Backup Documents 04/26/2011 Item #16D 3
ORIGINAL DOCUMENTS CHECKLIST & ROUTING t~ 0 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT Tb
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines # I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
. f h h' d I' h h . I' #1 h gh #4 I h h k1' d fi dIM' h II (I' #5)
exceptlon 0 t e C aIrman s signature, raw a me t rougl routmg mes t rou , comp ete t e c ec 1St, an orwar to an Itc e me
Route to Addressee(s) Office Initials Date
(List in routing order)
1.
2.
3.
4.
I
5. Ian Mitchell, Executive Manager Board of County Commissioners vV t/~ f>/ I(
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell, need to contact stafffor additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Nick Green, HHVS Phone Number 252-2376
Contact Grants Coordinator
Agenda Date Item was April 26, 2011 Agenda Item Number 1603
Approved by the BCC
Type of Document Agreement amendment Number of Original 3
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate.
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. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the final negotiated contract date whichever is applicable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
The document was approved by the BCC on 04/26/11 and all changes made during
the meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the chan es, if a licable.
Yes
(Initial)
NG
NI A (Not
Ap licable)
2.
3.
4.
5.
6.
nla
NG
NG
NG
NG
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
1603
MEMORANDUM
Date:
April 28, 2011
To:
Nick Green, Grants Coordinator
Housing, Human & Veteran Services
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
St. Matthew's HouseSubrecipient Agreement Amendment
for Hun Continuum of Care Grant #FL0296B4D060801
Attached are two (2) original copies of the document referenced above
(Item#16D3) approved by the Board of County Commissioners April 26, 2011.
The Minutes and Record's Department will hold the third original document in the
Board's Official Record.
If you have any questions please call me at 252-8406.
Thank you.
Attachments (2)
1603
EXHIBIT D-1 CONTRACT AMENDMENT #1 TO THE
AGREEMENT BETWEEN COLLIER COUNTY
AND
ST. MATTHEW'S HOUSE, INC.
Re: Catalog of Federal Domestic Assistance # 14.235
HUD Grant # FL0296B4D060801, PIN FL606
This Amendment, dated If ( z. ft, , 2011, to the referenced Agreement
shall be by and between the parties to the original Agreement, St. Matthew's House, Inc., a private not-
for-profit corporation existing under the laws of the State of Florida, (hereafter referred to as
"SUBRECIPIENT") and Collier County, a political subdivision of the State of Florida, (hereafter referred to
as "COUNTY").
In order to continue the services provided for in the original Agreement document referenced above,
the SUBRECIPIENT agrees to amend Exhibit "A" of the above referenced Agreement as follows:
Note: The additions to the existing language and numbers in the Agreement are shown herein by
underlining and deletions from the Agreement are shown by strikcthroughs.
EXHIBIT "A"
SCOPE OF SERVICES
ST. MATTHEW'S HOUSE, INC. - WOLFE APARTMENTS
* * * * * *
B. BUDGET:
Line Item:
CoC-SHP Funds Other:
OPERATING SERVICES:
Maintenance/Repair
Utilities-Electric, water, garbage, sewer
Equipment-replace A/C Appliances, lease
Purchase of heavy equipment for repairs
Supplies-General operating supplies
Insurance
TOTAL OPERATING SERVICES
$24,000.00 $18,000.00
$22,000.00
$2,000.00 $8.000.00
$2,500.00
$23,000.00
$73,500.00
******
All other terms and conditions of the Agreement shall remain in force.
Exhibit D-1 Contract Amendment Grant #FL0296B4D060801
St. Matthew's House, Inc.
1603
WITNESS our Hands and Seals on this
2Ct>
day of
4",,'/
I
,2011.
ATTEST:
DWIGHT E. BRf)~~, CLERK
~.-< ~ .~::...~ ..:~~ i~~
By: "
.....<.:::
BOARD OF COUNTY COMMISSIONERS OF COLLIER
COUNTY, FLORIDA
By: NW ~
FRED W. COYLE, CHAIRMAN "
First Witness
St. Matthew's House, Inc.
--~
~
Z_." da;7tC!J
BY:~~ (~.
Subrecipient Signature
~
Type/print witness name
second~~#
/1/1 elL (PI( t:eA/
.
Type/print witness name
Approved as to form and legal sufficiency:
Jen~;;~ ~
Assistant County Attorney
Exhibit D-1 Contract Amendment Grant #FL0296B4D060801
St. Matthew's House, Inc.
Item# ~
Agenda Lt...'l' ~ I
Date ~~
~=~~d ~ il (
.~..,
"I:,. ,...' .'
p ", ..
,'.."<;',;," ,,"'___c_,' ~