Backup Documents 10/25/2011 Item #16D13n'
ORIGINAL DOCUMENTS CHECKLIST & ROUTIN14R' 13
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines # 1 through #4 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 aline through routine lines # 1 through #4, complete the checklist, and forward to Ian Mitchell pine #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Lisa Oien
HHVS�
.
10/25/2011
2.Jennifer White
CAO
Agenda Item Number
to a>F A
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
4. Ian Mitchell, Executive Manager
Board of County Commissioners
6'� ay�-
Attached
5. Minutes and Records
Clerk of Courts Office
in
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 needs 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 1
Name of Primary Staff
Lisa Oien / Housing & Human Services
Phone Number
252 -6141
Contact
appropriate.
Initial
16D13
Agenda Date Item was
10/25/2011
Agenda Item Number
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Six (6) Signature Authority forms, 3
Number of Original
6'� ay�-
Attached
separate forms in duplicate all needing the
Documents Attached,�,`�
in
BCC Chairman's Original Signature
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.
51
INSTRUCTIONS & CHECKLIST
3
Z. '� C C-)
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
Initial
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
LO
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.
2.
All handwritten strike- through and revisions have been initialed by the County Attorney's
LO
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
LO
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
LO
sip-nature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
LO
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!
6.
The document was approved by the BCC on 5/25/2010 (enter date) and all changes
LO
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16013
MEMORANDUM
Date: November 4, 2011
To: Lisa Olen, Grants Coordinator
Housing, Human & Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Three Signature Authority Forms for Disaster Recovery Initiative
Grant Agreements: 07DB- 3V- 09- 21- 01 -ZO1, 08DB- D3- 09- 21- 01 -A03
and 1ODB- D4- 09- 21- 01 -K09 with Florida's DCA
Attached for State submission are two (2) duplicate original copies of the three (3)
forms referenced above, (Item #16D13) approved by the Board of County Commissioners
on October 25, 2011.
The Minutes and Record's Department will hold a copy of the three original forms for the
Board's Official Record.
If you have any questions please call me at 252 -8406.
Thank you.
Attachments (6)
Attachment K
16013 1
Department of Community Affairs
Florida Small Cities Community Development Block Grant, Disaster Recovery and Neighborhood Stabilization Programs
SIGNATURE AUTHORITY FORM
Submit an oriainal Signature Authoritv Form with each contract
Recipient
Contrail #
Funding Source
Board of Collier County Commissioners
07DB- 3V- 09- 21- 01 -ZO1
[ ] Small Cities CDBG
[X ] Disaster Recovery
Mailing Address (Street or Post Office Box)
3339 Tamiami Trail East, Suite 211
[ ] Neighborhood Stabilization
City, State and Zip Code
Local Government DUNS #
Naples, FL 34112
076997790
Project Contact Person
Telephone #
E -mail Address
Kim Grant, Director
239 - 252 -8442
kimberleygrant @colliergov.net
Collier County Housing, Human
and Veteran Services
Financial Contact Person
Telephone #
E -mail Address
Ashlee Franco, Accounting
239 - 252 -2689
ashleefranco @colliergov.net
Supervisor, Collier County Housing,
Human and Veteran Services
Requests for Funds (RFFs) require (check one); [ ] one signature ( X ] two signatures by individuals authorized below.
RFFs must be submitted via the Department's website at http://ecdtN,dca.state.fl.us/ (or by an alternative means specified by
the Department).
Typed Name -
Date --
Signature —^
Kim Grant, Director
I
i t)L7Ll-
_
[ X ] Check here if above person is authorized to submit RFFs
- - - --
E -mail Address ^ ^—
_ ____ —
kimberieygrant @colliergov.net
Typed Name
Date
1 Signature —
Ashlee Franco Accounting Supervisor,
t
[ X ] Check here if above person is authorized to submit RFFs
E-mall Ackifess
ashleefranco @collier ov.net
Typed Name
Dat
_
Signatur —
_KathlI n Larsen AccountigkTechnician
%G f
_
[ X ] Check here if above person is authorized to submit RFFs
E -mail Xddress
— -
kathleenlarsen @_ collier ov.net
_ —
Typed Name
Date Si oat
Lisa Olen, Grants Coordinator
'
— ^ - -- - -�
[ ] Check here if above person is authorized to submit RFFs E -mail Address
lisaoien @colliergov. net
I certify, as the recipient's Chief Elected Official, that the above signatures are of the individuals authorized to si Requests for
Funds and to submit RFFs electronically.
Typed Name
Date —
Fred W. Coyle, Chairman
-Signature
Board of Collier County Commissioners
[ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) from the State of Florida.
[ X ] Check here if your local government will be working on a reimbursement basis.
CDBG payments to local governments using EFT are automatically deposited in the local government's general account. If the
account is interest bearing, the CDBG funds must be transferred to a non - interest bearing account. Please call the CDBG
Program at 850/922 -1878 or 487 -3644 if you have questions. You can check the status of your deposit at the Comptroller's
website: htto: / /flair.dbf.state.fl.us /. Local governments not receiving EFT, and not working on a reimbursement basis, must
establish a non - interest bearing account. Provide account information for the financial institution (insured by FDIC) below. All
signatures on the account must be bonded.
- -- -- - - - --
-- - - -- - - -- - -- _ _ _ _
Name of Financial Institution Account Number
Fifth Third Bank — 113-8577 a
- -- - - `
Street Address or Post Office Box Telephone Number
999 Vanderbilt Beach Road 591 6397 rp
239
City, State and Zip Code
- Naples,_Florida 34108 _ -- - -- — -- - .' • + ,, e <_
AppfOVW as to form & legal 3umclency
ATTEST: April 2011
DWIGHT E. BR'gCK, Verk
By: �rtg •
Attachment K
16013
Department of Community Affairs
Florida Small Cities Community Development Block Grant, Disaster Recovery and Neighborhood Stabilization Programs
SIGNATURE AUTHORITY FORM
Submit an original Signature Authority Form with each contract
- - -- --- - - - - --
Recipient
--- - -
Contrail #
Funding Source
Board of Collier Coun Commissioners
08DB- D3- 09- -0. 1 -A03
[ ] Small Cities CDBG
Mailing Address (Street or Post Office Box)
3339 Tamiami Trail East, Suite 211
_21_ _
[x ] Disaster Recovery
[ ] Neighborhood Stabilization
City, State and Zip Code —
—
Local Government DUNS #
Naples, FL 34112
076997790
Project Contact Person
Telephone #
E -mail Address
Kim Grant, Director
239 - 252 -8442
kimberleygrant @colliergov.net
Collier County Housing, Human
and Veteran Services
Financial Contact Person
Tele hone #
E -mail Address
Ashlee Franco, Accounting
239 - 252 -2689
ashleefranco @colliergov.net
Supervisor, Collier County Housing,
Human and Veteran Services
Requests for Funds (RFFs) require (check one);
[ ] one signature [ X ] two signatures by individuals authorized below.
RFFs must be submitted via the Department's website
at http://ecdba.dca.state.fl.us/ (or by an alternative means specified by
i the De ap rtment).
Typed Name -- ____ - - - -- -- - - - - -- (-Date __— ._-- Signature --- - - - - -- ___._.------ _ -_--�
Kim Grant, Director - - - -_ --
[ X ] Check here if above person is authorized to submit RFFs E -mail Address _
Typed Name
Ashlee Franco Accounting 9 upervisor,
[ X ] Check here if above person is authorized to submit
_ kimberleygrant @colliergov.net
TDate Sign re
1
RFFs E -mail Add ess
ashleefranco @collier�qvnet
Typed Name — Date/ Signatures -
Kathleen Larsen, Accoun_ting_Technician -- _ _ /�' /�� / / /� Z
person is authorized to submit RFFs T
[ X ] Check here if above- E -mail Address
kathleenlarsen colliergov.net —
Typed Name Date Signat e
Lisa Olen, Grants Coordinator fG• /2,�/�� /
[ ] Check here if above person is authorized to submit RFFs E -mail Address
Iisaoienn colliergov.net
I certify, as the recipient's Chief Elected Official,
that the above signatures are of the individuals authorized to sign Requests for
Funds and to submit RFFs electronically.
Typed Name —
Date — Signature` --
; Fred W. Coyle, Chairman
Board of Collier Coun Commissioners
[ X ] Check here if your local government utilizes
t
Electronic Funds Transfer (EFT) from the State of Florida. —
[ X ] Check here if your local government will be working on a reimbursement basis.
j CDBG payments to local governments using EFT are automatically deposited in the local government's general account. If the
account is interest bearing, the CDBG funds must be transferred to a non - interest bearing account. Please call the CDBG
Program at 850/922 -1878 or 487 -3644 if you have questions. You can check the status of your deposit at the Comptroller's
website: hh=: / /flair.dbf.state.fl.us /. Local governments not receiving EFT, and not working on a reimbursement basis, must
establish a non - interest bearing account. Provide account information for the financial institution (insured by FDIC) below. All
sl0atures_on the account must be bonded.
Name of Financial Institution Account Number
Fifth Third Bank 113-8577 : +;
- -- — -- - -- -- - -- - -- - -- - -- -- -- �. , . r,r ._- - --
Street Address or Post Office Box Telephone Number
999 Vanderbilt Beach Road 239-591-6397 r '
City, State and Zip Code • �' `
_Naples, Florida 34108 - -- ------ - - - - -- - - - - -- - - — — _ ,
ATTEST: '� s'' - Revised April 2011
A01►rd as to form & legal Sufflclency
DWIGHT ,E. -OAbCjC,,k',
� � i►1, —r By: �' �� A0 cNi t"M •
Attachment K
16013
Department of Community Affairs
Florida Small Cities Community Development Block Grant, Disaster Recovery and Neighborhood Stabilization Programs
SIGNATURE AUTHORITY FORM
Submit an original Signature Authority Form with each contract
Recipient
I Contract #
Funding Source
Board of Collier Coun Commissioners
I 10DB- 134- 09- 21- 01 -09
[ ] Small Cities CDBG
[X ] Disaster Recovery
Mailing Address (Street or Post Office Box)
3339 Tamiami_Trail East, Suite 211
—
[ ] Neighborhood Stabilization
City, State and Zip Code Local Government DUNS #
(076997790
Naples, FL 34112
----- ------ _ _---.--------- .....- _---- _..----- - - -.._
Project Contact Person Telephone # E -mail Address
Kim Grant, Director 239 - 252 -8442 kimberleygrant @colliergov.net
Collier County Housing, Human
and Veteran Services
Financial Contact Person Telephone # I E -mail Address
Ashlee Franco, Accounting 239- 252 -2689 ashleefranco @colliergov.net
Supervisor, Collier County Housing,
Human and Veteran_ Services
Requests for Funds (RFFs) require (check one); [ ] one signature [ X ] two signatures by individuals authorized below.
RFFs must be submitted via the Departments website at httl2://ecdbg.dca.state.f1.us/ (or by an alternative means specified by
the Department).
Typed Name — — I
Date Signature --
Kim Grant, Director
�ll�
[ X ] Check here if above person is authorized to submit RFFs
--
E -mail Address
—
Typed Name T
kimbert rant @collier ov.net
Dat Signature
Ashlee Franco Accounting Supervisor, _
[ X ] Check here if above person is authorized to submit RFFs
L I1 ; (./1 ktXA,a„L /"T_Ck _
E- mairAdd�
ashleefranco@colliergov.net
�—
Typed Name Name
Date Signatur /
Kathleen Larsen, Accoun_tin9 Technician _
D
E- ail dress
( X ] Check here if above person is authorized to submit RFFs
kathieenLarsen @coll_iergov.net
Typed Name — Date —r Si nat
Lisa Olen, Grants Coordinator
- - - - - -- ----------------------
[ ] Check here if above person is authorized to submit RFFs E -mail Address
lisaolen @colliergovnet _ —.__ _ -_ _- _____ —_ ___ —_ —_ ._ - -- -_____
I certify, as the recipients Chief Elected Official, that the above signatures are of the individuals authorized to sign Requests for
Funds and to submit RFF's electronically.
— — —
Typed Name — Date — — I, Signature—
Fred W. Coyle, Chairman
Board of Collier _County Commissioners _ - -I
[ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) from the State o orida.
[ X ] Check here if your local government will be working on a reimbursement basis.
CDBG payments to local governments using EFT are automatically deposited in the local governments general account. If the
account is interest bearing, the CDBG funds must be transferred to a non - interest bearing account. Please call the CDBG
Program at 850/922 -1878 or 487 -3644 if you have questions. You can check the status of your deposit at the Comptroller's
website: http: / /fiair.dbf.state.fl.us /. Local govemments not receiving EFT, and not working on a reimbursement basis, must
establish a non - interest bearing account. Provide account information for the financial institution (insured by FDIC) below. All
signatures on the account must be banded. _.__
_ - - - - -- -----------
Name of Financial Institution Account Number
Fifth Third Bank 113-8577
_ _ _
Telephone Number in
Street Address or Post Office Box
9_99 Vanderbilt Beach Road _ _ — _ 239-591-6397
City, State and Zip Code
NaplesLFlodd# 34108 -
App *nd as to form & legal Sufficiency
DWIGHT "BROCK'Clerk,
fts Chill Ulm