Backup Documents 09/09/2014 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCMPANY ALL ORIGINAL DOCUMENTS SENT THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR GNATU D 5
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 be 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. Jennifer Belpedio County Attorney Office �( q I lid-
4. BCC Office Board of County
Commissioners y/// ck,VZ`\A
5. Minutes and Records Clerk of Court's Office -TM 11112 [14 (2:
,PM
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 Natali Betan ur \'c - °t''-� Phone Number 239-252-40
Contact/ Department
Agenda Date Item was 09/09/14 Agenda Item Number 16D
Approved by the BCC
Type of Document Report/Invoice Number of Original 1
Attached Documents Attached
PO number or account
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) pplicable)
1. Does the document require the chairman's original signature? NB
2. Does the document need to be sent to another agency for additional signatures? If yes, NB 1
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 NB
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 NIA cx=A'�
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 NB V
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 NB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NB
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 07/08/14 and all changes made during NB
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for • &
Chairman's signature.
N4pleaS k l�J�ek
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26. 5,Revised 2.24.05;Revised 11/30/12
1605
MEMORANDUM
Date: September 16, 2014
To: Natali Betancur, Operations Analyst
Park & Recreation Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Sovereignty Submerged Lands Lease Fees Annual Wetslip
Report and invoice information necessary to submit payment
to the Florida Department of Environmental Protection
Attached for submission to FDEP are the original documents referenced above,
(Item #16D5) approved by the Board of County Commissioners September 9, 2014.
The Board's Minutes and Records Department has maintained a copy of the report and
invoice information for the Board's Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachment
1 605
400001ECTION
VISNIMISIMIERSIM
SOVEREIGNTY SUBMERGED LANDS LEASE
ANNUAL WETSLIP REVENUE REPORT
As a submerged lands lessee,you are required to report annually to the Division of State Lands all income derived
directly or indirectly from the lease area,to report the number and type of wet slips and to certify that all information
provided is correct. This includes reporting any income collected by you or someone else. The three attached forms
must be completed and returned by all lessees.
Directions for completing forms
WET SLIP INFORMATION FORM-This form is for reporting the number and type of wet slips. Please enter the correct
number of each type of wet slip at the lease facility and total.
GROSS INCOME REPORTING FORM-This form is for reporting direct and indirect income that has been generated within
the lease boundary during the timeframe specified. This is required under the terms of your lease and under subsection
18-21.011(1)(a)2. Florida Administrative Code. Please enter the amount of both direct and indirect income generated by
month within the lease boundary. The definition of income can be found at the bottom of the form.
CERTIFICATION FORM-This form is the lessee's confirmation that all information provided is true and correct. This form
must be notarized.
General Lease Fee Information
Income is defined in Rule 18-21.003, Florida Administrative Code,as the gross revenue derived directly or indirectly from
the use of state-owned submerged lands such as slip rental, lease or sublease fees,dock or pier admission fees,
club membership,stock ownership or equity interest in activities where increased revenue is attributable to the
use of the submerged land. However,gross revenue shall not include pass-through fees for utility services,sale of the
facility or sales of products not occurring on sovereignty submerged lands. Gross revenue shall include all future
payments made for the transfer of the interest in a slip originally obtained from the Board's lessee,including transfer of
slip rights by slip sublessee,slip"sellers",slip interest transfers, new club memberships,and other similar transactions.
If you are required to pay 6%of the income generated on the lease area,you will receive a supplemental invoice which
will include State and County Tax on any additional fees owed. To view Chapter 18-21 Florida Administrative Code,on
Sovereignty Submerged Lands Management in its entirety go to:
http://www.flrules.org/gateway/ChapterHome.asp?Chapter=l8-21
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF STATE LANDS
3900 COMMONWEALTH BOULEVARD, MS 100
TALLAHASSEE, FLORIDA 32399-3000
(850)245-2555
CI)
1 605
2013/2014 Wetslip Information Form
Lessee:(10((ler(1,nUn-i T Instrument No: ( I o 314 .3 n6
I. INFORMATION ON WETSLIPS LOCATED ON STATE-OWNED LANDS
1. Number of Temporary Slips -Slips that are not rented and are used as
fuel docking, launching or removing boats, restaurants, or store purchases.
These slips should be Non revenue generating slips. Q
2. Number of Transient Slips-Slips that are rented on a short term basis.
3. Number of Public Slips -open to the public on a "first come,first
served" basis. - Rental term shall be no longer than one year and with no
automatic renewal rights or conditions.
4. Number of Slips Not Usable-Slips that are silted in or are in low water.
0
5. Number of Slips Sold, Subleased, Licensed,Assigned, etc. -Attach a
copy of the document which represents the sale, sublease, license or
assignment. The document should include the sublessee's name, unit
number, the slip number, and the amount of the transaction.
6. Number of Private Slips, not rented to the public-Slips used for
personal mooring, Association common area, etc. d
Total Number of Slips on State-Owned Lands,Add lines 1 through 6 i
Is your facility a Pier with Admission Fees? YES NO
Circle One
Boating has a tremendous economic impact on the State of Florida each year. In an effort to learn if boaters
have an adequate number of slips around the state, we are requesting information on wetslips that are not
within a state-owned submerged land lease. No income generated from these slips is to be reported.
II. INFORMATION ON WETSLIPS LOCATED ON PRIVATELY-OWNED LAND
1. Number of Slips Sold, Subleased, Licensed,Assigned,etc: d
2. Number of Public Slips-open to the public on a "first come,first
served" basis. O
3. Number of Private Slips, not rented to the public- Slips used for
personal mooring, Association common area, etc.
Total Number of Slips on Privately-Owned Lands,Add lines 1 through 3 t/
(1)
1 60 5
2013/2014 GROSS INCOME REPORTING FORM
Lessee: to((e'er ceu n-1--if Instrument #: 110,343 885
Direct Income Indirect Income
All income received directly by Lessee from All income received by someone
transactions within the lease boundary. * other than the Lessee for
transactions involving the use of
state-owned submerged land
June 2013 $ 3(0'14., 2 $ 5r745,&S
July 2013 S I S1 ► CS $ 414 L1Ur 1
August 2013 $ 2:3541 $ L'9'1 , 5-7
September 2013 $ I52.. 7 $ 3(o(0(o,zi-I-
October 2013 $ VI11li $ 1 of 24v40.6-7
November 2013 $ 359.405 $ 9i cD S J► LtS
December 2013 $ 715r 424 $ h (,( S. 3f
January 2014 $ 382, (11 $ 1, I 41. 43 b
February 2014 $ 3 Si. 0 $ gi t oq.
March 2014 S 21-11. q48 $ 5 i, 4f 39. V1
April 2014 $ 2-1-110 (0 9 $ G1 9L4 1'
May 2014 $ h25. 11:77 $ [Of Z1, 5. 13
TOTALS $ 'r/ en I .14 $ 0" j 40011 9
Every month must be filled out even if income for the month is zero.
"Enter Zero if slips are non-revenue generating or generated$0.00"
*Income is defined in chapter 18-21.003,Florida Administrative Code,as the gross revenue derived directly or
indirectly from the use of state-owned submerged lands such as slip rental,lease or sublease fees,dock or pier
admission fees,club membership,stock ownership or equity interest in activities where increased revenue is
attributable to the use of the submerged land.However,gross revenue shall not include pass-through fees such as
fees for utility services,sale of the facility or sales of products not occurring on sovereignty submerged lands. Gross
revenue shall include all future payments made for the transfer of the interest in a slip originally obtained from the
Board's lessee,including transfer of slip rights by slip sublessee's,slip"sellers",slip interest transfers,new club
PLEASE ATTACH LIST OF ANY SLIP TRANSFERS AS DEFINED ABOVE INCLUDING THE SLIP NUMBER,
AMOUNT OF INCOME RECEIVED,SUBLESSEE'S NAME AND UNIT NUMBER, IF APPLICABLE.
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF STATE LANDS
3900 COMMONWEALTH BOULEVARD, MS#100
TALLAHASSEE, FLORIDA 32399-3000
(850)245-2555
G
1 6D5
CERTIFICATION
Instrument No. I I 0 3S S 5
Lessee Name: �)C I ter C eun-k .norcdcr
Billing Address 1 6000 L{ (/I h .S t yr l 1.o ad
City/State/Zip N(,T1,r,J- 'FL. 34109
Telephone: (Z39 ) z52- 4-000
(Please provide area code)
Facility Address: 13S S l Van b• 14' Da Ve
City/County/Zip: Nlc It -a ,
I, being first duly sworn, hereby certify under penalty of perjury that the following statements are true:
(1)To the best of my knowledge and belief,the information contained on the Wetslip Information Form
and the Gross Income Reporting Form is true and correct; (2) 1 have read and understand the terms and
conditions of the sovereignty submerged lands lease, and the facility is in full compliance with all the
terms and conditions of the sovereign submer.ed lands lease; (3) I am authorized to execute this
certification on behalf of the lessee; a (4) 1 a,/:ware that any intentional false statement herein will
be grounds for cancellation of the s reign f bmerged lands lease.
r All& •
Signature o .see
Printed Name o Signature
C A +is c�
Title
ot 1114--
Date
STATE OF Aos.,-
COUNTY OF Cc\Ve)v--
Sworn to or affirmed and subscribed before me the \Z-k'h day or- )rn-t e5,20\,1-\
by -7oY'
Personally Known 1r�
uK
rroaucea taentmcatton — - - �s.€AP)_ "
,•N"Y O++I VIRt31NJAA.NEST
Type of identificaiton prod ed '— ':°` Notary Public-State of Florida
•illt` •:My Comm.Expires Jun 23,2017
Notary Signature ✓ E:.-' Commission# FF 11938
` J— .4di t�i•`' Bonded Through National Notary Assn.
Commission Expires _ 2_3�\"\ _ —' — _, " — T
ATTEST..
Approved as to form and legality DWIQHT E. iROCK, dirk
Assistant County�y 4A-A\ ' LS as-r ' '+'
Page 1 of 1
: ECEDvE
1605
DEPARTMENT OF ENVIRONMENTAL PROTECTI,1 AUG 0 1 2014 W.to
RECEIPTS SECTION s . ,
POST OFFICE BOX 3070
TALLAHASSEE, FL 32315-3070 Parks Recreation '�
Bill To: -- - '
COLLIER COUNTY FLORIDA
15000 LIVINGSTON ROAD INVOICE
NAPLES, FL 34109
** INVOICE / INSTRUMENT INFORMATION **
Invoice#: 79177 Instrument#: 110343885
Invoice Date: 07/15/2014 Expiration Date: 06/25/2015
Due Date: 08/14/2014 Extended Term Fee: NO
Rate: BASE RATE
Location: COCOHATCHEE RIVER PARK
** IMPORTANT REMINDERS **
If paying by mail, please return invoice with your payment to the above address.
Online payment by check, credit card or debit card is available at
http://www.fldepportal.com/go/pay-invoices/.
Late payments are subject to a 12% Interest fee pursuant to FAC 18-21.011(1)(b)11.
INFORMATION ANNUAL LEASE FEE DATA
Net Extended
Description Memo Object Square Rate Discount Term Fee *Amount
Feet
REPORTED INCOME
2013/2014 WET SLIP $91,312.53 X 6%=
SUPPLEMENTAL $5,478.75 LESS 13/14 021017 22,577 0 N/A Y $1,796.96
BILLING BASE FEE OF$3,681.79
=AMOUNT DUE
Subtotal $1,796.96
Sales Tax(0.0%) $0.00
County Tax (0%) $0.00
Note:2013/2014 SUPPLEMENTAL(SW) Total $1,796.96
Invoice $1,796.96
Balance Due
rzstrument/Lease $5,592.91
Balance Due
ANNUAL LEASE FEE FORMULA = BASE FEE* - DISCOUNT + EXTENDED TERM FEE
*BASE FEE= Base Rate x Net Square Feet OR
*BASE FEE=Minimum Rate
DISCOUNT= Base Fee x Discount Percentage
EXTENDED TERM FEE= Base Fee x Extended Term Fee Percentage
For any questions concerning this invoice,please call the Division of State Lands at(850) 245-2555.
7/30/2014
Page 1 of 1
1 605
DEPARTMENT OF ENVIRONMENTAL PROTECTION *yiOTE y
RECEIPTS SECTION
POST OFFICE BOX 3070
TALLAHASSEE, FL 32315-3070 1 "
-'->,r
Bill To:
COLLIER COUNTY FLORIDA
15000 LIVINGSTON ROAD STATEMENT
NAPLES, FL 34109
** STATEMENT/ INSTRUMENT INFORMATION **
Statement Date: 9/2/2014
Instrument#: 110343885 Expiration Date: 06/25/2015
Location: COCOHATCHEE RIVER PARK
** IMPORTANT REMINDER **
Late payments are subject to a 12% Interest fee pursuant to FAC 18-21.011(1)(b)11.
ACCOUNT ACTIVITY TO FIGURE INTEREST
Account Transaction &Balance Information Principal Information
Date Transaction Description Amount Balance Invoice# Late Balance
08/03/2009 INV#46613-ARREARS $29,290.49 $29,290.49 -- -- --
08/03/2009 INV#46613-ARREARS $13,953.68 $43,244.17 -- -- --
11/30/2009 PMT#984436 ($13,953.68) $29,290.49 -- -- --
11/30/2009 PMT#984436 ($29,290.49) $0.00 -- -- --
08/03/2009 INV#46615-SUBMERGED LAND $555.00 $555.00
PROCESSING FEE
11/30/2009 PMT#984437 ($555.00) $0.00 -- -- --
04/15/2011 INV#56868-ARREARS $5,781.00 $5,781.00 -- -- --
04/15/2011 INV#5636_,8.25'- INITIAL SURCHARGE $865.16 $6,646.16 -- -- --
04/12/2011 PMT#1076562 ($865.16) $5,781.00 -- -- --
04/12/2011 PMT#1076561 ($5,781.00) $0.00 -- -- --
05/31/2011 INV#58515-ANNUAL LEASE FEE 2011/2012 $3,536.08 $3,536.08 -- -- --
06/29/2011 PMT#1097970 ($3,5 ?8) $0.00 -- -- --
05/31/2012 INV#63638-ANNUAL LEASE FEE 2012/2013 $3,616.70 $3,616.70 -- -- --
06/25/2012 PMT#1159682 ($3,616.70) $0.00 -- -- --
06/30/2013 INV#70595-ANNUAL LEASE FEE 2013/2014 $3,681.79 $3,681.79 -- -- --
10/01/2013 PMT#1246531 ($3,681.79) $0.00 -- -- --
05/30/2014 INV#77362-ANNUAL LEASE FEE 2014/2015 $3,758.37 $3,758.37 -- -- --
07/15/2014 INV#79177-2013/2014 WET SLIP $1,796.96 $5,555.33
SUPPLEMENTAL BILLING
07/30/2014 INV#79380 12% INTEREST ON PAST DUE $37.58 $5,592.91 #71 132 30 days $3,758.37
SUBMERGED LAND INVOICE
AMOUNT DUE $5,592.91
For any questions concerning this Statement, please call(850) 245-2720,
9/2/2014