Backup Documents 04/26/2016 Item #16H 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16H 4
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 JAK 4/26/16
4. BCC Office Board of County 1)7\ -
Commissioners /j'
5. Minutes and Records Clerk of Court's Office l
(
4211 to 3:qD t
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 Wanda Rod guez,ACP Phone Number 252-8123
Contact/ Department Office of th County Attorney
Agenda Date Item was 4/26/16 Agenda Item Number 16-H-4
Approved by the BCC
Type of Document Resolution appointing alternate member to Number of Original one
Attached the Value Adjustment Board Documents Attached
PO number or account N/A
number if document is js
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? STAMP Ok N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/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 JAK
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 JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 4/26/16 and all changes made during the .
meeting have been incorporated in the attached document. The County Attorney's JAK
Office has reviewed the changes,if applicable. ""
9. Initials of attorney verifying that the attached document is the version approved b ��
BCC, all changes directed by the BCC have been made,and the document is read for theme ° �
Chairman's signature.
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
16H 4
RESOLUTION NO. 2016 -80
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, APPOINTING SHAWN J. KHAN AS AN
ALTERNATE CITIZEN MEMBER OF THE VALUE ADJUSTMENT
BOARD.
WHEREAS, Section 194.015, Florida Statutes, created a Value Adjustment Board for
each county; and
WHEREAS, Section 194.015, Florida Statutes, provides that this Board of County
Commissioners shall appoint two of its members and one citizen member to the Value
Adjustment Board; and
WHEREAS, on May 27, 2008, the Board of County Commissioners authorized the
addition of an alternate citizen member to the Value Adjustment Board; and
WHEREAS, there is currently a vacancy for an alternate citizen member on the Value
Adjustment Board; and
WHEREAS, the Board of County Commissioners previously provided public notice
soliciting applications from interested parties.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that SHAWN J. KHAN is hereby
appointed as an alternate citizen member of the Value Adjustment Board.
THIS RESOLUTION ADOPTED upon majority vote on the 26th day of April, 2016.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLIER
COUNTY, FLORIDA
4111
By• -V v a By: 401/1740'
Attest as to Chairman S Dept Clerk DONNA FIALA, CHAIRWOMAN
signature only.
Approved as . form and egality:
Jeffrey A. �• laa ow
County A torney