Backup Documents 01/24/2017 Item #16D2 • ��,
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SY/It 6 0 2
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original docu.ner.t. 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 Cor additional signatures,dates,and/or information needed. If the document is already complete with the
execution of the Chairman's si•nature,draw a I :ie t!trough routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee s (List in roue ng order) Office Initials Da e
1. Priscilla Doria Community & Human Services PO / �/-7
2. County Attorney Office ►\a41 �
3. BCC Office Board of County Commissioners K
\r.S / \7-1\V-
4. Minutes and Record Clerk of Court's Office t�l
ft‘ 423111 as)N
P JMARY CONTACT INFORMATION
Normally the primary contact is the person v ho created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for:.dc.1tional or missing information.
Name of Primary Staff Priscilla Thria, Grant Coordinator Phone Number 239-252-5312
Contact/ Department Communi.y and Human Service
Agenda Date Item was January 21,7141-6 =ice t i Agenda Item Number 16.D.2
Approved by the BCC
Type of Document State Hous in, Initiatives Partnership Number of Original 1
Attached (SHIP)IIc;is .:g Counseling Funding Documents Attached
Certificati 'tnd Request
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? `-Vo.,.,- v 19j)
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information (Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been sigted/initialed for legal sufficiency. (All documents to be A�
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 NA
Office and all other parties except the 11CC 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 cy043
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 require 3_
7. In most cases(some contracts :exception),the original document and this routing slip
should be provided to the Cour.: ney Office at the time the item is input into SIRE.
Some documents are time sensit _ ..d require forwarding to Tallahassee within a certain '—
time frame or the BCC's actions ,nullified. Be aware of your deadlines!
8. The document was approved l BCC on above date and all changes made during
the meeting have been incorr n the attached document. The County
Attorney's Office has reviewc ianges, if applicable.
9. Initials of attorney verifying tLa_ :!, ached document is the version approved by the
BCC, all changes directed by th „have been made,and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Origin. cats Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05:Revised 11/30/12
1 602
MEMORANDUM
Date: January 30, 2017
To: Pricilla Doria, Grants Coordinator
CHS Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Accepting supplemental (SHIP) Program funds for FY16/17 and
authorizing the chair to sign the SHIP Funding Certification and
Request form
Attached for your records is a copy of the documents referenced above, (Item #16D2)
approved by the Board of County Commissioners on January 24, 2017.
The original documents will be held in the Minutes and Records Department for the
Board's Official Record.
If you need further information, please feel free to contact me at 252-8406.
Thank you.
Attachment (s)
1602 t
State Housing Initiatives Partnership (SHIP) Program
Housing Counseling Funding Certification and Request
Florida Housing Finance Corporation is making funding available from the Foreclosure
Counseling Program to be used as SHIP funds for the specific purpose of providing housing
counseling for the following activities only:
• First-time homebuyer counseling
• Foreclosure prevention counseling
• Financial coaching
• Financial management education
• Extended financial management
Each SHIP eligible local government may request funding up to the corresponding amount
detailed in Exhibit A. This funding will be considered as part of the 2016-2017 fiscal year and
must be expended and reported in accordance with program requirements for such funding.
Request:
COLLIER COUNTY requests $ 49, 377.00.
(local government)
Certifications:
I hereby certify that the funding disbursed for housing counseling will be used only for the
stated purposes above and that all funding will be expended and reported as part of the 2016-
2017 fiscal year annual report in accordance with program requirements.
L-nay i main
Signature �% Title iem
•
ALi
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PENNY TAYLOR 0 Date '�
Print Name Date Date ,— a 1-
Recd ----------1:j
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1 The certification must be signed by the chief elected official or the City/County Manager. If any other soca
a._,„ „.,�
government staff person signs th.e form, it must be accompanied by a signed letter from the chief elected official :v
or City/Coup uggr designating the staff person as an authorized signatory.
DWIGHT E. MOCK, Clerk' Approved as to form and legality
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