Backup Documents 12/13/2022 Item #16B 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 8 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 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 County Attorney Office County Attorney Office
5A k//h' (Z//J/ZZ
2. BCC Office Board of County
Commissioners ttiVj43 12/(5f Z Z-
3 Minutes and Records Clerk of Court's Office I at�
VV1C 1�1lb'ag
4. Debrah Forester Immokalee CRA Office
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 Debrah Forester Phone Number 239-252-8846
Contact/ Department
Agenda Date Item was 12/13/2022 Agenda Item Number 16.B.1
Approved by the BCC
Type of Document Federal Forms Number of Original 3
Attached Documents Attached
PO number or account N/A
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? DPF
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 DPF
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 DPF
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 DPF
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip DPF
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 date above and all changes made during DPF N/A is not
the meeting have been incorporated in the attached document. The County 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 N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. 1)Akh this line.
10. And Return 1 fully executed copy to:Yvonne Blair via email Yvonne.Blairgcolliercountyfl.gov and
Debrah Forester via email Debrah.Forester@,colliercountyfl.gov. 91/
/041
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
1681
OMB Number:4040-0004
Expiration Date:12/31/2022
Application for Federal Assistance SF-424
*1.Type of Submission *2.Type of Application: *If Revision,select appropriate letter(s):
Preapplication ®New
®Application E Continuation *Other(Specify):
Changed/Corrected Application E Revision
*3.Date Received: 4.Applicant Identifier:
07/18/2022 Grant Number B-22-CP-FL-0233
5a.Federal Entity Identifier: 5b.Federal Award Identifier:
596000558
State Use Only:
6. Date Received by State: 7.State Application Identifier:
8.APPLICANT INFORMATION:
*a. Legal Name: Collier County Government
*b.Employer/Taxpayer Identification Number(EIN/TIN): *c.UEI:
596000558 JWKJKYRPLLU6
d.Address:
*Streetl: 3299 Tamiami Trail East
Street2:
*City: Naples
County/Parish: Collier
*State: FL: Florida
Province:
*Country: USA: UNITED STATES
*Zip/Postal Code: 34112-5746
e.Organizational Unit:
Department Name: Division Name:
Corporate Business Operations Community Redevelopment Areas
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: *First Name: Yvonne
Middle Name:
*Last Name: Blair
Suffix:
Title: Project Manager
Organizational Affiliation:
Immokalee Community Redevelopment Area
*Telephone Number: 239-867-0026 Fax Number
*Email: Yvonne.Blair@colliercountyf 1.gov
1681
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
0: County Government
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
*Other(specify):
*10.Name of Federal Agency:
Housing of Urban Develpment
11.Catalog of Federal Domestic Assistance Number:
CFDA Title:
*12.Funding Opportunity Number:
B-22-CP-FL-0233
*Title:
Collier County Government - Collier County Sidewalk Project
13.Competition Identification Number:
NA
Title.
14.Areas Affected by Project(Cities,Counties,States,etc.):
Add Attachment Delete Attachment View Attachment
*15.Descriptive Title of Applicant's Project:
Immokalee Community Sidewalk Safety Project Phase III - Eustis Avenue and W. Delaware Avenue
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments
1
166 ,
Application for Federal Assistance SF-424
16.Congressional Districts Of:
a.Applicant [FL-025 ] *b.Program/Project FL-025 ]
Attach an additional list of Program/Project Congressional Districts if needed.
I [ [ AddAttachment1 [ Delete Attachment .I L View Attachrnent_
17.Proposed Project:
a.Start Date 10/01/2022 'b.End Date: 09/30/2029 ]
18.Estimated Funding($):
"a.Federal 987,000.001
'b.Applicant 0.00]
A
'c.State 0.00]
'd Local 0.00]
'e.Other 0.00]
"f. Program Income 0.00]
"g.TOTAL I.
987,000..001
19.Is Application Subject to Review By State Under Executive Order 12372 Process?
❑ a.This application was made available to the State under the Executive Order 12372 Process for review on I I
® b.Program is subject to E.O.12372 but has not been selected by the State for review.
0 c.Program is not covered by E.O. 12372.
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
Yes ®No
If"Yes",provide explanation and attach
Add Attachment I Delete Attachment iew Atiachmer:t
21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 18,Section 1001)
Z "IAGREE
"The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix I [ *First Name: [William l
Middle Name: IL.
'Last Name: (ucpaniel _I
Suffix: [Jr. 1
'Title: [Chairman, Collier County BCC l
'Telephone Number: [239.252.8605 l Fax Number:
Email: [bill.mcdaniel®colliercountyfl.goy ftl
'Signature of Authorized Representative: . 'Date Signed 1211312021 ]
ATTEST (
CR %ST K.KIN L,CLERK ,
n
Ap.,.� . to form and legality:
BY:
Attest as to chairman's Jeffr: A.I latzkow
County A brney
skaraturP only.
ASSURANCES - CONSTRUCTION PROGRAMS OMB Number:4040-0009
Expiration Date:02/28/2025
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project(0348-0042),Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant:, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970(42 U.S.C. §§4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards of merit systems for programs funded
of project costs)to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
2. Will give the awarding agency, the Comptroller General 9. Will comply with the Lead-Based Paint Poisoning
of the United States and, if appropriate, the State, Prevention Act(42 U.S.C. §§4801 et seq.)which
the right to examine all records, books, papers, or prohibits the use of lead-based paint in construction or
documents related to the assistance; and will establish rehabilitation of residence structures.
a proper accounting system in accordance with
generally accepted accounting standards or agency 10. Will comply with all Federal statutes relating to non-
directives. discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
3. Will not dispose of, modify the use of, or change the which prohibits discrimination on the basis of race,
terms of the real property title or other interest in the color or national origin; (b)Title IX of the Education
site and facilities without permission and instructions Amendments of 1972, as amended (20 U.S.C. §§1681
from the awarding agency. Will record the Federal 1683, and 1685-1686),which prohibits discrimination
awarding agency directives and will include a covenant on the basis of sex; (c) Section 504 of the
in the title of real property acquired in whole or in part Rehabilitation Act of 1973, as amended (29) U.S.C.
with Federal assistance funds to assure non- §794),which prohibits discrimination on the basis of
discrimination during the useful life of the project. handicaps; (d)the Age Discrimination Act of 1975, as
4. Will comply with the requirements of the assistance amended (42 U.S.C. §§6101-6107), which prohibits
awarding agency with regard to the drafting, review and discrimination on the basis of age; (e)the Drug Abuse
approval of construction plans and specifications. Office and Treatment Act of 1972(P.L. 92 255), as
amended relating to nondiscrimination on the basis of
5. Will provide and maintain competent and adequate drug abuse; (f)the Comprehensive Alcohol Abuse and
engineering supervision at the construction site to Alcoholism Prevention, Treatment and Rehabilitation
ensure that the complete work conforms with the Act of 1970(P.L. 91-616), as amended, relating to
approved plans and specifications and will furnish nondiscrimination on the basis of alcohol abuse or
progressive reports and such other information as may be alcoholism; (g)§§523 and 527 of the Public Health
required by the assistance awarding agency or State. Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
6. Will initiate and complete the work within the applicable and drug abuse patient records; (h)Title VIII of the
time frame after receipt of approval of the awarding agency. Civil Rights Act of 1968(42 U.S.C. §§3601 et seq.), as
7. Will establish safeguards to prohibit employees from amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i)any other
using their positions for a purpose that constitutes or nondiscrimination provisions in the specific statue(s)
presents the appearance of personal or organizational under which application for Federal assistance is being
conflict of interest, or personal gain. made; and (j)the requirements of any other
nondiscrimination statue(s)which may apply to the
application.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424D(Rev.7-97)
Prescribed by OMB Circular A-102
162i
11. Will comply, or has already complied,with the Federal actions to State(Clean Air)implementation
requirements of Titles II and III of the Uniform Relocation Plans under Section 176(c)of the Clean Air Act of
Assistance and Real Property Acquisition Policies Act of 1955, as amended(42 U.S.C. §§7401 et seq.); (g)
1970(P.L. 91-646)which provide for fair and equitable protection of underground sources of drinking water
treatment of persons displaced or whose property is under the Safe Drinking Water Act of 1974,as
acquired as a result of Federal and federally-assisted amended(P.L.93-523);and,(h)protection of
programs. These requirements apply to all interests in real endangered species under the Endangered Species
property acquired for project purposes regardless of Act of 1973, as amended(P.L.93-205).
Federal participation in purchases.
16. Will comply with the Wild and Scenic Rivers Act of
12. Will comply with the provisions of the Hatch Act(5 U.S.C. 1968(16 U.S.C. §§1271 et seq.)related to protecting
§§1501-1508 and 7324-7328)which limit the political components or potential components of the national
activities of employees whose principal employment wild and scenic rivers system.
activities are funded in whole or in part with Federal funds.
17. Will assist the awarding agency in assuring compliance
13. Will comply,as applicable,with the provisions of the Davis- with Section 106 of the National Historic Preservation
Bacon Act(40 U.S.C.§§276a to 276a-7),the Copeland Act Act of 1966, as amended(16 U.S.C.§470), EO 11593
(40 U.S.C. §276c and 18 U.S.C.§874), and the Contract (identification and protection of historic properties), and
Work Hours and Safety Standards Act(40 U.S.C.§§327- the Archaeological and Historic Preservation Act of
333)regarding labor standards for federally-assisted 1974(16 U.S.C.§§469a-1 et seq).
construction subagreements.
14. Will comply with flood insurance purchase requirements of 18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Section 102(a)of the Flood Disaster Protection Act of 1973 Act Amendments of 1996 and OMB Circular No.A-133,
(P.L. 93-234)which requires recipients in a special flood "Audits of States, Local Governments,and Non-Profit
hazard area to participate in the program and to purchase Organizations."
flood insurance if the total cost of insurable construction
and acquisition is$10,000 or more. 19. Will comply with all applicable requirements of all other
15. Will comply with environmental standards which may be Federal laws, executive orders, regulations,and policies
governing this program.
prescribed pursuant to the following: (a)institution of
environmental quality control measures under the National 20. Will comply with the requirements of Section 106(g)of
Environmental Policy Act of 1969(P.L.91- the Trafficking Victims Protection Act(7VPA)of 2000, as
190)and Executive Order(EO)11514; (b)notification amended(22 U.S.C.7104)which prohibits grant award
of violating facilities pursuant to EO 11738; (c) recipients or a sub-recipient from(1)Engaging in severe
protection of wetlands pursuant to EO 11990; (d) forms of trafficking in persons during the period of time
evaluation of flood hazards in floodplains in accordance that the award is in effect(2)Procuring a commercial
with EO 11988;(e)assurance of project consistency sex act during the period of time that the award is in
with the approved State management program effect or(3)Using forced labor in the performance of the
developed under the Coastal Zone Management Act of award or subawards under the award.
1972(16 U.S.C.§§1451 et seq.); (f)conformity of
40FP
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Chai n, C County B. ig:///
APPLICANT ORGANIZATION DAT UBMITTED
Collier County Government I 12/13/2022
SF-424D(Rev.7-97)Back
ATTEST
CRYSTAL K.KINZEL,CLERK
BY: Approve •t, n and legality
Attest as to Chairman's 441i.
Signature only. Jeffrey A. Itz•' w, ounty Attorney
16 8l
DISCLOSURE OF LOBBYING ACTIVITIES OMB Control Number: 4040-0013
Expiration Date: 2/28/2025
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
1.*Type of Federal Action: 2.*Status of Federal Action: 3.*Report Type:
0 a.contract ❑ a.bid/offer/application ®a.initial filing
® b.grant ® b.initial award El b.material change
c.cooperative agreement c.post-award
d.loan
e.loan guarantee
f. loan insurance
4. Name and Address of Reporting Entity:
®Prime 0SubAwardee
'Name
Collier County Government
'Street 7 Street 2
3299 Tarsami Trail East
•City State Zip
Naples FL: Flcride 34112
Congressional District,if known: 25
5.if Reporting Entity in No.4 is Suhawardee, Enter Name and Address of Prime:
6.*Federal Department/Agency: 7.*Federal Program Name/Description:
Dept. of Housing and Urban Development Community Project. Funding (CPFI
CFDA Number.if applicable:
8.Federal Action Number,if known: 9.Award Amount,if known:
99',000.0
10.a.Name and Address of Lobbying Registrant:
Prefix 'First Name Amanda Middle Name
P1s.
*Last Name Suffix
Wood
*Street 1 Street 2
..-c=:er 5 Yotiakoff 1275 i( Street 1:6:, Suite 950
'City State Zip
Washington __. District of Columbia 20005
b.Individual Performing Services(including address if different from No.10a)
Prefix :es •First Name k,o-1a Middle Name
'Last Name ;good Suffix
'Street 1 Street 2
Becher 5 Pul1aiaff
'City Washington State Zip
11, Information requested through thi is authorized by title 31 U.S.C.section 1352. This sclosure of lobbying activities is a material representation of fact upon which
reliance was placed by the tier ore hen the transaction was made or e.- -•into. T • disclosure is required pursuant to 31 U.S.C.1352.This information will be reported to
the Congress semi-annually d will e blic inspection. ny pers• wh9 fails to tile the required disclosure shall be subject to a civil penalty of not less than
S10,000 and not than 00, each such fail
•Signature: l /
'Name: retix 'First Name Middle Name
9:i 11 tam L.
'Last Name Suffix
McDaniel Jr.
Title: Chairman, Collier County Sd cry Commissioners Telephone No.: 239-252-6605 Date: F 12/13/2022
•
1.
STANDARD FORM LLL(REV.7/1997)
iw ,rr Authorized for Locs1 Reproduction
Approval an legality: EINZLRK
County tutor ey 1
Attest as to Ghairtr►an's Deputy Clerk
signature onty.