Backup Documents 03/22/2022 Item #16D6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP i 6 6
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 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. Carolyn Noble Community and Human CN 3.16.22
Services
2. County Attorney Office—Jen Belpedio County Attorney Office
kl 3122�22
3. BCC Office Board of County //
Commissioners Ur1 L,/�3/5/ 3//,2/ z
4. Minutes and Records Clerk of Court's Office 5+33J7a-o ;,'i'"fL
fri
PRIMARY CONTACT INFORMATION �1
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 Carolyn Noble- CHS Phone Number 239-450-5186
Contact/ Department
Agenda Date Item was Agenda Item Number
Approved by the BCC 3 2 2 _ 22, ✓ I .. 0. 6
Type of Document 1 Amendment(Habitat Whippoorwill) ✓Number of Original 3 originals ✓
Attached Documents Attached
PO number or account
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 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 Yes-
signed by the Chairman,with the exception of most letters,must be reviewed and signed CN
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 fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CN
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 above date and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County 3*AKI01'2 an option for
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
BCC,all changes directed by the BCC have been made, and the document is ready for the 5A ki/e,
Chairman's signature.
16D6
MEMORANDUM
Date: March 23, 2022
To: Carolyn Noble, Grants Coordinator
Community & Human Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Habitat for Humanity Agreement Amendment #1:
Habitat Whippoorwill
Attached for your records are two original copies of the document referenced above,
(Item #16D6) approved by the Board of County Commissionerson March 22, 2022.
The third original amendment document will be held by this department for the
Board's Official Record.
If you have any questions, please feel free to contact me at 252-8406.
Thank you
Attachments (2)
Co er Caux.y 16 Q &
w�sedoaa�
AUTHORIZED SIGNATURE FORM FOR REQUEST FOR FUNDS& REPORTS
Recipient Name hici.0b 1' / t r thikiz i p of ('o/ilrGgrt/y .2
Project Name (uA,0epre/141
Contact Person (v‘c eYG S Title r����Pi,/
Phone R39 77 -D03C e-mail ..E21�C2k s/bAcre e. ih'i i 74(-7e11/cr, Gy�
New Submission Yes o No o Updated Date of initial submission
Request for Funds requires two signatures
All signatures are required to he employees. non-employees cannot be authorized to sign Request for Funds
Signature �� Date /Ol/`/4
1 Typed Name a yC K yOl,i /O h C'✓GcS Title l'f rs1 d Pii ,L
/
Report Authorization Yesyit No o Payment Authorization Yes.% No: Agreement Authorization Yes g No
Signature Date / l/i/�a /
2 Typed Name C ` 1 (7 Title
Report Authorization Yes Jet No as, Payment Authorization Yes sr No Agreement Authorization YesA No n
Signature t-!J /r-` Date /(>/iyla/
3 Title
Typed Name � ,ff� (°6 Os G , F. a
Report Authorization Yes ffi No o Payment Authorization Yes la No❑ Agreement Authorization Yes No pi
Signature Date
4 Typed Name Title
Report Authorization Yes: No Payment Authorization Yes a No Agreement Authorization Yes No
I certify that the signature(s) shown above are the legal signatures of those employees authorized to sign
requests for funds and/or Report and/or Agreements as Identified.
G7 /J//1//a/
Signature of CEO/President Date
(0 ►'cK (<O/A16kerel5 Pr es/0/e')/
Name Title
CHS 08.03.18
I6D6.
FAIN # M 16-UC 12-0217
M 18-UC 12-0217
M 19-UC 12-0217
Federal Award Date September 12, 2019
Federal Award HUD
Agency
CFDA Name Home Investment
Partnerships(HOME)
CFDA/CSFA# 14.218
Total Amount of $886,345
Federal Funds
Awarded
Subrecipient Name Habitat for Humanity
of Collier County, Inc.
DUNS# 080676690
FEIN 59-1834379
R&D No
Indirect Cost Rate No
Period of March 23, 2021 —
Performance December 31, 2022
Fiscal Year End 6/30
Monitor End: 6/32
FIRST AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
HABITAT FOR HUMANITY OF COLLIER COUNTY, INC.
New Construction-Homeownership
This Amendment is made and entered into as of this 22^Aday of MrtrGh 2022, by and
between Collier County, a political subdivision of the State of Florida(COUNTY) and Habitat for
Humanity of Collier County, Inc., (SUBRECIPIENT) a non-profit corporation existing under the
laws of the State of Florida, having its principal office at 1145 Tamiami Trail E., Naples, FL
34113.
WITNESSETH
WHEREAS, on April 13, 2021, Agenda Item 16D1, the COUNTY entered into an
Agreement using HOME Investment Partnerships(HOME)Program funds for a new construction,
infrastructure,project to provide new multi-unit single family homes for 52 families whose income
is at or below 80% AMI.
WHEREAS, the Parties desire to amend the Agreement to clarify the award amount and
match requirement.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and
Habitat for Humanity
HM 19-03
New Construction-Whippoorwill Page I AU
16 06
valuable consideration,the receipt and sufficiency of which is hereby mutually acknowledged,the
Parties agree to amend the Agreement as follows:
Words Stuck Through are deleted; Words Underlined are added.
PART 1
SCOPE OF WORK
1.2 PROJECT DETAILS
A. Project Description/Project Budget
FY 2019-2020 Action Plan and Substantial Amendment to the FY 2019-2020 Action Plan identified and
approved the Project to perform the tasks necessary to conduct the program as follows:
Activity HOME Budget Match Liability
Amount
Project Component One: Infrastructure associated with $866,345.00 $246,586.00
the construction of 52 homes to include but not limited $886,345.00 $221,586.00
to water, sewer, lighting, curbing, roadways, sidewalks,
electric and any other construction related activities.
Match: Minimum Required
match 25%of total
HOME funds expended
Grand Total: $866445A $24606 40
$886,345.00 $221,586.00
* * *
Remainder of Page Intentionally Left Blank
Habitat for I humility
I1M I9-03
New Construction-Whippoomill Page 2 rki
i606
IN WITNESS WHEREOF, the SUBRECIPIENT and the COUNTY, have each respectively, by
authorized person or agent, hereunder set their hands and seals on the date first written above.
ATTEST: BOARD OF CO ��y'' * ISSIONERS OF
CRYSTAL K. KINZEL,CLERK COLLIER C l ` , ORIDA
BUAAA. �-y. By: • I C. I
,.14lerk WIL M L. MC DAANIEL,JR.,
,,�ttest.as to Ch. a CH•'RPERSON
signature only.
}.,, +.* 3 Date: 3/22/22
HABITAT FOR HUMANITY OF COLLIER
Dated: .R COUNT , INC.
(SEAL)
B :
Lt SA LEFV-Or), CE
Date: 3 1 l ( 22
Ap.411101 . form and legality:
61
Jennifq A. :elpe•lo
Assist. t County Attorney
Date:
Habitat for 1lumanily
HM 19-03
New Construction-Whippoorwill Page 3 C.).�