Backup Documents 04/08/2025 Item #16C 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 C 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.
** 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 Attomey 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
5A144 4ig
4. BCC Office Board of County BS by MB
Commissioners [s] `{I g
5. Minutes and Records Clerk of Court's Office s4519"
14i V12026.
PRIMARY CONTACT INFORMAT ON
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 Agenda Item Number
Approved by the BCC I '8 f ZS 1666
Type of Document(s) / Number of Original
Attached Cert. oT F;neuc,;4' RArd.,s4iixb ! Documents Attached I
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 `f f f j2S and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County Attorney 01 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 a e•tion for
Chairman's signature. e.
1: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
1 6C 6
MEMORANDUM
Date: April 9, 2025
To: Madison Bird
County Attorney's Office
From: Martha Vergara, Sr. Deputy Clerk
Boards Minutes & Records Department
Re: Certification of Financial Responsibility for Local Government
Collier County Public Utilities Division
Attached is one (1) original of the document referenced above (Item #16C6),
approved by the Board of County Commissioners on Tuesday, April 8, 2025.
The original has been kept by Minutes and Records Department as part of the Board's
Official Records.
If you have any questions, please contact me at 252-7240.
Thank you.
Attachment
16C 6
CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR LOCAL GOVERNMENT
Collier County Public Utilities Division
, a unit of local government of
the State of Florida, hereby certifies that it has unconditionally obligated itself to have the
financial resources necessary to close, plug, and abandon its underground injection well(s)
and related monitoring wells, as required by Chapter 62-528, Florida Administrative Code. It
is further understood that the cost estimate to conduct plugging and abandonment,
established on February 24,2025 , shall be updated thirty (30) months after the date
of permit issuance and this obligation shall incorporate accumulated inflation costs. An
increase exceeding 10 percent compared with the amount stated below shall require submission
of an updated certification form.
Injection Wells and Monitoring Wells Covered By This Agreement:
(attach additional sheet if necessary)
North County Regional Water Treatment Plant IW-1, IW-2&DZMW-1
Facility Name:
Facility Address: 8005 Vanderbilt Beach Road, Naples, FL
Facility Contact: Christopher Todd, Plant Manager
Phone Nu►nber: 239-252-4165
Latitude/Longitude of Injection Well(s): 26* 14' 43.73" / -81* 40' 42.53"
Current Permit Number: 325802-004-UO/1 X/325802-003-UO/1 X
Current Plugging and Abandonment Cost Estimate: $811 ,266
(total for all injection and monitoring wells)
It is hereby understood that the cancellation of this certification may not take place without
the prior written consent of the Secretary of the Florida Department of Environmental
Protection.
NOTARY: See Next Page
(Signature)
OVA+ L SavncI erS
(Print Name)
Cho ,na
(Title)
(Date) 9/0
CRY ,TAL .Kl r'cL G!ERK ,
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A as`b-Ch airnian+SUepu`,
Ignature only,
1 F
1 6C 6
Notary Form
State of Florida
County of: CO1f ieLf
Sworn to (or affirmed) and subscribed before me this 8 day of Apr , 2025
by 'Air. L.. SCivn clef S ,
(Name of person making statement)
Personally known to me
OR
ElProduced the following identification
Notary Signature
�Adison lJircl
Print, Type, or Stamp Commissioned Name of Notary Public
Apply Seal of Notary Public below - State of Florida
<►sv� MAADISONBIRD
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