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Backup Documents 03/27/2018 Item #16D17 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 0 1 7 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 2. 3. County Attorney Office County Attorney Office ,, ^ „ 3'-2--)11 4. BCC Office Board of County Commissioners i\S JN s 3.018• t' 5. Minutes and Records Clerk of Court's Office 3 f t f('8 aii615?"1 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 Joshua Thomas/Tessie Sillery Phone Number 252-8989 or 252-5840 Contact/ Department PTNE Division(ol ATM Dept) Agenda Date Item was 03-27-2018 Agenda Item Number 16 D17 (#5058) Approved by the BCC Type of Document FYI 7 FTA Grant #5307 revised pages / Number of Original 1 Attached V Documents Attached PO number or account number if document is to See attachment- Memo ✓ be recorded Special instructions: email a copy to ;joshuathomas(;colliergov.net &tessiesillery(iP,colliergov.net INSTRUCTIONS&CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not Initial) Applicable) 1. Does the document require the chairman' original ignature? 2. Does the document need to be sent to another agency for additional signatures? If yes,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 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 5. The Chairman's signature line date has been entered as the date of BCC approval of the document Nips or the final negotiated contract date whichever is applicable. f 1 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip A` I should be provided to the County Attorney Office at the time the item is input into SIRE. Some \V 1A - 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 03-27-2018 and all changes made during the � QQ meeting have been incorporated in the attached document. The County Attorney's Office �,W`� V� has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all ` /p 4 s changes directed by the BCC have been made,and the document is ready for the Chairman's /eNct , ttu y« , 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 1601 7 Coi y.9f Collier CLERK OF THE CIRC IT COURT COLLIER COUNTOUR OUSE 7 3315 TAMIAMI TRL E STE 102 Dwight E Bros Clerk of Circuit Court P.O.BOX 413044 NAPLES,FL 34112-5324 NAPLES,FL 34101-3044 Clerk of Courts • Comptroller • Audito Ostodian of County Funds March 29, 2018 FDOT, District One Mail Station 1-39 801 North Broadway Avenue Bartow, FL 33830 Ms. Michelle Peronto, Enclosed you will find one (1) original and four (4) copies of revised FY17 5310 g p Grant Application approved by the Board of County Commissioners on Tuesday, March 27, 2018. If you have any questions, please contact me at 239-252-8411. Thank you, C9c4A5.1 Yet Teresa Cannon, Senior Deputy Clerk Minutes & Records Department Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerk@collierclerk.coln 16017 FedEx x w Num6aPackage Fea m Express US Airbill 810 7 0 7 5 8 4 5 7 3 D Na 0 2 0 0 P1 From Pkuspimand lord 4 Express Package Service .T nrozlacelian. Packages up to 150 lbs. forpackeges over ISOM.use the 1A 3 rL(T k Ca Sender's Fed& red&c:p,.rar igArusAirfiilf Date /�'l C� A1cAco�um�Nnum^be(r� E Sender's Twr^1�..q�i`,M c FedEx First Ovemight FedEx 20ay A.M. L..J Name LT,�IUUI. Phone I Earliest nee byS/p horningdeliaakaredect L_i Second IS —.. !craw.idY shipments delivered on Saturday DeliveryNOT S YA. � Monday Saturday Oni r elected. Ll�'C , -� ..�}YY ❑ C1 ht W� FedEx PnO Overnight FedEx 20ay company Nestbu yu Fid a MM�onaverr ba S db h Tllesa Saturday ms = r7ioa ^_ daMratlmMoMeyvnless Saturday Delivery wig be delivered on Monday unless SBNldw ,r LI J co . esdected. Delivery is selected. C IC cM'a, 3 —99 �glvt A/1 IAA e .f • FedEx Standard Overnight FedEx Express Saver R m Address Vt�l.e•'til ❑ Saturday lord• LI todO Exprdes z V0�/ Saturday Delivery NOT evadable. Sates a, available. 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Hold Saturday �Lj No L.]Aaac r anaahed LJ yslel ."Declera6an ❑Dryc0ce a r.dEalec.ti.nedere:: snipaero Deeluatian. required art •auN IN--• W t Address �� ❑aaD1R° Raasssooaa**for nods—see die eapentredEsSemloeG.Ne. ❑CargoAircrahOnly faAaStI.y Daemm�pMeerd pPA' Aeio�sg u..si•. so,MOLD location address or for cenlinvelion your shipping address, redEsIDal m selectkcaoms. Z `/A7)I ` 'CAs�)2d}��+ Q� 7 Payment stilts City ` ""'�--" __ State ZIP /U (xJ __ &Ward rAcetNo.acleatCm!No.lww. 1 `c Send r a . ❑A"`^roa"S""°n ❑Recipient Li Third Party ❑CreditCard ❑Cash/Check s webe Ned. riii FeaiAcetwn n Oaarad No Ode Total Packages Total Weight Total Declared Value, c Shipit.Track it. Pay for it.All online. tD li bglryla USSIDaun y dedveahigh e.Seebadf dml.Byusingthhairbalyou 6 4 4 Go to tedex.com. t'ti roteit ourlbbgd conditions ant beck oftis.451 d tlecoma F dEsS.ice Guide.including terms Rev Date XIS•Part 0167001•0212Zr15 fedEa•PAINTED IN 3 SA.WA MWD 16017 MEMORANDUM Date: March 29, 2018 To: Joshua Thomas, Grants Support Specialist Grants Management Office From: Teresa Cannon, Sr. Deputy Clerk Minutes & Records Department Re: Revised FY17 5310 Grant Application Attached, for your records, please find a scanned copy of the document as referenced above, (Item #16D17) adopted by the Board of County Commissioners on March 27, 2018. The Minutes and Record's Department has submitted the original and 4 copies (per your request) to FDOT and will keep a copy for the Board's Official Records. If you have any questions, please contact me at 252-8411. Thank you. Attachment MEMORANDUM 16 D 1 7 Date: March 29, 2018 To: Tessie Sillery, Operations Coordinator PTNE Division From: Teresa Cannon, Sr. Deputy Clerk Minutes & Records Department Re: Revised FY17 5310 Grant Application Attached, for your records, please find a scanned copy of the document as referenced above, (Item #16D17) adopted by the Board of County Commissioners on March 27, 2018. The Minutes and Record's Department has submitted the original and 4 copies (per your request) to FDOT and will keep a copy for the Board's Official Records. If you have any questions, please contact me at 252-8411. Thank you. Attachment 1 6 D 1 7 OMB Number:4040-0004 Expiration Date:8/31/2016 Application for Federal Assistance SF-424 1.Type of Submission: •2.Type of Application: "If Revision,select appropriate letter(s): Preapplication ®New ®Application El Continuation *Other(Specify): E Changed/Corrected Application 111 Revision *3.Date Received: 4.Applicant Identifier: 5a.Federal Entity Identifier: 5b.Federal Award Identifier: State Use Only: 6.Date Received by State: 7.State Application Identifier: 1001 8.APPLICANT INFORMATION: *a.Legal Name: Collier County Hoard of County Commissioners *b.EmployerfTaxpayer Identification Number(EIN/TIN): *c.Organizational DUNS: 59-6000558 0769977900000 d.Address: •Streetl: 3299 East Tamiami Trail 11103 Street2: *City: Naples County/Parish: "State: FL: Florida Province: *Country. USA: UNITED STATES *Zip/Postal Code: I3,.1 1.2 e.Organizational Unit: Department Name: Division Name: Publ.icTransit&NBHD Enhancement Public Services f.Name and contact information of person to be contacted on matters involving this application: Prefix: Mrs *First Name: yousi Middle Name: *Last Name: Cardeso Suffix: Title' Operations Analyst Organizational Affiliation: Employee "Telephone Number: 239-252-5886 Fax Number: 239-252-6754 *Email: yousi.cardeso@colliergov.net OOP 1 6 0 1 7 Application for Federal Assistance SF-424 *9,Type of Applicant 1:Select Applicant Type: 13: County Government Type of Applicant 2:Select Applicant Type: Type of Applicant 3:Select Applicant Type: Other(specify): *10.Name of Federal Agency: Federal Transit Administration 11.Catalog of Federal Domestic Assistance Number: 20.513 CFDA Title: Formula Grants for the Enhanced Mobility of Senior and Individuals with Disabilities *12.Funding Opportunity Number: *Title 13.Competition identification Number: Title: 14.Areas Affected by Project(Cities,Counties,States,etc.): Community of Immokalee, Naples, Marco Islan Add Attachment Delete Attachment View Attachment *15.Descriptive Title of Applicant's Project: Capital Assistance for replacement of paratransit vehicles that have outlived their useful life. Attach supporting documents as specified in agency instructions. Add Attachments Defoe Aitachmunt!,; Vir'w Atlaclitnonts •-) 16D17 Application for Federal Assistance SF-424 16.Congressional Districts Of: 'a,Applicant 19&25 •b.Program/Project f Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Vir:w Ailar.hmr:ni 17.Proposed Project: `a.Start Date: 10/01/201.7 "b.End Date: 09/30/2019 18.Estimated Funding($): 'a.Federal 276,737.00 "b.Applicant 45,569.00 'c.State 34,592.00 d. Local `e.Other f. Program Income *g.TOTAL 356,0913.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? LI a.This application was made available to the State under the Executive Order 12372 Process for review on ® b.Program is subject to E.O. 12372 but has not been selected by the State for review. c.Program is not covered by E.O. 12372. *20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) Yes ®No If"Yes",provide explanation and attach "•aJd:�tlariuruail I lclrlc',VBrit hnicrnt Vio„)All,Irl,tiwi 21.*By signing this application,I certify(1)to the statements contained in the list of certifications`*and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ►� ** I AGREE " The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix; Mr. `First Name: Andy Middle Name: *Last Name: Solis Suffix: Title: Chair 'Telephone Number: 239-252-8604 Fax Numb- : 'Email: Andy.Sol.is@coiliercountyfl.gov 'Signature of Authorized Representative:9 p � 'Date Signed: 3 2/. Approved as to form and legality a � U 1,....15e)4.p 3\ Assistant County Art„,),,•,, Ste'- - an's 16017 2.10 FORM C-3: PROOF OF LOCAL MATCH Name of Applicant: Collier County Board of County Commissioners Sources and amounts of local share for the vehicles/equipment, or mobility management, being requested: SOURCE: AMOUNT: Local Funds $45,569 gnattke of authorized representative) Andy Solis, Chairman (Name and title of authorized representative) Attach documentation of vehicle match funds immediately behind this page. Proof may consist of, but not be limited to: written statements from county coin m nissions, state agencies, city managers, mayors, tow in councils, organizations, accounting firms and financial institutions. Approved as to form and legality Assistant County At ty 'P �'7.7 _ rnans ;;z Urc only, 16017 2.12 FORM C-5: CAPITAL REQUEST FORM VEHICLE REQUEST Name of Agency: Collier County Board of County Commissioners R or E (a) Quantity Description (b) Estimated www.tripsflorida.org Cost R 4 22' Standard cutaway diesel vehicles $342,898.00 Sub-total $342,898.00 (a) Replacement (R) or Expansion(E). (b) Provide a brief description including the length and type vehicle, type of fuel, lift or ramp, number of seats and wheelchair positions. For example, 22' gasoline bus with lift, 12 ambulatory seats, and 2 wheelchair positions. Do not show the Make. Any bus options that are part of purchasing the bus itself should be part of the vehicle request and NOT separated out under equipment. EQUIPMENT REQUEST If item requested is after-market, it is recommended to gather and retain at least two estimates for the equipment requested. Purchases must be approved at the local level and follow Procurement Guidelines. Number Description(c) Estimated Cost requested 4 Two-way communication mobile radios for $14,000 the cutaway vehicles Sub-total $14,000 (c) Show mobile radios and identify the type of radio (i.e. two way radio or stereo radio), computer hardware/software, etc. under"Equipment Request." VEHICLE SUBTOTAL $342,898.00+EQUIPMENT SUBTOTAL$ 14,000=$356,898.00 (x). (x)X80`% = $285,518.00 [This equals the Federal request. Show this amount on Form 424 in block 18(a).1 0 16017 2.13 FORM C-6: CAPITAL REQUEST METHODOLOGY FORM Applicant Agency Name: Collier County Board of County Commissioners Contact Person: Yousi Cardeso, Operations Analyst, 239-252-5886, yousicardesotchcoIliergov.net (Name, Title,Telephone Number, and Email) Vendor Name and Contact info: Les Burres, Creative Bus Sales, 904-241-6004 (Vendor, Dealer's Name, Telephone Number) Contract #: Brief Vehicle Description: 4—22' diesel standard cutaways with lift, 14 ambulatory seats and 6 wheelchair positions (Example: 3—22'gas cutaways with lift, 12 ambulatory seats and 2 wheelchair positions) Price Estimation Table: Select only options available in the contract you are interested in. If there are no choices selected on any given row, we understand that you do not need that option. Computer users — the rows in yellow have formulas to calculate totals. To make the formulas work, first fill out the columns of unit cost $ and quantity # and then right click in the yellow cell and click Update Field. II 1bD17 Items Unit Cost x Quantity Unit Cost Quantity (Total Cost) Base Vehicle Type(Make,Model, Size/Length) 64,615Mill $258,460.00 wirtVehicle Description: Chevrolet 14200 23' TSSRVI ���� Floor Plan: Seat Manufacturer Name: :- Floor Plan/Ambulatory Seats: May choose more than one type of seat if needed. Standard Seat: 372.00 8 2,976.00 Foldaway Seat: 507.00 24 12,168.00 7765 =IIII 31,060.00 Securernent Systems: 4,280.00 Wheelchair Securement: 535 8 Seat Belt Extensions: 0 No © Yes, if yes quantify 26 8 208.00 Stretcher Securement:❑ No 0 Yes, if yes quantify Wheelchair Lift(Include Vendor Name and Cost): 325.00 4 1,300.00 ; un Engine Type: Diesel 3.2 L 7,411.00 4 29.646.00 Paint Scheme: 0 No ®Yes, if yes quantify 700 4 2,800,00 Vehicle Subtotal: $342,898.00 Title VI Notice Signs/Plaques: Equipment: 14,000 Ell Other: Cameras and other options 3500 Equipment: Other: Equipment Subtotal: 14,000.00 Total: $356,898.00