Backup Documents 10/24/2017 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 0 4
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 arc 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.
** g-r-��� /0/ lA
NEW** ROUTING SLIP fDD r 24,
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 c c ,4 O (2' 1)7
4. BCC Office Board of County Commissioners
/
5. Minutes and Records Clerk of Court's Office �(26(`01 2 3 f r
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the vent one
of the addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Joshua Thomas/Tessie Sillery Phone Number 252-8989 or 252-584
Contact/ Department PTNE Division ld ATM Dept)
Agenda Date Item was 10-24-2017 1r,! Agenda Item Number 16 D 4(3794)
Approved by the BCC
Type of Document FDOT—JPA Time Extension Agreement Memo Number of Original 1
Attached -FTA Section 5339-Rural Documents Attached
PO number or account
number if document is to Fed Ex
be recorded
Also please email a copy to ioshuathomas/lcolliergov.net &tessiesilleiy c colliergov.net
Special instructions:
Please Fed Ex;(One Original)
Pamela Barr
Transit Projects Coordinator
Florida Department of Transportation
10041 Daniels Parkway
Fort Myers,FL/33913
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the plicable column,whichever is appropriate. Yes N/A(Not
(I ' 'al) Applicable)
1. Does the document require the chairman original ignature? JT
2. Does the document need to be sent to another agency for additional signatures? If yes,provide JT
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 JT
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 f2
5. The Chairman's signature line date has been entered as the date of BCC approval of the document JT
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 JT
and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JT
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 10-24-2017 and all changes made during the N/A is not an
meeting have been incorporated in the attached document. The County Attorney's Office 411 option for
has reviewed the changes,if applicable. . -tr j this line.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all (1 N/A is not an
changes directed by the BCC have been made,and the document is ready for the Chairman's o(`wJV option for
signature. a`✓ this line.
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
160 4
County of Collier
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY CQURTHO\JSE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock- CleiIc,'pf Circuit Court P.O. BOX 413044
NAPLES,FL 34112-5324 1 NAPLES, FL 34101-3044
Clerk of Courts • Comptroller • Auditor • Custodian of County Funds
October 26, 2017
FDOT
Attn: Pamela Barr
Transit Projects Coordinator
10041 Daniels Parkway
Fort Myers, Florida 33913
Re: Time Extension, Financial Project Number: 437520-1-94-01
Contract Number: G0015, Proj. FTA Section 5339-Rural
Transmitted herewith is the original referenced document for your records per
request, as adopted by the Collier County Board of County Commissioners of
Collier County, Florida on Tuesday, October 24, 2017, during Regular Session.
Please forward/e-mail a copy of the fully executed aformentioned documents to
(martha.vergara@collierclerk.cotn) for the Boards Official Records.
Very truly yours,
DWIGHT E. BROCK, CLERK
.Th(\,uu‘—‘-- ir
' ,C
%.,‘
Martha Vergara, Depu Cler'
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
■ 160 4
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1 6 D 4
FD0T
Florida Department of Transportation
ItI('K StOIT 801 North Broadway MILL 10,:
GOVERNOR narrow. 11, 3.1830 SLURP:I MO
DATE: September 25, 2017
TO: Michelle Arnold, PTNE Director
FROM: Paul A. Simmons, District Modal Development Administrator
SUBJECT: Time Extension
Financial Project Number: 437520-1-94-01
Contract Number: G0015
Agency: Collier County Board of County Commissioners
Project Description: FTA Section 5339-Rural
The time allotted for the completion of services or goods on the subject agreement dated June 23,
2015 and any supplementals thereto will expire on December 31, 2017.
In accordance with Section 18.00 of the Joint Participation Agreement, a time extension may be
requested. Please complete, sign, date and return this form to me.
It is requested that the Joint Participation Agreement for the subject project be extended until
December 31, 2019.
The reason for the Time Extension request must be included in a letter to the Department from
the Director/Manager/CEO of the organization. A detailed summary of the reason for the Time
Extension and a schedule for completing the project must be included. Time Extensions will
not be granted for billing purposes if the project is complete.
Collier County Board of County Commissioners
RECOMMEND FOR APPROVAL:
AGENCY
SIGNATO PRINTED OR TYPED) DISTRICT MODAL DEVELOPMENT ADMINISTRATOR
SIGNATURE APPROVED:
TITLE DISTRICT SECRETARY OR DESIGNEE
Date: Date:
- Approved as to form and legality
ITPIIGI-ft i- OriciCK, "1Vat"k�
www.dot.slate.ILus 'Si,
11 i` ,. '" Assistant County
Attest as to Ch• airrri., oN
sianaturo nnly.