Backup Documents 06/14-15/2011 Item #16K6
ORIGINAL DOCUMENTS CHECKLIST & ROUTING L& K 6
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 hand delivered to the Board Office, The completed routing slip and original
documcnts are to bc forwarded to the Board OlTice 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
exce tion of the Chairman's sianature, draw a line throu h routin lines #1 throu h #4, com lete the checklist, and forward to Sue Filson (line #5 ,
Route to Addressee(s) Office Initials Date
(List in routin order)
I.
2.
3.
4. Colleen M. Greene, ACA
County Attorney
eM€;
06/14/11
5. Ian Mitchell, BCC Executive Manager
fe/tr tf
Board of County Commissioners
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 Sue Filson, need to contact staff for 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 Colleen M. Greene, ACA Phone Number 252-8400
Contact
Agenda Date Item was June 14,2011 Agenda Item Number 16-K-6
Approved by the BCC
Type of Document Partial Release of Property Damage Claim Number of Original I
Attached (Mudge) Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is appropriate.
Yes
(Initial
CMG
N/A (Not
A licable)
1.
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 ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's signature and
initials are re uired,
In most cases (some contracts are an exception), the original document and this routing slip should be
provided to Ian Mitchell in the BCC {)ffice within 24 hours of BCC approval. Some documents are
time sensitive and require forwarding to Tallahassee within a certain time frame or the BCe's actions
are nullified. Be aware of our deadlines!
The document was approved by the BCC on 06/14/11 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.
Please return one executed co to Colleen M. Greene, ACA
CMG
2.
N/A
3,
CMG
4.
CMG
5,
N/A
6,
CMG
7
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
<<matter _ n umbem/ <<document_number>>
16K 6
MEMORANDUM
Date:
June 16,2011
To:
Colleen Greene, Assistant County Attorney
County Attorney's Office
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Partial Release of Property Damage Claim (Mudge)
Attached for your records is a copy of the document referenced above
(Item #16K6) approved by the Board of County Commissioners on June 14,2011.
The original will be kept in the Minutes and Records Department for the
Board's Official Record.
If you have any questions, please call me at 252-8406.
Thank you.
Attachment
16K 6
PARTIAL RELEASE OF PROPERTY DAMAGE CLAIM
Claim Number: 0277428710101014/1314
The BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, in
consideration of the payment of TWO THOUSAND ONE-HUNDRED and no/lOOths Dollars
($2,100.00) hereby gives and grants a release, and waives any further claim against and to
GEICO INSURANCE COMPANY, and a Partial Release to KIM CHRISTINE MUDGE n/k/a
KIM SHUBERT, to the amount set forth herein for the property damage claim arising o>>tofthe
motor vehicle accident that occurred ~in Naples, Florida on or about the~ day of
A~~af)' 200f involving the insured KIM CHRISTINE MUDGE n/k/a KIM SHUBERT, insured
with GEICO INSURANCE COMPANY.
. It is expressly understood that said KIM CHRISTINE MUDGE n/k/a KIM SHUBERT shall
remain liable to BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA
for the remainder of its damages in the amount of THREE THOUSAND ONE-HUNDRED
TWENTY-TWO and 09/100ths Dollars ($3,122.09), for which KIM CHRISTINE MUDGE
n/k/a KIM SHUBERT has heretofore agreed to pay. *
It is also understood, that upon payment by GEICO INSURANCE COMPANY of the
aforesaid amount of TWO THOUSAND ONE-HUNDRED and no/lOOths Dollars ($2,100.00),
GEICO INSURANCE COMPANY will have no further obligation to pay any further damages
due to the above-described accident.
Each party to this Partial Release is responsible for their own attorneys' fees and costs, if
any.
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BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Colleen Greene.
Assistant County Attorney
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