Backup Documents 12/13/2016 Item #16F5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6F5
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
7eie.t4A'i&e_jc
3. County Attorney Office County Attorney Office
4. BCC Office Board of County bk..`
Commissioners S(4/ r z_\u\\kc
5. Minutes and Records Clerk of Court's Office c_rry LzI/ I;cvPr✓L
PRIMARY CONTACT INFORMATION I
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of e
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Pho e Number
Contact/ Depai turent QLe 7.<*e_.v`, c r/ `I
Agenda Date Item was / Benda Item Number
Approved by the BCC - G Z° 3• /‘ • /r 5
Type of Document Number of Original
Attached Watt,( 61reotAtc c..V C.u. Documents Attached 1
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) Applicable)
1. Does the document require the chairman's original signature?
2. Does the document need to be sent to another agency for additional signatures? If yes, f f e&se reittorlA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. , +O ate--
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
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
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
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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 f2./3.(61:hd all changes made 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 e •.• ,�
BCC,all changes directed by the BCC have been made, and the document is ready or the or-7
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2. 4175; evised 11/30/12
r .
MEMORANDUM
Date: December 22, 2016
To: Jace Kentner
Office of Business & Economic Development
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Federal Grant Application for the Florida Culinary Accelerator @
Immokalee
Attached, for your records is an original of the document referenced above, (Agenda
Item #16F5) adopted by the Board of County Commissioners on Tuesday, December
13, 2016.
If you should have any questions, please call 252-8411.
Thank you.
Attachment
16F5
OMB Number:4040-0004
Expiration Date:8/31/2016
Application for Federal Assistance SF-424
*1.Type of Submission: *2.Type of Application: *If Revision,select appropriate letter(s):
Preapplication n New
n Application n Continuation *Other(Specify):
I I Changed/Corrected Application j Revision
*3.Date Received: 4.Applicant Identifier:
05/17/2016
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
State Use Only:
6.Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
*a.Legal Name: Collier County Board of County Commissioners
*b.Employer/Taxpayer Identification Number(EIN/TIN): *c.Organizational DUNS:
596000558 0769977900000
d.Address:
*Streetl: 3299 Tamiami Trail East
Street2: Suite 202
*City: Naples
County/Parish: Collier County
*State: FL: Florida
Province:
*Country: USA: UNITED STATES
*Zip/Postal Code: 34112-5749
e.Organizational Unit:
Department Name: Division Name:
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: Hr *First Name: Jace
Middle Name:
*Last Name: Kentner
Suffix:
Title: Interim Director
Organizational Affiliation:
*Telephone Number: 239-252-4040 Fax Number: 239-252-6718
*Email: JaceKentner@colliergov.net
1 6 1:
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
B: County Government
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
*Other(specify):
*10.Name of Federal Agency:
Economic Development Administration
11.Catalog of Federal Domestic Assistance Number:
11.300
CFDA Title:
Investments for Public Works and Economic Development Facilities
*12.Funding Opportunity Number:
EDAP201.6
*Title:
FY 2016 Economic Development Assistance Programs • Application submission and program requirements
for EDA's Public Works and Economic Adjustment Assistance programs.
13.Competition Identification Number:
PW-EAA-C
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
14 areas affected.pdf Add Attachment Delete Attachment View Attachment
*15.Descriptive Title of Applicant's Project:
Immokalee Agribusiness Accelerator - Innovation Center - Building Improvements Only
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments I View Attachments
16F5
Application for Federal Assistance SF-424
16.Congressional Districts Of:
*a.Applicant 19, 25 *b.Program/Project 25
Attach an additional list of Program/Project Congressional Districts if needed.
I6a_conyress i ona:1.pdf Add Attachment Delete Attachment View Attachment
17.Proposed Project:
*a.Start Date: 06/0 L/2016 *b.End Date: 07/30/2017
18.Estimated Funding($):
*a.Federal 1,000,000.10
*b.Applicant 975,000.00
*c.State 0.00
*d.Local 0.00
*e.Other 0.00
*f. Program Income 0.00
*g.TOTAL 1,975,000.00
*19.Is Application Subject to Review By State Under Executive Order 12372 Process?
a.This application was made available to the State under the Executive Order 12372 Process for review on 05/02/2016 .
7 b.Program is subject to E.O. 12372 but has not been selected by the State for review.
C c.Program is not covered by E.O. 12372.
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
11 Yes n No
If"Yes",provide explanation and attach
Add Attachment Delete Attachment View Attachment l
21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001)
`*!AGREE
**The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix: *First Name: Donna
Middle Name: L.
*Last Name: Fiala
Suffix:
*Title: Chairman
*Tglapty501C mber: 239-252-8601 Fax Number:
ErnaiL. donnafielk@colliergov.net •
• *3itinatt re of AutfiQnzed Representative: I"470"'!%-rOFnts-.• !A!s'IA,r! .n. *Date Signed: com ie! GrinScipvit
p‘ubmission.
g Ap v ',as t m and legality:
l •� �1.�> j., J Jeff ,t� l
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