Backup Documents 05/10/2011 Item #16C 1
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper, Attach to original document. Original documents should be hlllld delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only ~ the Board has taken action on the item,)
ROUTING SLIP
Compl,ete routing ~ tJ 1 ~ugh #4 as 8Pprop~iate for additio~al s~gnatures, dates, and/or information nee~ If the docUl'JllC.QJ: is Il!rotldy ~~. ~ fhl,.
exec. tiOll.ofthc ChlWman's ture, draw a lme through routing hnes #1 through #4, com lete the checklifi,lIIld furwmod to Sue PiIIoJa (1iIiot# .;J;. ..
R.oute~Mdressee(s) Office Initials D~;
(List in rolltlll order
1.
2.
3.
4.
5. Ian Mitchell, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk ofCoUTt's Office
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PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCe approval. Normally the primary contllCt is the person who erefll:etft
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contllCt sl:llfffor
information, All original documents needing the BeC Chairman's signature are to be delivered to the BCC office only after the ace Ms
item..
Name of Primary Staff Alicia Abbott
Contact
Agendtl.Date Item was May 10,2011
A.. vedb theBCC
'I'ypeof Document
Atmclled
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a fO nate.
1. OrigWal docwnent has been signed/initialed for legal sufficiency. (All docwnents 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
Cha.irnJ.an and Clerk to the Board and ossibl State Officials.
2. All handwritten strike-through and revisions have been initialed by the County Attorney's NfA
Office md all other ames exce t the BCC Chairman and the Clerk to the Board
3. The Cb.!1irman's si,gwrture line date has been entered as the date ofBCC approval of the Yes
document or the final negotiated contract date whichever is a lieable.
4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's Yes. '.
si wu:ure and initials are re uired.
5. In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Ian Hamilton in the BCe office within 24 hours ofBCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the Bee's actions are nullified. Be aware of your deadlinesl
6. The document WWl approved by the Bee on Mav 10. 2011 {enter date) and all
changes made during the meeting have been incorporated in the attached doeument
The Coun Attorne'8 Office has reviewed the chan es, if a licable.
Phone Number
Agenda Item Number
FDEP Certification of Financial
Responsibility FOnD
Number of Original
Documents Attached
~.
16Ci
2
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I: Forrnsl County Forms! Bec Forms! Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2,24,05
16 Cl
MEMORANDUM
Date:
May 13, 2011
To:
Alicia Abbott, Project Manager
PUED
From:
Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re:
FDEP Certification of Financial Responsibility Form
Enclosed please find two (2) original documents, as referenced above,
(Agenda Item #16C1), which was approved by the Bo.ard of County
Commissioners on Tuesday, May 10, 2011.
If you should have any questions, please call me at 252-8411.
Thank you.
Enclosures
16 Cl
CERTIFICATION OF FINANCIAL RESPONSIBILITY
The Collier County Board of Commissioners, a unit of local government of
the State of Florida, hereby certifies that it has unconditionally
obligated itself to have the financial resources necessary to close,
plug, and abandon its Class I underground injection well(s) and related
monitoring wells, as required by Chapter 62-528, Florida Administrative
Code, It is further understood that the cost estimate to conduct
plugging and abandonment, established on February 7, 2011, shall be
reviewed on an annual basis and this obligation shall incorporate
accumulated inflation costs. An annual adjustment exceeding 10 percent
in anyone year shall require submission of an updated certification
form.
List of Injection Wells Covered By This Agreement:
well list the following information)
(for each injection
Facility Name:
South County Regional Water Treatment Plant
Facility Address:
3851 Utilities Drive, Naples, FL
Facility Contact:
Steve Messner
Phone Number:
(239) 252-6937
Latitude/Longitude of Injection Well:
26*09'52"N / 81*40'58"W
DEP/EPA Identification Number: FLS 173528-003 & 004-UO
Current Plugging and Abandonment Cost Estimate: $731,578
It is hereby understood that the cancellation of this certification may
not tak~.plaG~ without the prior written consent of the Secretary of the
Florida:.(~p}irp'ment of Environmental Protection.
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BY:"'~' L ~~
" ...t,es,t..I'S~.~~na4fF~
:l1g6a€ii~t";:~ I of
STATE OF FLORIDA)"
COUNTY OF COLLIER)
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Acknowledged before me this ~day of n~ , 2011, by Fred W. Coyle,
known to me to be the Chairman of the ~of County Commissioners of
Collier County, Florida. By, A I ~ ~ ~
Approved as to form and Notar~
legal sufficiency:
BOARD OF COUNTY
COLLIER COUNTY,
By:
By:
Jenni~r~~i~
Assistant County Attorney
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