Backup Documents 05/23/2017 Item #16A 3 ORIGINAL DOCUMENTS CHECKLIST& ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO3
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 //),
4. BCC Office Board of County
Commissioners
5. Minutes and Records Clerk of Court's Office
5 Zcef 17 Z:
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 Diane Lynch-Road Maintenance Phone Number 252-5820
Contact/ Department
Agenda Date Item was 5/23/2017 _ Agenda Item Number 16A3
Approved by the BCC
Type of Document Adopt-a-Road Agreement—Lozano's Number of Original 1
Attached Mexican Restaurant Documents Attached
PO number or account
number if document is
to be recorded
Please return an executed copy to Diane Lynch in Road Maintenance. Thank you
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? dml
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed dml
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 dml
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 dml
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip dml
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 5/23/17 and all changes made during the d
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if ap•licable.
9. Initials of attorney verifying that the attached document is the version approved by the Aft
BCC,all changes directed by the BCC have been made,and the document is ready for t % z
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
16A 3
Martha S. Vergara
From: Martha S.Vergara
Sent: Friday, May 26, 2017 4:56 PM
To: Lynch, Diane
Subject: Agenda Item#16A3 from the 5/23/17 BCC Meeting
Attachments: Diane Lynch.pdf
Hi Diane,
Attached for your records is a copy of the aforementioned document.
Thanks,
Martha Vergara, BMR Senior Clerk
Minutes and Records Dept.
Clerk of the Circuit Court
& Value Adjustment Board
Office: (239) 252-7240
Fax: (239) 252-8408
E-mail: martha.vergara(a,collierclerk.com
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COLLIER COUNTY ADOPT-A-ROAD PROGRAM AGREEMENT
Terms and Conditions
THIS COLLIER COUNTY ADOPT-A-ROAD AGREEMENT entered into this a3 day
of Pr1 2_3 , 2017, by and between Collier County (hereinafter the "COUNTY"),
and the volunteer group, Lozano's Restaurant & Sports Bar, Inc. (hereinafter the "GROUP")
whose address is 405 New Market Road East, Immokalee, FL 34142.
WITNESSETH:
WHEREAS, the COUNTY and the GROUP recognize the need and desire for litter-free
roads, and enter this Agreement to permit the GROUP to contribute toward the effort of safely
maintaining a litter-free Collier County;and
WHEREAS, by signature below, the GROUP agrees to adopt the segment of roadway
known as N 9th Street from SR 29 to Lake Trafford Road and acknowledges the hazardous
nature of picking up litter, and agrees to the following terms and conditions:
A. THE GROUP SHALL:
1. Obey and abide by all laws and regulations relating to safety on the Adopted Roadway.
2. Perform litter removal on the Adopted Roadway in accordance with the Florida
Department of Transportation's Accident Prevention Manual, Safe Field Practices, the Florida
Manual on Uniform Traffic Control Devices (MUTCD), and the Florida Department of
Transportation Design Roadway and Standard Index 601 and 602, all of which by this reference
are incorporated herein.
3. Only allow such persons to participate as are determined by the GROUP to be
responsible enough to safely participate in litter removal activities. Participants must be at least
14 years of age and the GROUP shall provide at least one adult supervisor for every 5 minors
participating in the litter removal. There shall at all times be at least one person 18 years of age
or older who is on site and responsible for supervising all litter removal activities, with no one at
the site under the age of 14 for any reason.
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4. Conduct at least two safety procedure meetings per year for its participating members.
Participants must sign the hold harmless agreement provided by the COUNTY, and attend a
safety meeting conducted by the GROUP before participating in a cleanup activity pursuant to
this Agreement.
5. Call the Collier County Adopt-A-Road contact and set up dates and times for their safety
meetings.
6. Remove litter during daylight hours only, in good weather conditions only.
7. Pick up litter on one side of the road at a time.
8. Not pick up litter at construction sites, in tunnels, on bridges or over-passes, and on
medians, or where otherwise hazardous to do so.
9. Park all vehicles well clear of the Adopted Roadway, at least 20 feet from the edge of the
pavement.
10. Remove litter a minimum of once monthly, and whenever the appearance of the Adopted
Roadway is objectionable.
11. Obtain required supplies and material from the COUNTY.
12 Place traffic control signs supplied by the COUNTY during trash pickup.
13. Ensure that all participants wear COUNTY supplied or approved safety vests at all times
during the litter removal activity. The local maintenance office should be contacted to obtain
safety vests, traffic control signs and litter collection bags at least five (5) days prior to litter
removal activity and return the same when activity is complete.
14. Not wear clothing that will hinder the sight of participants.
15. Coordinate pickup details with the County's project coordinator at least one week prior to
a pickup.
16. Place filled trash bags at the site for pickup and disposal by the COUNTY.
17. After each pickup, the adopting GROUP coordinator will file a report detailing the
number of people involved, number of bags of litter collected, composition and estimate of
recyclable materials, and hours spent. Pre-printed forms will be furnished by the COUNTY for
making the reports, and filed with the COUNTY project coordinator.
18. The GROUP is encouraged to separate recyclable materials. All proceeds from
redemption of recyclable materials shall become the property of the Group.
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19. Unused materials and supplies furnished by the COUNTY shall be returned to the
COUNTY within two workdays following cleanup or, with COUNTY coordinator's permission,
be retained by the GROUP during the term of this Agreement.
B. THE COUNTY SHALL:
1. Provide safety vests, trash bags, pickup sticks, and traffic control signs.
2. Provide GROUP with an outline pertaining to safety regulations.
3. Remove the filled trash bags as soon as possible after the pickup.
4. Remove litter from the Adopted Roadways only under unusual circumstances, i.e., to
remove large, heavy or hazardous items.
5. Construct and place a roadside sign stating that the GROUP is responsible for keeping the
area free of litter.
C. TERM OF AGREEMENT: This is a month-to-month, at-will agreement, terminable by
either party, with or without cause, on 30 days written notice to the other party. This Agreement
creates no rights or interest. If, in the sole judgment of the County Project Coordinator, it is
found that the GROUP is not meeting the terms and conditions of this Agreement, the COUNTY
may terminate this Agreement effective immediately. The COUNTY reserves the right to
modify or cancel the program at any time. Upon the termination of this Agreement by either
party, the GROUP will immediately return all County-owned materials to the County project
coordinator.
D. HOLD HARMLESS CLAUSE: The GROUP covenants and agrees that it will indemnify
and hold harmless Collier County and its officers, agents and employees from any claim, loss,
damage, cost, charge or expense arising out of any act, action, neglect or omission by the Group
or by any person performing litter removal as part of the GROUP during the performance of the
Agreement, whether direct or indirect, and whether to any person or property to which Collier
County or said parties may be subject, except that neither GROUP nor any of its members shall
be liable under this provision for damages arising out of injury or damage to persons or property
directly caused or resulting from the sole negligence of Collier County, and its officers,
employees or agents.
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E. NO ASSIGNMENT: This Agreement is non-transferable and non-assignable in whole or in
part without the prior written consent of Collier County.
F. MISCELLANEOUS PROVISIONS: This Agreement is the full and complete agreement
between the parties, and may not be modified except by a writing signed by both parties. Any
and all prior understandings between the parties, either oral or written, with respect to the matters
set forth above, have been incorporated and merged into this Agreement, and are otherwise of no
further force or effect. This Agreement is for litter removal activities only. No beautification
activities are authorized by this Agreement.
IN WITNESS WHEREOF,the Parties have caused this Agreement to be executed as of
the date written above.
BOARD OF COUNTY COMMISSIONERS
ATTEST: •,.,,1 OF COLLIER COUNTY, FLORIDA
DWIGHT K'lROCK,.'N"lerk
By: Vii►/
Ati--(2.4-^- \ By: 77
Deputy Clerk dip Penny or, Chai or
Attest as to Chair 's'
signature only.
GROUP: Lozano's Restaurant & Sports
Bari, c.
I
By:
Name 1 rint). 1 !W'
, , 1 C Z
Title (print): f)'V-n e
Phone# (day): c.3' — WI, ',NI
Phone#(night): 237_ VI- 11%5
Approved as to form
and leality:
IV
Scott A. tone, Ab 4/r-/..li7
Assistant County Attorney
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