Backup Documents 09/22/2020 Item #16C 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 C 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
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 routinglines#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. County Attorney Office County Attorney
—so-uvu f 4,) I,,,,.�'6 �-0`� 9 Ms Iry
2. BCC Office Board of County "..e>s
Commissioners J ) 1 ,g
3. Minutes and Records Clerk of Court's Office
MU +exp.() Q:>7a.u�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 Cindy M. Erb Phone Number 239-252-8917
Contact/ Department
Agenda Date Item was 4 ' Agenda Item Number _/
Approved by the BCC tuck
Type of Document Ouittrg P1 V L W g D 4. 0 S Number of Original
Attached Documents Attached 2—.
PO number or account Account: Fund , Cost Center
number if document is Object Code 649030, Project
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? S O c ,
2. Does the document need to be sent to another agency for additional signatures? Iflyes, 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
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 N/A_
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 AA,,,��,,,, tt
signature and initials are required. U►,L
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 f/ .2- LA,'G.C` ,and all changes
made during the meeting have been incorporated in the attached document. The Nit
County Attorney's Office has reviewed the changes,if applicable. v
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made, and the document is ready for th
Chairman's signature.
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
I6C 1
MEMORANDUM
DATE: September 30, 2020
TO: Cindy Erb, Sr. Property Acquisition Specialist
Facilities Management Department
FROM: Martha Vergara, Sr. Deputy Clerk
Minutes and Records Department
RE: Utility Facilities Warranty Deed and Bill of Sale, and Owner's
Affidavit — EMS Station #25 — Hacienda Lakes
Attached per your memo are the originals of the document referenced above,
(Items #16C1) approved by the Board of County Commissioners on Tuesday,
September 22, 2020.
When fully executed please forward the originals to Minutes and Records
Department to be kept as part of the Board's Official Records.
If you have any questions, please contact me at 252-7240.
Thank you.
Attachment
16C 1
Memorandum
TO: Minutes & Records Y1(\-°\
FROM: Cindy Erb, Property Acquisition Specialist, Sr., Real Property Management
DATE: September 22, 2020
RE: EMS Station #25 - Utilities
This item was accepted by the BCC on September 22, 2020, Agenda Item 16C1.
Please attest to Commissioner Saunders' signature as Chairman on the Utility Facility
Warranty Deed and Bill of Sale, and Owner's Affidavit.
Once attested, please advise so we can pick up ORIGINALS. These documents will
eventually go to the Growth Management department for processing.
Please contact me if you have any questions or comments at Extension 8917.
Thank you!
16C 1
PROJECT: EMS Station#25—Hacienda Lakes-Utilities
Prepared by:
Jennifer A. Belpedio,Assistant County Attorney
Office of the County Attorney
3329 East Tamiami Trail, Suite 800
Naples,Florida 34112-5749
(239)252-8400
UTILITY FACILITIES WARRANTY DEED AND BILL OF SALE
THIS INDENTURE made this • day of , 2020, between COLLIER
COUNTY, A POLITICAL SUBDIVISION OF THE STATE OF FLORIDA, (hereinafter referred
to as "Grantor"), and the BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY,
FLORIDA, AS THE GOVERNING BODY OF COLLIER COUNTY AND AS THE EX-OFFICIO
GOVERNING BOARD OF THE COLLIER COUNTY WATER-SEWER DISTRICT, its
successors and assigns, (hereinafter referred to as "Grantee").
WITNESSETH:
That said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good
and valuable consideration to said Grantor in hand paid by said Grantee, the receipt whereof is
hereby acknowledged, has granted, bargained and sold to the said Grantee, and Grantee's
heirs, successors and assigns forever, all utility facilities and/or system(s) or portion(s) thereof
lying in, on, over and under the following described land, for operation, relocation, installation,
repair and/or maintenance of said facilities, system(s) or portion(s) thereof, all situate and lying
and being in Collier County, Florida, to wit:
See attached Exhibit "A" and Exhibit "B" which are
incorporated herein by reference.
and said Grantor does hereby fully warrant the title to said utility facilities and/or system(s) or
portion(s) thereof, be they realty, personalty, or mixed, and Grantor will defend such title against
all claims of all persons whomsoever. For the purposes of this conveyance, the utility facilities,
system(s) and/or portion(s) thereof conveyed herein shall not be deemed to convey any of the
lands described in either exhibit. Grantor and Grantee are used for singular or plural, as context
allows. A sketch or other graphic representation showing the location of the utility facilities, etc.,
being conveyed is attached as Exhibit B.
TO HAVE AND TO HOLD the same unto the Grantee and its assigns, together with the right to
enter upon said land, excavate, relocate and/or take or introduce materials for the purpose of
constructing, relocating, operating, repairing and/or otherwise maintaining utility systems
thereon. Grantor and Grantee are used for singular or plural, as the context requires.
Od
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Warranty Deed&Bill of Sale
16C 1
IN WITNESS WHEREOF, Grantor has caused these presents to be executed the date and year
first above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, Clerk COLLIER COUNTY, FLORIDA
i BY: Aed,,X,Feeeoihaf•--
Attest as to Chairman's Deputy Clerk BURT L. SAUNDERS, Chairman
signature on!!.
Approved as to form and legality:
0
JennifeK Belpedio, Assista\4,County Attorney 0a.D
Warranty Deed&Bill of Sale 111)
16C 1
Exhibit "A"
There is an existing 8" PVC gravity sewer that fronts the EMS property
within the existing CUE as recorded in OR Book 5812 Page 2709 of the
Public Records of Collier County, Florida. The proposed conveyed sewer
item is a 6" sanitary lateral that was tapped to the main.
There is an existing 10" PVC water main that runs along the front of the
property within the existing CUE as recorded in OR Book 5812 Page 2709
of the Public Records of Collier County, Florida. The items to be conveyed
include a 6" PVC water main and 6" gate valve that were tapped off the 10"
main to provide fire protection to the EMS station.
16C 1
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PROJECT: EMS Station#25—Hacienda Lakes-Utilities
Prepared by:
Jennifer A.Belpedio,Assistant County Attorney
Office of the County Attorney
3329 East Tamiami Trail, Suite 800
Naples, Florida 34112-5749
(239)252-8400
OWNER'S AFFIDAVIT
STATE OF FLORIDA
COUNTY OF COLLIER
BEFORE ME, the undersigned authority, personally appeared BURT L. SAUNDERS,
who to me is well known, and having been duly sworn and under oath, deposes and
states:
1. My name is BURT L. SAUNDERS, I am over the age of twenty-one (21) years, am
sui juris, and have personal knowledge of the facts asserted herein.
2. COLLIER COUNTY is the owner of said real property located at 3675 The Lord's
Way, and known as EMS Station #25, and described on Exhibit A, which shows the
location of the subject utility facilities being conveyed.
3. All persons, firms, and corporations, including the general contractor, all laborers,
subcontractors and sub-subcontractors, materialmen and suppliers who have
furnished services, labor or materials according to plans and specifications, or extra
items; used in the construction, installation and/or repair of water and wastewater
utility system(s) or portion(s) thereof on the real estate hereinafter described, have
been paid in full and that such work has been fully completed and unconditionally
accepted by the current owner of such facilities.
4. No claims have been made to the owner, nor is any suit now pending on behalf of
any contractor, subcontractor, sub-subcontractor, supplier, laborer or material-men,
and no chattel mortgages or conditional bills of sale have been given or are now
outstanding as to the subject utility system(s) or portion(s) thereof placed upon or
installed in or on the aforesaid premises.
5. Title to the subject utility system(s) or portion(s) thereof and/or easement(s), if any,
being conveyed to the County is not encumbered by any recorded mortgage,
recorded assignment of rents or profits, by any recorded Uniform Commercial Code
Financing Statement, or by any other recorded document that imposes a security
interest that could negatively affect conveyance of marketable title to the utility
system(s) or portion(s) thereof and/or any easement being conveyed to the County.
6. As and on behalf of the owner of the subject utility system(s) or portion(s) thereof,
does for valuable consideration hereby agree and guarantee, to hold the Board of
County Commissioners of Collier County, Florida, as the governing body of Collier
County and as the Ex-Officio Governing Board of the Collier County Water-Sewer
District harmless against any lien, claim or suit by any general contractor,
subcontractor, sub-subcontractor, supplier, mechanic, material-man, or laborer, and
against chattel mortgages, security interests or repair of the subject utility system(s) or
portion(s) thereof by or on behalf of Owner. Affiant is used as singular or plural, as
the context requires.
Owner's Affidavit
16C 1
7. The utility system(s) or portion(s) thereof referred to herein are located within the
real property described in the attached Exhibit "A".
FURTHER AFFIANT SAYETH NAUGHT.
DATED this - day of 2020.
ATTEST: _ BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, Clerk COLLIER COUNTY, FLORIDA
BY:
Attest as to Chairman's , Deputy Clerk BURT L. SAUNDERS, Chairman
signature only.
Approved as to form and legality:
Jennif A. Belpedio, Assist t County Attorney Oa0
kU
Owner's Affidavit
16C 1
Exhibit "A"
t tA 2-
There is an existing 8" PVC gravity sewer that fronts the EMS property
within the existing CUE as recorded in OR Book 5812 Page 2709 of the
Public Records of Collier County, Florida. The proposed conveyed sewer
item is a 6" sanitary lateral that was tapped to the main.
There is an existing 10" PVC water main that runs along the front of the
property within the existing CUE as recorded in OR Book 5812 Page 2709
of the Public Records of Collier County, Florida. The items to be conveyed
include a 6" PVC water main and 6" gate valve that were tapped off the 10"
main to provide fire protection to the EMS station.
16C 1
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