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Backup Documents 05/27/2025 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 D 4 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. Parker Smith Community and Human PS 05/23/2025 Services 2. County Attorney Office County Attorney Office 5AglANti 5/2/ 3. BCC Office Board of County Commissioners bs I(r M /5/ 5 27 4. Minutes and Records Clerk of Court's Office 5 �-S slob 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 Parker Smith. Grants Coordinator I, Phone Number 239-252-6141 Contact/ Department Community and Human Services Agenda Date Item was May 27 2025 Agenda Item Number 16.D.4 Approved by the BCC Type of Document Recommendation to approve the submittal Number of Original l Attached and authorize the Chairman to sign the Documents Attached Grant Eligibility Application for a grant donation to support the replacement of carpet at the East Naples Library... PO number or account number if document is N/A 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? PS 2. Does the document need to be sent to another agency for additional signatures? If yes, PS 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 PS 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 PS 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 PS 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 PS signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip PS 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 2/28/2023 and all changes made during 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. this line. 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 *** ONLY USE FOR AGREEMENTS*** 1 6 U 4 Instructions 1) Return signed originals to: Vanessa Collier State and Federal Grants Manager Collier County Government I Community and Human Services 3339 E. Tamiami Trail, Bldg. H, Suite 213 Naples, FL 34112 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 1 6 D 4 Grant Eligibility Application for Government Entities DAFgiving360 Page 1 of 2 Congratulations'You are receiving this form because one of our donors has recommended a grant to your organization.However,to process this grant recommendation,we need to update some information.Please respond within two business days of receipt of this form.If you cannot,or if you have questions or need assistance,please contact the Giving Specialist noted below. We appreciate your help in completing this form and supplying any requested documentation. Questions or need assistance? Giving Specialist: Trent Collins Email: trent.collins@schwab.com _ Phone:1-800-746-6216 ext.766353 Please reference Grant ID: 9398363 Charity ID: 3320029 1. Organization Information Collier County Public Libraries Organization Legal Name Federal Employer Identification Number(FEIN) Collier County Other names by which donors can search for your organization 2.Contact Information 2385 Orange Blossom Drive Physical Address of Business Office(HO.box not acceptable) Naples Florida 34109 City State or Province Zip or Postal Code Grant Mailing Address(if different from above) City State or Province Zip or Postal Code (2 3 9)2 5 2-6 1 4 1 Parker.Smith@Colliercountyfl.gov Primary Telephone Contact Email Address https://www.collierlibrary.org/ Web Address 3. Responses Required A.Return this application with a copy of any letter from the Internal Revenue Service describing your organization's status for federal tax purposes. B.Is your organization any of the following?(Check all that apply.) ❑ State government(including the District of Columbia,Puerto Rico,the Virgin Islands,and interstate instrumentalities) • Local government and subdivisions ❑ Indian tribal governments ❑ Instrumentalities C.Does your organization have any of the following governmental powers?(Check all that apply) ❑ The power to levy any tax ❑� The power of eminent domain ❑ Police power over any area For any checked boxes,please provide a supporting statement or documentation. ©2025 Donor Advised Charitable Giving,Inc. All rights reserved. Dig 0, AEM11584218 (0225-VSER) MKT94445-06(02/25) Y' CAQ 0` 16D4 Grant Eligibility Application for Government Entities Page 2 of 2 D.If your organization was formed pursuant to a statute or a constitutional provision,provide a copy of such statute or provision. E.Provide copies of your organization's founding documents(e.g.,charter or other evidence of incorporation,joint powers agreement,or any other document that created or governs the entity). 4. Certification(Please read,complete,and sign this section.) A tax-exempt organization will jeopardize its exemption if it ceases to be operated exclusively for exempt purposes.An organization will be operated exclusively for exempt purposes only if it engages primarily in activities that accomplish the exempt purposes specified in Internal Revenue Code Section 501(c)(3).An organization will not be so regarded if more than an insubstantial part of its activities does not further an exempt purpose.A tax-exempt organization: •must absolutely refrain from participating in the political campaigns of candidates for local,state,or federal office •must restrict its lobbying activities to an insubstantial part of its total activities •must ensure that itslearnings do not inure to the benefit of any private shareholder or individual;In addition to loss of the organization's tax-exempt status,activities conbtituting inurement may result in the imposition of penalty excise taxes on individuals benefiting from excess benefit transactions. •must not operate for the benefit of private interests such as those of its founder,the founder's family,its shareholders,or persons controlled by such interests •must not operate for the primary purpose of conducting a trade or business that is not related to its exempt purpose,such as a school's operation of a factory •may not provide commercial-type insurance as a substantial part of its activities •may not have purposes or activities that are illegal or violate fundamental public policy •must satisfy annual filing requirements A tax-exempt organization that does not file a required annual return or notice for three consecutive years automatically loses its tax-exempt status. By completing and returning this Grant Eligibility Application,I certify that: •This organization is a governmental entity as described in Section 170(c)(1)of the Internal Revenue Code and that I am not aware of any revocation or challenge to the organization's tax-exempt status. •The organization acknowledges that the grant funds from DAFgiving360'will be used solely for public purposes as that term is used in Section 170(c)(1)of the Internal Revenue Code. •No donor or related individual or entity will receive any quid pro quo or other benefit as a result of grants from DAFgiving360. •The informati contained in this application is correct,complete,and accurate. x . 44e411.,i�.. 27/?S Signature lease sign in b ue or black ink.) Today' Date(mm/dd/yyyy) Burt L. Saunders, Chairman Print Name Title 5. Delivery Instructions Completion and return of this form does not guarantee your organization will receive a grant from DAFgiving360. STOP!For faster processing,please be sure to deliver any requested documentation with this form. •Email: Recommended for fastest processing,scan all pages of this form and attach in an email to the Giving Specialist identified at the beginning of this form. •Fax: 1-877-535-3852 •Mail: DAFgiving360,P.O.Box 2430,Omaha,NE 68103 DAFgiving360'is the name used for the combined programs and services of Donor Advised Charitable Giving,Inc.,an independent nonprofit organization which has entered into service agreements with certain subsidiaries of The Charles Schwab Corporation.DAFgivirrg360 is a tax-exempt public charity as described in Sections 501(c)(3),509(a)(1),and 170(b)(1)(A)(vi)of the Internal Revenue Code. ,f c`''+.•+r • ..?• r „1" F .d 4 !17Vi Appr. d : • and legality: '%' ©2025 Donor Advised Charitable Giving,Inc. All rights reserved. ' ^ ATTEST::: AEM11584218 (0225-VSER) MKT94445-06(02/25) �y h( Rrt � 1' Mirej+ I OW fJr�,6rel /1L �1V � •'•I y County •tior ey r L'P . Cspu C;Perta Attest as to Chairman's �` . signature only