Backup Documents 01/28/2025 Item #16F 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6F
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 he received in the County Attorney Office no later
than Monday preceding the Board meeting.
** ROUTING SLIP**
Complete routing lines#I 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#I through#2.complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) tl.ist in routing order) Office Initials Date
I.
3. County Attorney Office County Attorney Office
C6;VA— 119-)1)17
4. BCC Office Board of County
Commissioners 135.5) j itP(51 /5//25
5. Minutes and Records Clerk of Court's 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 .Irt.tm-\.‘ k Phone Number
Contact/Department ccf-+ 'i:?C;48
Agenda Date Item was Agenda Item Number
r
Approved by the BCC i0 13--.7 -I -R6-
Type of Document(s) Number of Original
Attached .;-\61 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)
I. Does the document require the chairman's original signature(instead of stamp)?
2. Does the document need to be sent to another agency for additional signatures? If yes,
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
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
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
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
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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 oat-1,A-15 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County Attorney 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
MILI"TRY AIRCRAFT HOLD HARMLESS AGREEMENT 16F 3
1.THE LAND OWNER NAMED BELOW,HEREBY GRANTS PERMISSION TO THE UNITED STATES ARMED
FORCES TO USE PROPERTY FOR PURPOSES OF CIVILIAN LANDING SITE(S),AGREES:
a.The Owner releases forever the United States,its agencies,and United States personnel,from every liability arising out
of the use of these civilian landing site(s),supplies,or services,by the United States personnel.The Owner will defend,
pay or settle every claim or suit against the United States,its agencies,and United States personnel,by agents or
employees of the Owner or persons claiming through them.or by third parties,and will hold the United States,its
agencies,and United States personnel,harmless against every such claim or suit,including attorney fees.costs,and
expenses,arising out of the use of these civilian landing site(s)or military supplies or services,by the United States
personnel. Indemnification by the County shall be subject to the limitations set forth in Florida Statute§768.28.Nothing in
this agreement shall be construed as a waiver by the County of its sovereign immunity protection as provided by Florida
Statute§768.28
EXCEPTION:Death,Injury,toss or damage to persons or property resulting solely from the willful misconduct and/or
negligence of United States personnel;and,in addition,any liability from another contract concerning the use of the
military airfield,supplies,or services shall not be affected by the Hold Harmless Agreement.
b.This agreement replaces previous Hold Harmless Agreements,if any,by the same Owner,as of the date of this
agreement.Termination by the User requires 60 days written notice to the military authority where the agreement was
submitted.
(1) TYPED COMPANY NAMES)
LAND OWNER
Street Address
City ST Zip
ATTEST: . BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KiNZEL, CLERK OF COLLIER COUNTY, FLORIDA
THE CIRCU(T.000RT &
COMPTROLLER
By: /34..•)%......10441104—
.4 Burt Saunders, Chairman
6 eat ,t r r,,,,i1 Clerk
signature vM?P y
Approv;a - to form -nd legality:
0•_
Ste'. -r (i
Assistant :- ty Attorney UIL
4.DATE SIGNED(YYYYMMOD) \
5.REMARKS(If additional space is required,continue here.Refer to item number)
Location of Landing site(s) N
deg min sec
w
Street Address deg run sec
City ST Zip
Landing area description and any limitations(attach,map,thinvng or photo as appropriate. (Ise reverse snit as freededl
PRIVACY ACT STATEMENT
AUTHORITY:49 U S.Code,Section 44502(d)
PRINCIPAL PURPOSE(S):Indicates certification by an irfdrvrdual or corporation to hold the U S Government harmless in consideration of
permission granted for the operation of m=t Lary aircraft into civilian landing site(s).it is maintained indefinitely
ROUTINE USE(S):None,
DISCLOSURE:Voluntary,however,failure to provide this Information will result in an individual or corporation being unable to operate
military aircraft into a civilian landing site(s)
INSTRUCTIONS
I Form must be filed out and signed prior to a military aircraft/helicopter landing at a civilian site. a+
2.Complete an applicable items and submit to military authorized operators you are allowing to use your facilities andior site(s) CAA
Bald harmless A.rvrmr:at 16 Slept 2Oflt
3,If the owner,s a corporationicompany,all blocks must be completed and the form must be signed by a corporate officer if the owner is
an individual,only Items 2b and 4 should be completed 1 6 F 3
4 Ongina:,hand scnbed signatures are required Signature Vamps,camera copied signatures or any type of facsimile signatures are
unacceptable
Held harmless Aerectnernt 16 Seel 2001 CA a