, Naples, FL 34113
Facility Address:
Facility Contact: Robert VonHolle
Phone Number: (239) 252-2246
Latitude/Longitude of Injection well: 26°05'42"N /81°43'22" W
DE-P/EPA Identification Number: FLS V22V8-34V-UO/IM
Current Plugging and Abandonment Cost Estimate: $545,814.00
It is hereb understood that the cancellation of this certification
may not ta • place w' hout the prior written consent of the Secretary
of the Flo da Dep. r ment of Environmental Protection.
Signature) —
Tom Hennin g V
(Print PIame)
Chairman, Collier County Board of County Commissioners
(Title)
September 9, 2014
(Date)
ATTEST- pprove. :2 to ■r'an• egality - _
DWIGHT E. BROC :CLERK G ; ,,r
B Scott R. Teach, Deputy County Attorney
Attest as to Chairman's •
signature only.