Backup Documents 07/12/2022 Item #16D15 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 b D 1 5
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Maria Kantaras Community and Human MK 7/7/2022
Services
2. County Attorney Office—DDP County Attorney Office o o e 111 aI2Z
3. BCC Office Board of County
Commissioners y/*j h1 7/Z0/2�
4. Minutes and Records Clerk of Court's OfficeQe '7/2-�/L� �
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 Maria Kantaras, CHS Phone Number 239-252-6141
Contact/ Department
Agenda Date Item was 7/12/2022 Agenda Item Number 16.D.15
Approved by the BCC
Type of Document ATTACHMENT XIII Number of Original 1
Attached Documents Attached
PO number or account
number if document is 111.138759.649030-
to be recorded DVCn
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 MK
2. Does the document need to be sent to another agency ? If yes, Yes
provide the Contact Information(Name;Agency;Address;Phone)SEE BOTTOM OF SHEET. MK
3. Original document has been signed/initialed for legal sufficiency. (All documents to be MK
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 MK
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 MK
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 DO('
! i
the meeting have been incorporated in the attached document. The County e •+`,
Attorney's Office has reviewed the changes,if applicable. +
9. Initials of attorney verifying that the attached document is the version approved by the e + ka
BCC,all changes directed by the BCC have been made, and the document is ready for the �1{n e +'' 6"
Chairman s signature. �JJ �T
BCC signed/executed attachment is required to be recorded with Collier County Court. Once attachment is recorded with
Collier County, please e-mail signed,AND COURT STAMPED copy of the Attachment Xlii to Carl Epperson at the DOEA:
eppersonc@elderaffairs.org
Please CC Maria Kantaras,Grants Coordinator CHS:
Maria.Kantaras@colliercountyfl.gov
16D115
MEMORANDUM
Date: August 1, 2022
To: Maria Kantaras, County Attorney's Office DDP
From: Mende Ragan
Minutes & Records Department
Re: Item #16D15
Attachment
Please find the attached document for your records.
The Minutes and Record's Department has kept the original of the agreement as part
of the Board's Official Record.
If you have any questions, please feel free to call me at 252-8411.
Thank you.
Attachment
Melinda S. Ragan
From: Melinda S. Ragan
Sent: Wednesday, July 20, 2022 10:56 AM
To: 'Maria.Kantaras@colliercountyfl.gov'
Subject: Item 16D7 Grant Agreement-10163
Attachments: Backup Documents 07_12_2022 Item # 16D7.pdf
Hello Maria,
Please find the attached document for your records.
Thank You!
Mende Ragan
BMR&VAB Deputy Clerk
Office: 239-252-8411
'> Fax: 239-252-8408
Melinda.Ragan@CollierClerk.com
x - Office of the Clerk of the Circuit Court
& Comptroller of Collier County
3299 Tamiami Trail E, Suite#401
<"��r�'�' Naples, FL 34112
www.CollierClerk.com
1
T,,,,o ins 21 XQ103
INSTR 6291186 OR 6159 PG 2852 ATTACHMENT XIII
LERKRECORDED 8/2THE
22RC IT PAGES 1 ITAL OUTLAY CERTIFICATION 6 p 15 •'
CLERK OF THE CIRCUIT COURT AND COMPTROLLER
COLLIER COUNTY FLORIDA
REC$10.00
The Fixed Capital Outlay Certification acknowledges that Collier County , Owner, hereinafter
referred to as the Contractor, is using state funds in the form of a fixed capital outlay grant in the amount
of $250,000.00 ,to improve, construct or repair real property owned by the Contractor, and in accordance with
executed contract XQ103 between the Contractor and the State of Florida, Department of Elder Affairs,
Hereinafter referred to as the"Department". The following items must be completed by the Contractor:
1. State the legal address of the real property that is being improved by the fixed capital outlay grant.
4898 Coronado Parkway
Naples,FL 34116
2. List the name of the owner of the real property and the contact address for the owner of the real property.
Owner-Collier County(a political subdivision of the state of Florida)
Contact-Tanya Williams,Public Services Department Head(Ph.:239-252-7392;email:tanya.williams@colliercountyfl.gov)
3339 Tamiami Trail East,Bldg.H,2nd FL,Naples,FL 34112
3. In accordance with section 287.05805, F.S. (2017), and Section 38 of this contract and Section IV.D. of
Attachment I,the Contractor shall execute and deliver a security interest or other appropriate document securing the
interest of the Department, in the total amount of funds received under this contract, in the improvements, renovations,
and personality being purchased with funds received under this contract. The Department's security interest shall last for
at least five (5) years from the date of completion of the improvements and during this time the Contractor is prohibited
from selling, transferring, mortgaging, or assigning the Department's interest in the leasehold, improvements, renovations,
or personality, unless the Department approves, in writing,the sale, transfer,mortgage, or assignment.
4. The Contractor shall continue the operation, maintenance, repair, and administration of the property in accordance
with the purposes for which the funds were originally appropriated and for at least five (5)years from the date of
completion of the improvements. If the Contractor fails to operate, maintain, repair, and administer the property in
accordance with the purposes for which the funds were originally granted, the Contractor shall return to the Department,
no later than upon demand by the Department, the total amount of funds received under this contract, less 20% of that
total amount for each full year for which the property was used for such purposes after the date of completion of the
improvements.
5. The Department shall be immune from civil or criminal liability resulting from acts or omissions of the Contractor
and the Contractor's agents, employees, or assigns.
6. The Department shall execute a satisfaction of security interest upon full compliance by the Contractor with the
terms of this cont t.
SIG A U• ' i ' ,•HORIZE 1 41, RT ' OFFICIAL TITLE
•. .,,r_ CHAIRMAN
..41111.
WI.11 m `L• * • rt
APPLI'ANT,ORGANIZATION DATE SUBMITTED
Collier County'Board of County Commissioners July 12, 2022
Attest: ,.,.tTh�. ..
ae C1i i�'�$ A oved as to Form and Legality:
CRYSTAL K._KINZEL; CLERK
signature d111y.
024.. t1/4.
• , P
De t
1' Y Clerk Derck D. terry �V
Page 50 of 50 Assistant County Attorney `
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