Backup Documents 04/26/2016 Item #16D12 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 1 2
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 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. County Attorney Office County Attorney Office SRT 4-26-16
4. BCC Office Board of County
Commissioners d yl AkV(,,
5. Minutes and Records Clerk of Court's Office
2)Att.ki1,6 .3:40P4
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 Michelle Arnold 239-252-5841
Contact/ Department
Agenda Date Item was April 26,2016 Agenda Item Number 16D12
Approved by the BCC
Type of Document Time Extension to Contract AQQ85 Joint Number of Original One
Attached Participation Agreement with FDOT 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 r <2j_, SRT
2. Does the document need to be sent to another agency for additional signatures? If yes, SRT � et
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed ‘ 11�
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 CJ at-16 and all changes made during SRT `.„
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 the
Chairman's signature. rce
•
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16012
County of Collier
CLERK OF THE CIRCU T COURT
COLLIER COUNTY CQURTHOUSE
3315 TAMIAMI'rRL E STE 102 Dwight E. Brock-CIer1 "pf Circuit Court
P.O. BOX413044
341
NAPLES, FL 34112-5324 NAPLES, FL 341011-3044
Clerk of Courts • Comptroller • Auditor • Custodian of County Funds
April 26, 2016
FDOT
Attn: Debbie Stephens
10041 Daniels Parkway
Fort Myers, Florida 33913
Re: Joint Participation Agreement Time Extension
Financial Project No.: 432836-1-94-01
Contract No.: AQQ85;
Agency: Collier County Board of County Commissioners
Project Description: Collier County Service Development for ADA Bus Stop
Improvements
Transmitted herewith is one (1) original Extension Agreement and one (1)
certified copy of the above referenced document for your records per request, as
adopted by the Collier County Board of County Commissioners of Collier County,
Florida on Tuesday, April 26, 2016, during Regular Session.
Please forward/e-mail a copy of the fully executed documents to
(martha.vergara a collierclerk.com) for the Boards Official Records.
Very truly yours,
DWIGHT E. BROCK, CLERK
.-"),ItS(LL
Martha Vergara, Deput Clec
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
16012
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16012
STATE OF FLORIDA)
COUNTY OF COLLIER)
I, DWIGHT E. BROCK, Clerk of Courts in and for the
Twentieth Judicial Circuit, Collier County, Florida, do
hereby certify that the foregoing is a true and correct
copy of :
FDOT - Time Extension
Financial Project Number: 432836-1-94-01
Contract Number: AQQ85
Agency: Collier County Board of County Commissioners
Project Description: Collier County Service Development for ADA
Bus Stop Improvements
Agenda Item #16D12 from the
BCC Meeting on Tuesday, April 26, 2016
WITNESS my hand and the official seal of the Board of
County Commissioners of Collier County, Florida, this 27th day
of April, 2016 .
DWIGHT E. BROCK
Clerk of Courts and clerk
Ex-officio to Board of
County Commissioners
By: Martha Vergara 6'
Deputy Clerk
16 D 1 2
'D "
...... --- -
Florida Department of Transportation
RICK SCO1'T801 North Broadway JIM BOXOLD
GOVERNOR Bartow, FL 33830
SECRETARY
DATE: March 16, 2016
TO: Michelle Arnold, Director, Public Transit & Neighborhood Enhancement
FROM: Paul A. Simmons, District Modal Development Administrator
SUBJECT: Time Extension
Financial Project Number: 432836-1-94-01
Contract Number: AQQ85
Agency: Collier County Board of County Commissioners
Project Description: Collier County Service Development for ADA Bus Stop
Improvements
The time allotted for the completion of services or goods on the subject agreement dated January 11,
2013 and any supplementals thereto will expire on December 31, 2016.
In accordance with Section 18.00 of the Joint Participation Agreement, a time extension may be
requested. Please complete, sign, date and return this form to me.
It is requested that the Joint Participation Agreement for the subject project be extended until
December 31, 2017.
The reason for the Time Extension request must be included in a letter to the Department from
the Director/Manager/CEO of the organization. A detailed summary of the reason for the Time
Extension and a schedule for completing the project must be included. Time Extensions will
not be granted for billing purposes if the project is complete. E!
Collier County BOCC
RECOMMEND FOR APPROVAL: a;(;:• .0
AGENCY •1 ->
Donna Fiala f, ="fQ� - 2.
SIGNAT Y(PRINTED R TYPED) DISTRICT MODAL DEVELOPMENT ADMINISTRATORS ' (.
4114/0APPROVED: 'i,;: 1
SIGNA URE Cl)
<
Chairman wk'----
..
TITLE DISTRICT SECRETARY OR DESIGNEE
G 03
Date: A` col‘to Date:
Ap oved as to form and legality
v.,o,v ot.X( e.t is Odd
net 4,
Scott R.Teach,Deputy Coun rney
16012
FDDD
_....-- --- •-
Florida Department of Transportation
RICK SCOTT 801 North BroadwayAvenue JIM BOXOLD
GOVERNOR Bartow,FL 33830 SECRETARY
May 17,2016
Collier County-Alternative Transportation Modes
Growth Management Division
Ms.Michelle Edwards-Arnold,Director
3299 East Tamiami Trail, Suite 7000
Naples,Florida 34112
RE: Time Extension
Financial Project Number: 432836-1-94-01
Contract Number: AQQ85
Agency: Collier County
Project Description: State Service Development Program
Dear Ms.Arnold:
Enclosed please find the fully-executed time extension for the above referenced project.
We look forward to working with you to carry out the terms of this Agreement. If you have any questions,please
contact Ms. Debi Stephens, Transit Projects Coordinator, at 239-225-1982 or at debra.stephens@dot.state.fl.us.
Sincerely,
/ / liawil------
Debi Stephens
Transit Projects Coordinator 1
1
Enclosures
cc: Martha Verga,Deputy Clerk, Collier County
www.dot.state.fl.us
160 1 2
FDC:k\,1
....,00 .-- -
Florida Department of Transportation
RICK scow 80 North 13roadwa) JIM BOXOI.D
GOVERNOR Bartow,FI. 3 830 SECRETARY
DATE: March 16, 2016
TO: Michelle Arnold, Director, Public Transit& Neighborhood Enhancement
FROM: Paul A. Simmons, District Modal Development Administrator
SUBJECT: Time Extension
Financial Project Number: 432836-1-94-01
Contract Number: AQQ85
Agency: Collier County Board of County Commissioners
Project Description: Collier County Service Development for ADA Bus Stop
Improvements
The time allotted for the completion of services or goods on the subject agreement dated January 11,
2013 and any supplementals thereto will expire on December 31, 2016.
In accordance with Section 18.00 of the Joint Participation Agreement, a time extension may be
requested. Please complete, sign, date and return this form to me.
It is requested that the Joint Participation Agreement for the subject project be extended until
December 31, 2017.
The reason for the Time Extension request must be included in a letter to the Department from
the Director/Manager/CEO of the organization. A detailed summary of the reason for the Time
Extension and a schedule for completing the project must be included. Time Extensions will , 1
not be granted for billing purposes If the project is complete.
Collier County BOCC
COM
,QMEND FOR APPROVAL: `..)
AGENCY "'
;t
Donna Fiala —h . -.(i �'` `s
SIGNAT Y(PRINTED R TYPED) (STRICT MODA D LOPMENT ADMINISTRATOR?'% '•''
. --j?2%...,...• :i
APPROVED: a!,
SIGNA RE
LU '
Chairman Q 0 m
TITLE DISTRICT SECRETARYd4/76
OR DESIGNEE
Date: y12,�.�kti, Date:
A oved as to�f�or ym��and legality
�4 L‘Ly..�{(1t.xa.yc115 2
Scott R.Teach,Deputy Coun rney