Backup Documents 05/08/2018 Item #16F5 I ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
40
�� d✓" ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
�,�-,., TO 6 F 5
�
IS 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
aLe '4AA Scan.bvtu c. `,
1
2.
3. County Attorney Office County Attorney Office , 3 Si ISIIE
4. BCC Office Board of County
Commissioners J 5-I5-
5. Minutes and Records Clerk of Court's Office ��;>S
s-lsrlg
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 � APhone Number
Contact/ Department 34 C. 7
Agenda Date Item wasAgenda Item Number I [
Approved by the BCC 1-k 4t % 1"' s I L , Ft 5
Type of Document ��.Se. t - V E..\ V Number of Original
Attached Ot Q�Q„S�W 0k Documents Attached a
PO number or account ei(O a d ban1
number if document is C7�
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whi er t`s_-- Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? iziil.1A-N p a /V/A-
2. Does the document need to be sent to another agency for additions signatures? f yes, N
provide the Contact Information(Name;Agency;Address;Phone)on an attached et. /A
3. Original document has been signed/initialed for legal sufficiency. ( ents to be �
signed by the Chairman,with the exception of most letters,must be reviewed and signed �.aA3
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 J
5. The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final negotiated contract date whichever is applicable. 0-C._.1‹.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required. J
7. In most cases(some contracts are an exception),the original document and this routing slip
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 /f/`A
time frame or the BCC's actions are nullified. Be aware f your deadlines!
8. The document was approved by the BCC on-i'-hi. d all changes made during the
meeting have been incorporated in the attached document. The County Attorney's s -Ci-b B
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 the ', a0
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
INSTR 5556827 OR 5510 PG 814
RECORDED 5/16/2018 11:18 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00
RELEASE OF LIEN
JOB CREATION INVESTMENT PROGRAM AGREEMENT 16 F 5
KNOWN ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA ("COUNTY") is the owner and holder
of a certain lien against real property owned by:
ANCHOR HEALTH CENTERS, P.A., AND NAPLES INVESTMENT GROUP, LLC
(collectively the "EMPLOYER").
and described as:
Lot 10, EDISON VILAGE, a subdivision according to the map or plat
thereof recorded in Plat Book 43, pages 76-77, in the Office of the Clerk of
the Circuit, Collier County, Florida. ("PROPERTY")
The EMPLOYER is the beneficiary of financial relief for eligible targeted industry paid by the
COUNTY pursuant to the terms of the Job Creation Investment Program Agreement, recorded
on January 22, 2009 in Official Records Book 4421, Page 4106 in the Official Records of Collier
County, State of Florida ("Agreement"). The lien secures the sum of $80,000 and imposes
certain obligations against the PROPERTY.
COUNTY, by execution of this Release of Lien, acknowledges satisfaction of the terms of the
Agreement as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release of Lien in the Official
Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
DWIGHT E, BROCK, CLERK COLLIER CO i Y FLORID
_ By:
Attest as to�ar�ati se ,Deputy Clerk ANDY SOLIS, CHAIRMAN
� �
egnii:Urrorliy.
Approved as to form and legality:
JenmferBelpedio Q-
Assistant County Attorney
Page 1 of 1
INSTR 5556828 OR 5510 PG 815
RECORDED 5/16/2018 11:18 AM PAGES 1
DWIGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
REC$10.00
RELEASE OF LIEN
ADVANCED BROADBAND INFRASTRUCTURE INVESTMENT PROGRAM 16 F 5
AGREEMENT
KNOWN ALL MEN BY THESE PRESENTS: That the BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA("COUNTY")is the owner and holder of
a certain lien against real property owned by:
ANCHOR HEALTH CENTERS, P.A., AND NAPLES INVESTMENT GROUP, LLC
(collectively the "EMPLOYER").
and described as:
Lot 10, EDISON VILAGE, a subdivision according to the map or plat thereof
recorded in Plat Book 43,pages 76-77,in the Office of the Clerk of the Circuit,
Collier County, Florida. ("PROPERTY")
The EMPLOYER is the beneficiary of approved business project system installation or upgrade
paid by the COUNTY pursuant to the terms of the Advanced Broadband Infrastructure Investment
Agreement,recorded on January 22,2009 in Official Records Book 4421,Page 4093 in the Official
Records of Collier County, State of Florida ("Agreement"). The lien secures the sum of
$25,000.00 and imposes certain obligations against the PROPERTY.
COUNTY, by execution of this Release of Lien, acknowledges satisfaction of the terms of the
Agreement as satisfaction of the lien and hereby cancels and releases said lien.
The Clerk of the Circuit Court is hereby directed to record this Release of Lien in the Official
Records of Collier County, Florida, to acknowledge that the lien ceases to exist.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
DWIGHT E. BROCK, CLERK COLLIER CO , FLORID
•
By: ,
,� , Deputy Clerk ANDY SOLIS, CHAIRMAN
Atter -;Vit/man .,
tignar.Anfits
Approved as to form and legality:
Jennifer Belpedio A�\
Assistant County Attorney �
Page 1 of 1
16F5
FORM 8B MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOARD,COUNCIL,COMMISSION,AUTHORITY,OR COMMITTEE
Solis,Andrew I. Collier County Board of County Commissioners
MAILING ADDRESS THE BOARD,COUNCIL,COMMISSION,AUTHORITY OR COMMITTEE ON
3299 East Tamiami Trail, Suite 300 WHICH I SERVE ISA UNIT OF:
CITY COUNTY 0 CITY al COUNTY 0OTHER LOCAL AGENCY
Naples Collier NAME OF POLITICAL SUBDIVISION:
Collier County
DATE ON WHICH VOTE OCCURRED MY POSITION IS:
May 8,2018 pl( ELECTIVE ❑ APPOINTIVE
WHO MUST FILE FORM 8B
This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board,council,
commission,authority,or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of
interest under Section 112.3143, Florida Statutes.
Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending
on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before
completing and filing the form.
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which
would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on
a measure which would inure to the special gain or loss of a principal (other than a govemment agency) by whom he or she is retained
(including the parent, subsidiary,or sibling organization of a principal by which he or she is retained);to the special private gain or loss of a
relative;or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies(CRAs)under
Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited
from voting in that capacity.
For purposes of this law, a "relative" indudes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in-law.A"business associate" means any person or entity engaged in or carrying on a business
enterprise with the officer as a partner,joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation
are not listed on any national or regional stock exchange).
ELECTED OFFICERS:
In addition to abstaining from voting in the situations described above,you must disclose the conflict:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are
abstaining from voting;and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the
minutes of the meeting,who should incorporate the form in the minutes.
APPOINTED OFFICERS:
Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise
participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision,
whether orally or in writing and whether made by you or at your direction.
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN:
• You must complete and file this form (before making any attempt to influence the decision)with the person responsible for recording the
minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2)
CE FORM 8B-EFF.11/2013 PAGE 1
Adopted by reference in Rule 34-7.010(1)(f),F.A.C.
16F5
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immediately to the other members of the agency.
• The form must be read publicly at the next meeting after the form is filed.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your conflict in the measure before participating.
• You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the
meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the
agency,and the form must be read publicly at the next meeting after the form is filed.
DISCLOSURE OF LOCAL OFFICER'S INTEREST
Andrew I. Solis hereby disclose that on May 8 , 20 18
(a)A measure came or will come before my agency which(check one or more)
inured to my special private gain or loss;
inured to the special gain or loss of my business associate,
inured to the special gain or loss of my relative, ;
inured to the special gain or loss of a client of my law firm by
whom I am retained;or
inured to the special gain or loss of ,which
is the parent subsidiary,or sibling organization or subsidiary of a principal which has retained me.
(b)The measure before my agency and the nature of my conflicting interest in the measure is as follows:
On May 8,2018,the Board of County Commissioners will consider Agenda Item 16-F-5,a recommendation to
approve a Release of Lien for the Job Creation Investment Program and Broadband Infrastructure Investment
Agreements with Anchor Health Centers P.A.and Naples Investment Group LLC.
Naples Investment Group LLC, is a client of my law firm, and in the abundance of caution, I will abstain from
voting pursuant to Section 286.012, Fla. Stat.,to avoid any perceived prejudice or bias.
If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer,
who is also an attorney, may comply with the disclosure requirements of this section by disclosing t) nature of the,interest in such a way
as to provide the public with notice of the conflict,
r
May 8, 2018
Date Filed Signature
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT,
REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A j
CIVIL PENALTY NOT TO EXCEED$10,000.
CE FORM 8B-EFF.11/2013 PAGE 2
Adopted by reference in Rule 34-7.010(1)(f),F.A.C.