Backup Documents 04/09/2024 Item #16F 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 3
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.
** 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 routingzlines#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. (Enter your Dept here)
3. County Attorney Office County Attorney Office 00, ♦ 1 `
4. BCC Office Board of County C`by MB
Commissioners [s]
5. Minutes and Records Clerk of Court's Office Alloy (Q;/v
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 Madison Bird Phone Number 2939
Contact/Department
Agenda Date Item was 4/9/24 Agenda Item Number 16.F.3
Approved by the BCC
Type of Document(s) Release of Claims Number of Original 1
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 signature?(stamped unless otherwise stated) MB
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 legality. (All documents to be signed by MB
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 MB
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 MB
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 MB
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 uploaded to the
agenda. 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_4/9/24 and all changes made durin N/A is not
the meeting have been incorporated in the attached document. The County Attorne an option for
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. ) this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05; 11/30/12;4/22/16;9/10/21
16F3__
Release of Claims
On this I day2024, the undersigned Collier Count of March, y ("Customer") with an address of
3299 Tamiami Trl F,,Naples, FL 34112, for good and valuable consideration consisting of the replacement
of the engine in Customer's vehicle,a 2013 Ford Escape SE, I FMCUOGX8DUB84893 (the"Vehicle") by
Brian Ring's Auto Repair with an address of 4484 Enterprise Ave, Naples, FL 34104 paid for by Sunshine
Lobes LLC dba Valvoline Instant Oil Change (the "Company"), in the amount of$6,644.14, the receipt
and sufficiency of which is hereby acknowledged, does hereby for, itself, its successors and assigns,
affiliates, subsidiaries, managers, officers, employees, agents, and insurers, release, and forever discharge
the Company, Valvoline Instant Oil Change Franchising, Inc., Valvoline, Inc., and each of their successors
and assigns, affiliates, subsidiaries, managers, officers, employees, agents, attorneys, and insurers from
any and all claims, demands, damages (including, but not limited to, general, special, consequential,
punitive, liquidated and compensatory damages) and causes of action of every kind, nature and
character, known and unknown, in law or equity. connected in any way with that oil change service
performed on Customer's Vehicle on July 12, 2023 by the Valvoline Instant Oil Change facility located at
2257 Pine Ridge Rd., Naples, FL 34109. This release and discharge includes, but is not limited to, all
claims relating to contracts of any kind,express or implied; any covenant of good faith and fair dealing,
express or implied; any tort of any nature; and any federal, state, or municipal statute, regulation or
ordinance. It is understood and agreed that the terms of this Release shall not be construed as an admission
of liability by the Company in connection with the incident described above. This Release sets forth the
entire agreement between the parties, and supersedes any and all prior oral or written agreements or
understandings concerning the subject matter of this Release. Additionally. Collier County hereby
certifies that they authorized the repairs for the above listed Vehicle, either through legal ownership, lease
rights,or written authorization from the Vehicle's owner, and the person signing this Release on behalf of
Customer is authorized to do so.
This release is intended to be, and is executed as, a witnessed, sealed, and binding instrument, and
is not intended to be a mere recital.
CUSTOMER: ATTEST:
Crystal K. Kinzel,Clerk tit Courts
BOARD OF COUNTY COMMISSIONERS OF &Comptroller,:
COLLIER O NTY, FLORIDA •
By: By:
C a ,Chairman Attest as to•Ch.it ;'malty erk
signature'u rsty,:-.°: "
Approved as to form and legality:
•
Sally A. As kar, A s'stant County Attorney t;? ?