Backup Documents 03/28/2017 Item #16A14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 A 14
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 � � y �Z
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 JAK 4/10/17
4. BCC Office Board of County '\'
Commissioners y'/C) 4k`\\\`A
5. Minutes and Records Clerk of Court's Office
C(1 Luditi 2:31Q,-
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 Liz Gosselin,G D Phone Number 252-5867
Contact/Department
Agenda Date Item was 3/28/17 Agenda Item Number 16-A-14
Approved by the BCC
Type of Document Change Order 1 to DEP Agreement No. Number of Original Two
Attached S0859 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 JAK
2. Does the document need to be sent to another agency for additional signatures? If yes, JAK
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 JAK
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 JAK
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 JAK
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 JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JAK
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 JAK
meeting have been incorporated in the attached document. The County Attorney's iso-
Office has reviewed the changes,if applicable. — 'Cs;
9. Initials of attorney verifying that the attached document is the version approved by the Zy"RV.,_•
BCC,all changes directed by the BCC have been made, and the document is ready for the n P ` _€ z-
Chairman's signature. �V
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 4
1
, - - _ telti
County--of colli` r
CLERK OF THE CICU . COURT
COLLIER COUNTY C( 1RTHO SE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock-Clem f Circuit Court
P.O. BOX3044
NAPLES,FL 34112-5324 i NAPLES,FL 341011-3044
1
Clerk of Courts • Comptroller • Auditor • as odian of County Funds
April 12, 2017
FDEP
Attn: Tom Edwards, Environmental Specialist
Division of Water Restoration Assistance
Clean Water Stat Revolving Fund
Douglas Building
3900 Commonwealth Blvd.
MS-3505
Tallahassee, Florida 32399-3000
Re: DEP Agreement No. S0859, Change Order No. 1 — Collier County
Transmitted herewith are two (2) originals of the above referenced document for your
records per request, as adopted by the Collier County Board of County Commissioners of
Collier County, Florida on Tuesday, March 28, 2017, during Regular Session.
Please forward an original of the fully executed to Board Minutes and Records
Department in the envelope provided; it will be kept as part of the Board's Official
Records.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara, De. y Cler
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com collierclerk.com
1
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DEP AGREEMENT No. S0859
CHANGE ORDER No. I
Collier County
This agreement entered into on the 1st day of June,2016 is hereby revised as follows:
WHEREAS,the Department's Grant Manager requires update.
NOW,THEREFORE,in consideration of the mutual benefits to be derived herefrom,the
DEPARTMENT and the GRANTEE do hereby agree as follows:
1. Paragraph 17 of the Agreement is deleted and replaced as follows:
The Department's Grant Manager for this Agreement is identified below.
Tom Edwards
Florida Department of Environmental Protection
3900 Commonwealth Blvd.MS#3505
Tallahassee,Florida 32399
Phone:(850)245-2968
Email: Tom.Edwards@dep.state.fl.us
Any changes to the contact information shown above must be reduced to writing in the
form of a Change Order to this Agreement.
2. All other terms and conditions of the Agreement shall remain unchanged.
IN WITNESS WHEREOF,the parties have caused these presents to be duly executed,the
day and year, last written below.
FLORIDA DEPARTMENT OF
,� ENV/KN)NMENTrAiL PROTEC ION
itgt. 1 BY.
Penny Taylor,Chairw(an Proi,rAdministrator
f
Date: March 28, 2017 Date: ` ^D s -i-7
FEID No. 59-6000558
Tom Edwards,DEP Grant Manager
ATTEST:
DWIGIT ROCK.CLERK
Approved i it, orm and legality ` -
° ur.
Jeffrey A.K. County Attorney St as t0'��181fttldil'S
DEP Agreement No. S08 , hange Order No 1,Page 1 of 1