Backup Documents 12/08/2020 Item #16K 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 K 1
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 routingjines#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. RislE- anagement Risk-Management
3. County Attorney Office County Attorney Office JAB 12/21/20
4. BCC Office Board of County BS by JH/s/ 12/21/20
Commissioners
5. Minutes and Records Clerk of Court's Office �n ,
V V\Jv a'aa ao a
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 Jennifer Belpedio/CAO Phone 239-252-2461a
Contact/ Department �f I
Agenda Date Item was December 8,2020 Agenda Item Number 16K5
Approved by the BCC •
Type of Document Satisfaction and Release of Claim Number of Original 1
Attached Documents Attached
PO number or account Please send to Probate under File No.18-
number if document is CP-291 l
to be recorded t
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?STAMP OK N/A
2. Does the document need to be sent to another agency for additional 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 JAB
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 JAB
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 JAB
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 December 8,2020 and all changes made JAB
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
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 the
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
16K5
INTEROFFICE MEMORANDUM
TO: COLLIER COUNTY CLERK OF CIRCUIT COURT
PROBATE DEPARTMENT
3315 TAMIAMI TRAIL EAST,STE. 102
NAPLES,FLORIDA 34112-5324
FROM: JESSICA HAYES vb.
COLLIER COUNTY ATTORNEY'S OFFI E
3329 TAMIAMI TRAIL EAST,STE. 800
NAPLES,FLORIDA 34112
SUBJECT: SATISFACTION AND RELEASE OF CLAIM
DATE: DECEMBER 21,2020
CC: COLLIER COUNTY CLERK OF CIRCUIT COURT
BOARD MINUTES AND RECORDS DEPARTMENT
3299 TAMIAIMI TRAIL EAST,STE. 401
NAPLES,FLORIDA 34112-5746
Once this document has been fully executed by the Clerk of Courts' Minutes and Records
Department, please send to the Clerk of Courts' Probate Department to be filed under 18-CP-
2911. If there are any issues or questions, please contact Jennifer Belpedio at the County
Attorney's Office at 239-252-8194.
Ib1( 5
IN THE CIRCUIT COURT FOR COLLIER COUNTY,
FLORIDA PROBATE DIVISION
IN RE: ESTATE OF
File No. 18-CP-2911
MICHAEL A. CAMPBELL,
Deceased.
SATISFACTION AND RELEASE OF CLAIM
The Board of County Commissioners, Collier, Florida, hereby acknowledges full payment of
the claim that was filed in this proceeding against the above estate on or about May 2, 2019, in the
amount of$170.20, or has otherwise settled or compromised said claim, and this Satisfaction and
Release of Claim is executed to acknowledge discharge of the claim and to release the estate and the
personal representative of the estate from all further liability with respect thereto.
Signed on j fkrigyr $' 2020.
A.t.)17::„t4e-e0A.a-4--
Y•
(Signature)
t l_ . Sc c\de rs its C 1., ► r
(Printed Name) (Title)
ATTt'.S1 Approved as to form and legality
CRYSTAL K.KINZEL.CLE`L�RK�
BY: i`'42—• Assistant County Attu t• _ �j O
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