Backup Documents 12/13/2016 Item #16E9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6E 9
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.
Routed by Procurement Services to the Office Initials Date
Following Addressee(s) (In routing order)
2. County Attorney Office County Attorney Office
3. BCC Office Board of County Commissioners .
4. Minutes and Records Clerk of Court's Office *-1. •
P—I`t II(6 11
5. Return to Procurement Services Division Procurement Services
Contact: Viviana Giarimoustas
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 Viviana Giarimoustas Phone Number 239-252-8375
Procurement Staff
Contact and Date
Agenda Date Item was 12/13/2016 ift Agenda Item Number 16E9 V
Approved by the BCC
Type of Document Amendment Number of Original 2
Attached Documents Attached
PO number or account N/A Solicitation/Contract 16-6559/EMS Bank
number if document is Number/Company Loan
to be recorded Name
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? VG
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 VG
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 N/A
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 VG
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip Ye--
should
e"should be provided to the County Attorney Office at the time the item is input into SIRE. Imo'
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 the date above and all changes made VG
during 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 /'l' ,�
Chairman's signature. ij
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 6 E 9
MEMORANDUM
Date: December 15, 2016
To: Viviana Giarimoustas
Procurement Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment to Contract #16-6559 "EMS Bank Loan"
Attached is a copy of the document referenced above, (Item #16E9) approved by the
Board of County Commissioners on Tuesday, December 13, 2016.
The original has been held by the Minutes and Records Department as part of the
Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
16E9
16-6559 -EMS Bank Loan
CrZb fl k. Amendment#2 PAYMENT ADDENDUM
EQUIPMENT FINANCE AGREEMENT #
2055949
Addendum to Agreement # 2055949, dated 4/26/16, 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 $11,728.68. Payments 13-60 includes a pass-through amount of
$3,859.38 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.
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
COMMISSIONERS
Lessor/Secured Party Customer
1/411.741A2-1k4_-- X irk4242 1.4C..,
Signatur" Signature ONNA FIALA
)1Af 't 'i ) '/ I Ohl i tb CHAIRMAN ‘,2_\13\\l4:,
Title Date Title Date
ATTEST:
DWIIF, T E. BROQ Cl
(, Clerk
A roved as to Form and Legality: .Aro -
(f I Attest as tohairinan's
// signature-only. -
ssistant county Attorney
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