Backup Documents 04/23/2019 Item #16C6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 L V L
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE V
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
1.
2.
3. County Attorney Office County Attorney Office JAK 4/23/19
4. BCC Office Board of County
Commissioners X=i-j 4.\z9'1
5. Minutes and Records Clerk of Court's Office l
41741141 2'-131pm
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 Howard Bro don,k...),=&<34--, ct-k Phone Number 252-4166
Contact/Department 'C s\z. ¢sr—
Agenda Date Item was 4/23/19 Agenda Item Number 16-C-6
Approved by the BCC
Type of Document Certification of Financial Responsibility Number of Original One
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature NOTARY JAK
2. Does the document need to be sent to another agency for additional signatures? If yes, JAK
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAK
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAK
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this JAK
routing slip should be provided to the County Attorney Office at the time the item is
input into MinuteTraq. 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!
8. The document was approved by the BCC on 4/23/19 and all changes made during the JAK
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable. 4
9. Initials of attorney verifying that the attached document is the version approved by the -4 '
BCC,all changes directed by the BCC have been made,and the document is ready for tt e tV
Chairman's signature.
Please contact Howard Brogdon (4166)when ready
[04-COA-01081/1344830/1]1: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
16C6
MEMORANDUM
Date: April 30, 2019
To: Howard Brogdon, Public Utilities
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Certificate of Financial Responsibility for Local Government—
Collier County Public Utilities
Attached is the original of the document as referenced above, (Item #16C6) approved
by the Board of County Commissioners on Tuesday, April 23, 2018.
If you have any questions, please contact me at 252-8411.
Thank you.
16C6
CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR LOCAL GOVERNMENT
Collier County Public Utilities Department
,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 underground injection well(s)
and related monitoring wells, as required by Chapter 62-528, Florida Administrative Code. It
is further understooddr.
t the cost estimate to conduct plugging and abandonment,
established on z_.\ -. , shall be updated thirty(30) months after the date
of permit issuance and this obligation shall incorporate accumulated inflation costs. An
increase exceeding 10 percent compared with the amount stated below shall require submission
of an updated certification form.
Injection Wells and Monitoring Wells Covered By This Agreement:
(attach additional sheet if necessary)
Facility Name: NCRWTP IW-2 AND DZMW-1
Facility Address: 8701 Vanderbilt Bch Rd, Naples, FL
Facility Contact: Howard Brogdon
Phone Number: 239-252-4166
Latitude/Longitude of Injection Well(s): 26 deg 14' 43.7" N, -81 deg 40' 39.4" W
Current Permit Number: 0325802-001-UO/1 I
Current Plugging and Abandonment Cost Estimate: $304,360.00
(total for all injection and monitoring wells)
It is hereby understood that the cancellation of this certification may not take place without
the pri• . - consent of the Secretary of the Florida Department of Environmental
Prote ''oA
`/ 4 NOTARY: See Next Page
(sir _) ��.-
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ATTEST:
r. •I. K. KIN, :L, CLERK chc_ 1
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ty Clerk
16C6
Notary Form
State of Florida
County of: �cs\\j e?r-
Sworn to (or affirmed) and subscribed before me this?_ {t,day of r-\\. ,•-a),\9,
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(Name of person making statement)
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OR
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Notary Signature
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Print, Type, or Stamp Commissioned Name of Notary Public
Apply Seal of Notary Public below- State of Florida
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Notary Public-State of Florida
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Commission t GG 093412
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Appr 'ed�as`{t tbrm and legality
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Jeffrey A KIitzkbw, ounty Attorney
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16C6
Youngquist Brothers, Inc.
15465 Pine Ridge Road
Fort Myers,Florida 33908
Tel.: 239-489-4444/Fax: 239-489-4545
February 5, 2019
Ms. Christina M. Alario-Garcia
CDM Smith
Re: NCRWTP Class I Injection Well System
Plugging and Abandonment Cost Estimate IW-1 —Price Detail
Injection Well:
Initial Mobilization/Demobilization $ 60,000.00
Remove Wellhead $ 10,000.00
Geophysical Logging [MIT] $ 35,000.00
Emplace Gravel to 2505 ft bp( [2,300 CF] @$10/CF $ 23,000.00
Emplace Cement [2,900 CF—Neat] @$22/CF $ 63,800.00
Complete below ground/add monument $ 10,000.00
Sub-Total for Injection Well $201,800.00
15%Contingency $ 30,270.00
Total Estimated Cost for IW Abandonment $232,140.00
Monitor Well:
Mobilization& Demobilization $ 15,000.00
Remove Wellhead $ 4,000.00
Geophysical Logging $ 10,000.00
Emplace Cement LZ [400 CF—Neat] @$22/CF $ 8,800.00
Emplace Cement UZ [ 1,100 CF—Neat] @$22/CF $ 20,000.00
Complete below ground/add monument $ 5,000.00
Sub-Total for Monitor Well $ 62,800.00
15%Contingency $ 9,420.00
Total Estimated Cost for MW Abandonment $ 72,220.00
Total Estimate Injection Well & Monitor Well $304,360.00
I trust the above is sufficient to your purposes. Please contact me should you have any questions
regarding this estimate.
Sincerely,
gill, Mu.sselwkite
YOUNGQUIST BROTHERS, INC.
C.W. (Bill)Musselwhite
Sr. Vice President
Water Well Contractors Licenses 1509&2172
CGC1517866,EC0002556
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