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Backup Documents 03/28/2017 Item #16A12 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 A I2 2 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 SRT 3/28/17 4. BCC Office Board of County �F Commissioners - / '3\- \-- 5. Minutes and Records Clerk of Court's Office ;1341— , 5/4'Qy, 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 Mark McCleary,Transportation Phone Number 252-8442 Contact/Department Engineering Division, Growth Management Department Agenda Date Item was 3/28/17 � Agenda Item Number 16-A-12/e7V--- Approved by the BCC Type of Document Public Offices-Conflict of Interest Number of Original One Attached Certification-Fiala 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 signature SRT 2. Does the document need to be sent to another agency for additional signatures? 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 3/28/17 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. 4. 9. Initials of attorney verifying that the attached document is the version approved by the S — X F s BCC, all changes directed bythe BCC have been made,and the document is readyfor the 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 6 A 0 MEMORANDUM Date: March 31, 2017 To: Mark McCleary, Project Manager Transportation Engineering From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Public Office Conflict of Interest Certification — Commissioner Fiala Attached please find a copy of the document as referenced above (Agenda Item #16Al2), approved by the Board of County Commissioners on Tuesday, March 28, 2017. The original document is being held in the Minutes & Records If you should have any questions, please contact me at 252-8411. Thank you. Attachments 1 6 A 1 2 PUBLIC OFFICER CONFLICT OF INTEREST CERTIFICATION Collier County is a Florida Department of Transportation (FDOT) Local Agency Program (LAP) certified agency. The funding source for LAP projects is the Federal Highway Authority (FHWA); whereby grant dollars are passed through the FDOT via a LAP agreement. I certify that I have no present conflict of interest on the following Financial Project Number projects: Financial Project Number:4175405-SR 29 from Cr 846(Airport Rd)To N.of New Market Road N. Financial Project Number:4175407-SR 29 from First Street to Ninth Street Financial Project Number:433175-SR 82(Immokalee Rd)At Cr 850(Corkscrew Rd) Financial Project Number:433176-Pine Ridge Rd at Various Locations Financial Project Number:433177-CR 886(Golden Gate)At Livingston Financial Project Number:434990-Golden Gate Various Locations Sidewalk Financial Project Number:435029-Us 41 from CR 846(111th Ave)To N.of 91st Ave Financial Project Number:435030-Sunshine Blvd from 17th Ave SW to Green Blvd Financial Project Number:435116-Golden Gate Collector Sidewalks Various Locations Financial Project Number:435117-North Naples Sidewalks at Various Locations Financial Project Number:435118-CR 862(Vanderbilt Beach Rd)From CR 901 to Gulf Pavilion Dr Financial Project Number:435119-49th Terrace SW from 20th Place SW to 19th Place SW The projects listed above will have LAP funded Design Services provided by Johnson Engineering,Inc. I further certify that I will recuse myself from any capacity of decision making, approval,disapproval or recommendation of any consultant/contractor/vendor for selection on any contract if I have a conflict of interest or potential conflict of interest.As set forth in Sections 112.313 and 334.193,Florida Statutes,public officers of an agency may not have any interest,financial or otherwise direct or indirect;engage in any business transaction or professional activity;or accept any obligation of any kind which is in conflict with the proper conduct of their duties in the public interest.By signing below,I attest that public officers should avoid any conduct that might undermine the public trust,whether or not that conduct is unethical or lends itself to the appearance of ethical impropriety;and that public officers in the State of Florida are expected to safeguard their ability to make objective,fair and impartial decisions,in part,by not accepting any benefit under circumstances that could be inferred by a reasonable observer that the benefit was provided to influence a pending or future decision,or to reward a past decision. I realize that a violation of the above mentioned statutes is punishable in accordance with Section 112.317 or Section 334.193,Florida Statutes,and could result in disciplinary action. Al EST BOARD OF COUNTY COMMISSIONERS DWIGHT E.BROCK,CLERK COLLIER COUNTY,FLORIDA to- i..-et_ :''' By: ›i'Yiefe9 4%14/ Fttersx p y DONN FIALA,COMM.ISSIONER ,����� .�5�air�d�;�De ut Clerk signature only. z 2.% 2.s7)\--\ Dated: �Qr- A.proved as t r•rm a • gal', : i ler id Scott R.Teach Deputy County Attorney ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 4 - 4 .F'. TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO i J. `.. 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 3/28/17 4. BCC Office Board of County W\-3\ Commissioners \/k,c S j 3\\k---, 5. Minutes and Records Clerk of Court's Office 3)3i I 1lopn 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 Mark McCleary, Transportation Phone Number 252-8442 Contact/Department Engineering Division, Growth Management Department Agenda Date Item was 3/28/17 Agenda Item Number 16-A-12 Approved by the BCC Type of Document Public Office,Conflict of Interest Number of Original One Attached Certification-McDaniel 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 signature SRT 2. Does the document need to be sent to another agency for additional signatures? 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 3/28/17 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. jun 9. Initials of attorney verifying that the attached document is the version approved by th- ���\p BCC, all changes directed by the BCC have been made, and the document is ready fo thy; Chairman's signature. C �' - ci rAp,„ 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 16Al2, MEMORANDUM Date: April 3, 2017 To: Mark McCleary, Project Manager Transportation Engineering From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Public Office Conflict of Interest Certification — Commissioner McDaniel Attached please find a copy of the document as referenced above (Agenda Item #16Al2), approved by the Board of County Commissioners on Tuesday, March 28, 2017. The original document is being held in the Minutes & Records If you should have any questions, please contact me at 252-8411. Thank you. Attachments 1 6 A I PUBLIC OFFICER CONFLICT OF INTEREST CERTIFICATION Collier County is a Florida Department of Transportation (FDOT) Local Agency Program (LAP) certified agency. The funding source for LAP projects is the Federal Highway Authority (FHWA); whereby grant dollars are passed through the FDOT via a LAP agreement. I certify that I have no present conflict of interest on the following Financial Project Number projects: Financial Project Number:4175405-SR 29 from Cr 846(Airport Rd)To N.of New Market Road N. Financial Project Number:4175407-SR 29 from First Street to Ninth Street Financial Project Number:433175-SR 82(Immokalee Rd)At Cr 850(Corkscrew Rd) Financial Project Number:433176-Pine Ridge Rd at Various Locations Financial Project Number:433177-CR 886(Golden Gate)At Livingston Financial Project Number:434990-Golden Gate Various Locations Sidewalk Financial Project Number:435029-Us 41 from CR 846(111th Ave)To N.of 91st Ave Financial Project Number:435030-Sunshine Blvd from 17th Ave SW to Green Blvd Financial Project Number:435116-Golden Gate Collector Sidewalks Various Locations Financial Project Number:435117-North Naples Sidewalks at Various Locations Financial Project Number:435118-CR 862(Vanderbilt Beach Rd)From CR 901 to Gulf Pavilion Dr Financial Project Number:4351 19-49th Terrace SW from 20th Place SW to 19th Place SW The projects listed above will have LAP funded Design Services provided by Johnson Engineering,Inc. I further certify that I will recuse myself from any capacity of decision making, approval,disapproval or recommendation of any consultant/contractor/vendor for selection on any contract if I have a conflict of interest or potential conflict of interest.As set forth in Sections 112.313 and 334.193,Florida Statutes,public officers of an agency may not have any interest,financial or otherwise direct or indirect;engage in any business transaction or professional activity;or accept any obligation of any kind which is in conflict with the proper conduct of their duties in the public interest.By signing below,I attest that public officers should avoid any conduct that might undermine the public trust,whether or not that conduct is unethical or lends itself to the appearance of ethical impropriety;and that public officers in the State of Florida are expected to safeguard their ability to make objective,fair and impartial decisions,in part,by not accepting any benefit under circumstances that could be inferred by a reasonable observer that the benefit was provided to influence a pending or future decision,or to reward a past decision. I realize that a violation of the above mentioned statutes is punishable in accordance with Section 112.317 or Section 334.193,Florida Statutes,and could result in disciplinary action. ATTEST: BOARD OF CO ,iimiCOMMISSION_ DWIGHT E.BROCK, CLERK COLLIER C•.' •RIDA at' By: .4if >�__ dt By: ,Deputy Clerk WIL(lAM L.McDA1 ,JR • ISSIONER. Dated: I . Z."; `'_ A proved a• F. form,: 6 A ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO -la 2 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 3/28/17 4. BCC Office Board of County �S Commissioners 5"/ 4\c- 5. Minutes and Records Clerk of Court's Office I! 1�� a��� 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 Mark McCleary,Transportation Phone Number 252-8442 Contact/Department Engineering Division,Growth Management Department Agenda Date Item was 3/28/17 Agenda Item Number 16-A-12 Approved by the BCC Type of Document Public Offic€onflict of Interest Number of Original One Attached Certification-Saunders 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 signature SRT 2. Does the document need to be sent to another agency for additional signatures? 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 3/28/17 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. 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 t - \§ iX Chairman's signature. - Ami 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 A 1 2 MEMORANDUM Date: April 6, 2017 To: Mark McCleary, Project Manager Transportation Engineering From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Public Office Conflict of Interest Certification — Commissioner Saunders Attached please find a copy of the document as referenced above (Agenda Item #16Al2), approved by the Board of County Commissioners on Tuesday, March 28, 2017. The original document is being held in the Minutes & Records If you should have any questions, please contact me at 252-8411. Thank you. Attachments ,.. 16Ai ' PUBLIC OFFICER CONFLICT OF INTEREST CERTIFICATION Collier County is a Florida Department of Transportation (FDOT) Local Agency Program (LAP) certified agency. The funding source for LAP projects is the Federal Highway Authority (FHWA); whereby grant dollars are passed through the FDOT via a LAP agreement.I certify that I have no present conflict of interest on the following Financial Project Number projects: Financial Project Number:4175405-SR 29 from Cr 846(Airport Rd)To N.of New Market Road N. Financial Project Number:4175407-SR 29 from First Street to Ninth Street Financial Project Number:433175-SR 82(Immokalee Rd)At Cr 850(Corkscrew Rd) Financial Project Number:433176-Pine Ridge Rd at Various Locations Financial Project Number:433177-CR 886(Golden Gate)At Livingston Financial Project Number:434990-Golden Gate Various Locations Sidewalk Financial Project Number:435029-Us 41 from CR 846(111th Ave)To N.of 91st Ave Financial Project Number:435030-Sunshine Blvd from 17th Ave SW to Green Blvd Financial Project Number:435116-Golden Gate Collector Sidewalks Various Locations Financial Project Number:435117-North Naples Sidewalks at Various Locations Financial Project Number:435118-CR 862(Vanderbilt Beach Rd)From CR 901 to Gulf.Pavilion Dr Financial Project Number:435119-49th Terrace SW from 20th Place SW to 19th Place SW The projects listed above will have LAP funded Design Services provided by Johnson Engineering,Inc. I further certify that I will recuse myself from any capacity of decision making, approval,disapproval or recommendation of any consultant/contractor/vendor for selection on any contract if I have a conflict of interest or potential conflict of interest.As set forth in Sections 112.313 and 334.193,Florida Statutes,public officers of an agency may not have any interest,financial or otherwise direct or indirect;engage in any business transaction or professional activity;or accept any obligation of any kind which is in conflict with the proper conduct of their duties in the public interest.By signing below,I attest that public officers should avoid any conduct that might undermine the public trust,whether or not that conduct is unethical or lends itself to the appearance of ethical impropriety;and that public officers in the State of Florida are expected to safeguard their ability to make objective,fair and impartial decisions,in part,by not accepting any benefit under circumstances that could be inferred by a reasonable observer that the benefit was provided to influence a pending or future decision,or to reward a past decision. I realize that a violation of the above mentioned statutes is punishable in accordance with Section 112.317 or Section 334.193,Florida Statutes,and could result in disciplinary action. ATTEST. '• ' BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK,CLERK COLLIER COUNTY,FLORIDA illti, % By: /%KA„-. Attest as to Chairman's,Deputy Clerk BURT L. SAUNDERS,COMMISSIONER s; naturd only. Dated: F-1wkr-zS1. Z<4,J?sz:V \ A..roved as to' 1r a i a . 11 ,)0111 di i Sc o.Teach Deputy County Attorney ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TOT1 TO 2 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 3/28/17 4. BCC Office Board of County Commissioners \r14/5/ A\\\ 5. Minutes and Records Clerk of Court's Office `� 2 ,W PM PRIMARY CONTACT INFORMATION /.� I J 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 Mark McCleary,Transportation Phone Number 252-8442 Contact/Department Engineering Division, Growth Management Department Agenda Date Item was 3/28/17 Agenda Item Number 16-A-12 Approved by the BCC Type of Document Public Office Conflict of Interest Number of Original One Attached Certification-Solis 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 signature SRT 2. Does the document need to be sent to another agency for additional signatures? 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 3/28/17 and all changes made during the SRT meeting have been incorporated in the attached document. The County Attorney's • u 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 e 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 16Al2 MEMORANDUM Date: April 6, 2017 To: Mark McCleary, Project Manager Transportation Engineering From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Public Office Conflict of Interest Certification — Commissioner Solis Attached please find a copy of the document as referenced above (Agenda Item #16Al2), approved by the Board of County Commissioners on Tuesday, March 28, 2017. The original document is being held in the Minutes & Records If you should have any questions, please contact me at 252-8411. Thank you. Attachments 16A12 PUBLIC OFFICER CONFLICT OF INTEREST CERTIFICATION Collier County is a Florida Department of Transportation (FDOT) Local Agency Program (LAP) certified agency. The funding source for LAP projects is the Federal Highway Authority (FHWA); whereby grant dollars are passed through the FDOT via a LAP agreement. I certify that I have no present conflict of interest on the following Financial Project Number projects: Financial Project Number:4175405-SR 29 from Cr 846(Airport Rd)To N.of New Market Road N. Financial Project Number:4175407-SR 29 from First Street to Ninth Street Financial Project Number:433175-SR 82(Immokalee Rd)At Cr 850(Corkscrew Rd) Financial Project Number:433176-Pine Ridge Rd at Various Locations Financial Project Number:433177-CR 886(Golden Gate)At Livingston Financial Project Number:434990-Golden Gate Various Locations Sidewalk Financial Project Number:435029-Us 41 from CR 846(111th Ave)To N.of 91st Ave Financial Project Number:435030-Sunshine Blvd from 17th Ave SW to Green Blvd Financial Project Number:435116-Golden Gate Collector Sidewalks Various Locations Financial Project Number:435117-North Naples Sidewalks at Various Locations Financial Project Number:435118-CR 862(Vanderbilt Beach Rd)From CR 901 to Gulf Pavilion Dr Financial Project Number:435119-49th Terrace SW from 20th Place SW to 19th Place SW The projects listed above will have LAP funded Design Services provided by Johnson Engineering,Inc. I further certify that I will recuse myself from any capacity of decision making, approval,disapproval or recommendation of any consultant/contractor/vendor for selection on any contract if I have a conflict of interest or potential conflict of interest.As set forth in Sections 112.313 and 334.193,Florida Statutes,public officers of an agency may not have any interest,financial or otherwise direct or indirect;engage in any business transaction or professional activity;or accept any obligation of any kind which is in conflict with the proper conduct of their duties in the public interest.By signing below,I attest that public officers should avoid any conduct that might undermine the public trust,whether or not that conduct is unethical or lends itself to the appearance of ethical impropriety;and that public officers in the State of Florida are expected to safeguard their ability to make objective,fair and impartial decisions,in part,by not accepting any benefit under circumstances that could be inferred by a reasonable observer that the benefit was provided to influence a pending or future decision,or to reward a past decision. I realize that a violation of the above mentioned statutes is punishable in accordance with Section 112.317 or Section 334.193,Florida Statutes,and could result in disciplinary action. ATTE BOARD OF COUNTY a . �' ' • ►s RS DWI ?BLOCK,CLERK COLLIER COUNT t I eil r • Ir By. -.s cailutivt Its By: 'tteS �0Chairman's Deputy Clerk ANDY SOLIS,VICE CHAIR � Dated: \--\e,.-GV ZS ,7 \\ A.sr() ed a. is for . d gality: 41111 1 — Scott R.Teach Deputy County Attorney ORIGINAL DOCUMENTS CHECKLIST & ROUTING IP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 A THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATUR 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 3/28/17 4. BCC Office Board of County i�--T'b/ Commissioners 4 > 5. Minutes and Records Clerk of Court's Office 130I1 3,3b 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 Mark McCleary,Transportation Phone Number 252-8442 Contact/Department Engineering Division,Growth Management Department Agenda Date Item was 3/28/17 Agenda Item Number 16-A-12/ Approved by the BCC Type of Document Public OfficerConflict of Interest Number of Original One Attached Certification-Taylor 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 signature SRT 2. Does the document need to be sent to another agency for additional signatures? 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 3/28/17 and all changes made during the SRT meeting have been incorporated in the attached document. The County Attorney's h\. Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the ScZ BCC, all changes directed by the BCC have been made,and the document is ready for'he �� 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 16Al2 6 MEMORANDUM Date: March 31, 2017 To: Mark McCleary, Project Manager Transportation Engineering From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Public Office Conflict of Interest Certification — Commissioner Taylor Attached please find a copy of the document as referenced above (Agenda Item #16Al2), approved by the Board of County Commissioners on Tuesday, March 28, 2017. The original document is being held in the Minutes & Records If you should have any questions, please contact me at 252-8411. Thank you. Attachments PUBLIC OFFICER CONFLICT OF INTEREST CERTIFICATION 6 A Collier County is a Florida Department of Transportation (FDOT) Local Agency Program (LAP) certified agency. The funding source for LAP projects is the Federal Highway Authority (FHWA); whereby grant dollars are passed through the FDOT via a LAP agreement. I certify that I have no present conflict of interest on the following Financial Project Number projects: Financial Project Number:4175405-SR 29 from Cr 846(Airport Rd)To N.of New Market Road N. Financial Project Number:4175407-SR 29 from First Street to Ninth Street Financial Project Number:433175-SR 82(Immokalee Rd)At Cr 850(Corkscrew Rd) Financial Project Number:433176-Pine Ridge Rd at Various Locations Financial Project Number:433177-CR 886(Golden Gate)At Livingston Financial Project Number:434990-Golden Gate Various Locations Sidewalk Financial Project Number:435029-Us 41 from CR 846(111th Ave)To N.of 91st Ave Financial Project Number:435030-Sunshine Blvd from 17th Ave SW to Green Blvd Financial Project Number:435116-Golden Gate Collector Sidewalks Various Locations Financial Project Number:435117-North Naples Sidewalks at Various Locations Financial Project Number:435118-CR 862(Vanderbilt Beach Rd)From CR 901 to Gulf Pavilion Dr Financial Project Number:435119-49th Terrace SW from 20th Place SW to 19th Place SW The projects listed above will have LAP funded Design Services provided by Johnson Engineering,Inc. I further certify that I will recuse myself from any capacity of decision making,approval,disapproval or recommendation of any consultant/contractor/vendor for selection on any contract if I have a conflict of interest or potential conflict of interest.As set forth in Sections 112.313 and 334.193,Florida Statutes,public officers of an agency may not have any interest,financial or otherwise direct or indirect;engage in any business transaction or professional activity;or accept any obligation of any kind which is in conflict with the proper conduct of their duties in the public interest.By signing below,I attest that public officers should avoid any conduct that might undermine the public trust,whether or not that conduct is unethical or lends itself to the appearance of ethical impropriety;and that public officers in the State of Florida are expected to safeguard their ability to make objective,fair and impartial decisions,in part,by not accepting any benefit under circumstances that could be inferred by a reasonable observer that the benefit was provided to influence a pending or future decision,or to reward a past decision. I realize that a violation ofthe above mentioned statutes is punishable in accordance with Section 112.317 or Section 334.193,Florida Statutes,and could result in disciplinary action. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E BROCK,CLERK COLLIER COUNTY,FLORIDA By: Attest as.to cOtIlfares,Deputy Clerk PENNY YLOR, AIR Slgfl livre My.- Dated: \AQrc:k."a%X70 l� App ove. s o or 1111C-- fir 1M"R. each Deputy County Attorney