Backup Documents 07/12/2016 Item #16E 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO E
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 7/15/16
4. BCC Office Board of County
Commissioners •Aki/5l --� I(5 I
5. Minutes and Records Clerk of Court's Office , f( /
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 Sandra Herrera,Purchasing 252-4270
Contact/Department
Agenda Date Item was 7/12/16 '/ Agenda Item Number Item 16-E-8(#12 on
Approved by the BCC Admin.Change Order
Report—Attached)
Type of Document Payment and Amount Financed Agreement Number of Original 2 each
Attached —Delivery and Acceptance Certificate 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 si. .ture STAMP OK SRT
2. Does the document need to be sent to another agency for ional s' : res? 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
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 7/12/16 and all changes made during the SRT
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable. �1
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.
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
1 E
MEMORANDUM
Date: July 18, 2016
To: Sandra Herrera, Procurement Manager
Procurement Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Payment and Amount Financed Agreement— Delivery and
Acceptance Certificate
Attached is an original of the documents referenced above, (Agenda Item #16E8)
approved by the Board of County Commissioners on Tuesday, July 12, 2016.
The second set of originals has been kept by the Minutes and Records Department for
the Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
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VAPAYMENT AND
AMOUNT FINANCED ADDENDUM
F,SENT. FINA\CE AGREEMENT #
2055949
Addendum to Agreement # 2055949, dated qo7 V1.t, , between COLLIER COUNTY BOARD OF COUNTY
COMMISSIONERS, as Customer and U.S. Bank Equipment Finance, a division of U.S. Bank National Association ("U.S.
Bank Equipment Finance"), as Lessor/Secured Party.
The parties wish to amend the above-referenced Agreement as set forth below:
The term of the above-referenced Agreement is Twelve (12) monthly Payments of$7,869.30 followed by Forty-
Eight (48) monthly payments of $11,716.95. Payments 13-60 includes a pass-through amount of $3,847.65
for Supplies and/or Services as defined on page 2 of the Lease Agreement. The first monthly Payment
is due 30 days from the commencement of the Agreement.
The total sum of the minimum equipment payments for the 60 month term will not exceed the financed amount of
$472,158.00 and there are no additional costs to finance other than the taxes/fees defined herein.
The above financing arrangement represents the cost of the Equipment identified in Schedule A to the Delivery&
Acceptance Certificate, less the trade-in allowance Physio-Control, Inc. provided the Customer for thirty-three
(33)Zoll AutoPulse units and their related accessories, and includes the cost of on-site comprehensive coverage
supplied by Physio-Control.
Equipment Cost:$571,158.00
Amount Financed:$472,158.00
See attached Exhibit 1 to Schedule A for serial numbers for thirty-five(35) Lucas 2.2 Chest Compression Systems.
By signing this Addendum, Customer acknowledges the above changes to the Agreement and authorizes Lessor/Secured
Party to make such changes. In all other respects, the terms and conditions of the Agreement remain in full force and
effect and remain binding on Customer.
U.S.Bank Equipment Finance COLLIER COUNTY BOARD OF COUNTY
COMMISSIO ERS
Lessor/Secured Party Customer
Si. - u / Signature 1tonna Fiala, Chairman
AUison-Kaams-1 teria4-F-Foeur Aea#Bifestor
Title Date Title
Zl . : Apprqyed as to firm nd legality
t3R00 a CLERK '\ r
Scott R.Teach,Dep ty County Attorney
Sr.*
�.�..�
NOTE: SIGNER OF THIS DOCUMENT MUST BE SAME AS ON THE AGREEMENT. A FACSIMILE OF THIS DOCUMENT WITH SIGNATURE
SHALL BE CONSIDERED TO BE AN ORIGINAL. CAPITALIZED TERMS IN THIS DOCUMENT ARE DEFINED AS IN THE AGREEMENT,UNLESS
SPECIFICALLY STATED OTHERWISE.
A629 REV 05/14
1/5 &rfy
I
Y?.
4, ',,,,' ,' s („)
AGREEMENT 2055949 EXHIBIT 1 TO SCHEDULE A
Device Type Serial Number Device Number Asset Number
LUCAS 2 3016H174 LD-3
LUCAS 2 3016H178 LD-4
LUCAS 2 3016H176 LD-1
LUCAS 2 3016H179 LD-2
LUCAS 2 3016H175 LD-5
LUCAS 2 3016H177 LD-6
LUCAS 2 3016H181 LD-7
LUCAS 2 3016H180 LD-8
LUCAS 2 3016H183 LD-9
LUCAS 2 3016H152 LD-10
LUCAS 2 3016H151 LD-11
LUCAS 2 3016H150 LD-12
LUCAS 2 3016H146 LD-13
LUCAS 2 3016H148 LD-14
LUCAS 2 3016H149 LD-15
LUCAS 2 3016H153 LD-16
LUCAS 2 3016H145 LD-17
LUCAS 2 3016H208 LD-18
LUCAS 2 3016H209 LD-19
LUCAS 2 3016H216 LD-20
LUCAS 2 3016H215 LD-21
LUCAS 2 3016H213 LD-22
LUCAS 2 3016H214 LD-23
LUCAS 2 3016H211 LD-24
LUCAS 2 3016H210 LD-25
LUCAS 2 3016H219 LD-26
LUCAS 2 3016H184 LD-27
LUCAS 2 3016H185 LD-28
LUCAS 2 3016H191 LD-29
LUCAS 2 3016H189 LD-30
LUCAS 2 3016H190 LD-31
LUCAS 2 3016H186 LD-32
LUCAS 2 3016H192 LD-33
LUCAS 2 3016H187 LD-34
LUCAS 2 3016H188 LD-35
{ �. 3
ka.,, L *,A.
DELIVERY & ACCEPTANCE CERTIFICATE
bank.
AGREEMENT#
EQUIPMENT FINANCE 2055949
This Certificate is delivered to and for the benefit of Lessor/Secured Party and pertains to the below-described Equipment
and/or Financed Items which are the subject of the above-referenced Agreement between U.S. Bank Equipment Finance,
a division of U.S. Bank National Association as Lessor/Secured Party and the undersigned as Customer. The words you
and your refer to Customer. The words we, us and our refer to Lessor/Secured Party.
You certify and acknowledge that all of the Equipment and Financed Items (as applicable): 1) have been received,
installed and inspected, and 2) are fully operational and unconditional accepted. Further, all terms and conditions of the
above-referenced Agreement have been reviewed and acknowledged. Upon you signing below, your promises in the
Agreement will be irrevocable and unconditional in all respects. You understand and agree that we have paid for the
purchase of the Equipment and/or Financed Items from the below-referenced Supplier and you may contact the Supplier
for any warranty rights, which, if the Agreement is a lease, we transfer to you for the term of the Agreement (or until you
default).
Supplier: Equipment and/or Financed Items Description
PHYSIO CONTROL INC SEE SCHEDULE A including Exhibit 1
together with all replacements, parts, repairs, additions, and accessions incorporated therein or attached thereto and any and all proceeds of the
foregoing,including, without limitation,insurance recoveries.
COLLIER CO TY BOARD OF COUNTY COMMISSIONERS
Customer • °
ATTEST- X
DWI , T E.BR K. CLERK Donna Fiala, Chairman
- ` . Allison Kearnsi DiL,pf Interim r Lt.i Py'o- enr ar e,.s
�
Title Acceptance 7/12/16
Date
i, \fYfa b °'ri's
proved s t fo an9 legality
ii .e. ( _
Scott R.Teach,Deputy County Attorney
NOTE: A FACSIMILE OF THIS DOCUMENT WITH SIGNATURE SHALL BE CONSIDERED TO BE AN ORIGINAL. CAPITALIZED TERMS IN THIS
DOCUMENT ARE DEFINED AS IN THE AGREEMENT,UNLESS SPECIFICALLY STATED OTHERWISE.
10000 REV 02/15
1ÔEB
AGREEMENT 2055949 EXHIBIT 1 TO SCHEDULE A
Device Type Serial Number Device Number Asset Number
LUCAS 2 3016H174 LD-3
LUCAS 2 3016H178 LD-4
LUCAS 2 3016H176 LD-1
LUCAS 2 3016H179 LD-2
LUCAS 2 3016H175 LD-5
LUCAS 2 3016H177 LD-6
LUCAS 2 3016H181 LD-7
LUCAS 2 3016H180 LD-8
LUCAS 2 3016H183 LD-9
LUCAS 2 3016H152 LD-10
LUCAS 2 3016H151 LD-11
LUCAS 2 3016H150 LD-12
LUCAS 2 3016H146 LD-13
LUCAS 2 3016H148 LD-14
LUCAS 2 3016H149 LD-15
LUCAS 2 3016H153 LD-16
LUCAS 2 3016H145 LD-17
LUCAS 2 3016H208 LD-18
LUCAS 2 3016H209 LD-19
LUCAS 2 3016H216 LD-20
LUCAS 2 3016H215 LD-21
LUCAS 2 3016H213 LD-22
LUCAS 2 3016H214 LD-23
LUCAS 2 3016H211 LD-24
LUCAS 2 3016H210 LD-25
LUCAS 2 3016H219 LD-26
LUCAS 2 3016H184 LD-27
LUCAS 2 3016H185 LD-28
LUCAS 2 3016H191 LD-29
LUCAS 2 3016H189 LD-30
LUCAS 2 3016H190 LD-31
LUCAS 2 3016H186 LD-32
LUCAS 2 3016H192 LD-33
LUCAS 2 3016H187 LD-34
LUCAS 2 3016H188 LD-35