Backup Documents 01/28/2020 Item #16A 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE 1 6 A 6
**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
3. County Attorney Office County Attorney Office b I _
4. BCC Office Board of County Commissionersi1�4 �Zo�O
5. Minutes and Records Clerk of Court's Office or-
06 — 2111120 \\i's
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 Karen Dancsec Phone Number 239-252-5805
Contact/ Department
Agenda Date Item was Agenda Item Number 16.A.6
Approved by the BCC 01/28/2020
Type of oct, ent\\ 2 License Agreements(FDOT)2 copies of Number of Original
Attached D each. Please return 1 of each original Documents Attached 4
m signed document to me so I can send to
FDOT
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not •. ' ., - olumn,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chainna ' original signature? XD
2. Does the document need to be sent to another agency for a.ditional signatures? If yes, N/A
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed SCD
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
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 XD
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 XD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
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 January 28,2020 and all changes XV N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the /A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the W5C2 option for
Chairman's signature. his line.
I: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
1 6 A 6
MEMORANDUM
Date: February 11, 2020
To: Karen Dancsec, Property Acquisition Specialist
Transportation Engineering
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: (2) License Agreements requested by FDOT relating to County
owned property required for upgrading traffic signal and related
facilities on US41
Attached, are two original copies of the agreements referenced above (Item #16A6)
approved by the Board of County Commissioners on Tuesday January 28, 2020.
The second (identical) set of original agreements will be held in the Minutes and
Records Department for the Board's Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachment (2)
1 6 A 6
09-LA.11
Date: November 6, 2019
This instrument prepared F.P. NO. 4380591
under the direction of: PARCEL 900.1
Angela D. Tucker, Chief Counsel SECTION 03010-000
Post Office Box 1249 STATE ROAD 90
City: Bartow, Florida 33831-1249 COUNTY COLLIER
Department of Transportation
LICENSE AGREEMENT
This Agreement made the oa 0+day of 40v1404.
20 , between COLLIER COUNTY, a political division o the
State of Florida, herein called licensor, and the STATE OF
FLORIDA DEPARTMENT OF TRANSPORTATION, herein called licensee.
In consideration of the benefits accruing unto the licensor,
the parties agree as follows:
Licensor hereby grants to licensee a license to occupy and
use, subject to all of the terms and conditions hereof, the
following described premises:
SEE EXHIBIT "A"
The premises may be occupied and used by licensee solely for
sloping, grading, tying in, harmonizing and reconnecting existing
features of the licensor's property with the highway improvements
which are to be constructed together with incidental purposes
related thereto during the period beginning with the date first
above written and continuing until completion of the
transportation project.
The making, execution and delivery of this agreement by
licensor has been induced by no representations, statements,
warranties, or agreements other than those contained herein. This
agreement embodies the entire understanding of the parties and
there are no further or other agreements or understandings,
written or oral, in effect between the parties relating to the
subject matter hereof.
Page 1 of 3 for Parcel 900.1
1 6 A 6
IN WITNESS WHEREOF, the said licensor has caused these
presents to be executed in its name by its Board of County
Commissioners acting by the Chairperson or Vice-Chairperson of
said Board, the day and year aforesaid.+
. C011 e e County,Florida,
By Its Board of Count Commissioners
_ a:
By:
Burt L. aun ers
Its Chairperson (or Vice-Chairperson)
AT'N! T" 1.1.t 4`
CVSTAL K: UT EL,,CLERK Approved as to form and legality
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16A6
09-LA.11
Date: November 6, 2019
This instrument prepared F.P. NO. 4380591
under the direction of: PARCEL 901.1
Angela D. Tucker, Chief Counsel SECTION 03010-000
Post Office Box 1249 STATE ROAD 90
City: Bartow, Florida 33831-1249 COUNTY COLLIER
Department of Transportation
LICENSE AGREEMENT
This Agreement made the d156 day of ,
20 , between COLLIER COUNTY, a political s division of he
State of Florida, herein called licensor, and the STATE OF
FLORIDA DEPARTMENT OF TRANSPORTATION, herein called licensee.
In consideration of the benefits accruing unto the licensor,
the parties agree as follows:
Licensor hereby grants to licensee a license to occupy and
use, subject to all of the terms and conditions hereof, the
following described premises:
SEE EXHIBIT "A"
The premises may be occupied and used by licensee solely for
sloping, grading, tying in, harmonizing and reconnecting existing
features of the licensor's property with the highway improvements
which are to be constructed together with incidental purposes
related thereto during the period beginning with the date first
above written and continuing until completion of the
transportation project.
The making, execution and delivery of this agreement by
licensor has been induced by no representations, statements,
warranties, or agreements other than those contained herein. This
agreement embodies the entire understanding of the parties and
there are no further or other agreements or understandings,
written or oral, in effect between the parties relating to the
subject matter hereof.
Page 1 of 3 for Parcel 901.1
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1 6 A 6
IN WITNESS WHEREOF, the said licensor has caused these
presents to be executed in its name by its Board of County
Commissioners acting by the Chairperson or Vice-Chairperson of
said Board, the day and year aforesaid.
Co l V i e. e County,Florida,
By Its Bo d of County C�/o�,�,�Ii�_ssioners
GL—
By:
Burt L.Saunders
Its Chairperson (or Vice-Chairperson)
Approved as to form and legalityATTEST a�F�"
CRYSTAL K.IZEIi,CLERK
A cant County A y G, gyp` BY: , , - V C,
a test as to y• • w�
signature only , � •0 1310
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