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Backup Documents 09/23/2025 Item #10A ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 10 A 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 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. 2. (Enter your Dept here) 3. County Attorney Office County Attorney Office cm q23 2 4. BCC Office Board of County BS by MB Commissioners [s] 123/5. Minutes and Records Clerk of Court's Office • A f/g5 PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is ne ded 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 q/231 g I J Type of Document(s) ) Number of Original Attached A ,&,c.#„qA1 d O(/ Documents Attached 1.— 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 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 1 /2'" and all changes made during N/A is not the meeting have been incorporated in the attar ed document. The County Attorney L an option for Office has reviewed the changes, if applicable. C�G(11 this line. 9. Initials of attorney verifying that the attached document is the version approved by the ` I N/A is not BCC, all changes directed by the BCC have been made, and the document is ready for the 6 M an option for Chairman's signature. this line. Please email a completed copy to 1:Forms/County Forms/BCC Fc Mad1SOn.Blyd@CO111ercountyfl.gov i.05;2.24.05; 11/30/12;4/22/16;9/10/21 1 0 A SECOND AMENDMENT TO MEMORANDUM OF AGREEMENT BETWEEN FLORIDA DEPARTMENT OF VETERANS' AFFAIRS AND COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS d This Second Amendment to the Memorandum of Agreement is made and entered into this day of ,2025,by and between the Florida Department of Veterans' Affairs("FDVA") and the Collier County Board of County Commissioners ("Collier County"). tY ) RECITALS WHEREAS, on March 14, 2023, the FDVA and Collier County entered into a Memorandum of Agreement regarding the FDVA's State Veterans' Nursing Home ("Project") to be developed on property presently owned by Collier County; and WHEREAS,the Memorandum of Agreement required the County to commit$30 million (thirty million dollars) in County funds to be used as matching funds toward the construction and development costs of the Project, and further required the County to commit County-owned land for donation to the Board of Trustees of the Internal Improvement Trust Fund of the State of Florida ("BOTIITF") for the Project; and WHEREAS, on November 14, 2023, the Parties entered into the First Amendment to revise Exhibit B to include the Sketch and Legal Description for the Proposed VA Parcel prepared by Coastal Engineering Consultants, Inc. (dated 10/13/23); and WHEREAS, the Parties wish to enter into a Second Amendment to revise Exhibit B to include the revised VA Parcel Legal Description (dated 6/23/25) and the Boundary Survey (dated 6/6/25)prepared by Coastal Engineering Consultants, Inc. WITNESSETH NOW, THEREFORE, the FDVA and the County agree to amend the Memorandum of Agreement as follows: 1. The recitals above are true, correct, and incorporated herein. 2. The Memorandum of Agreement is amended to replace Exhibit B, Sketch and Legal Description for the Proposed VA Parcel prepared by Coastal Engineering Consultants,Inc. (dated 10/13/23) with revised documents prepared by Coastal Engineering Consultants, Inc. to include: the VA Parcel Legal Description(dated 6/23/25) and the Boundary Survey (dated 6/6/25)(attached hereto as Exhibit"A"). 3. This revised Legal Description increases the proposed property for the project from approximately 20.07 acres to approximately 23.59 acres of land. 4. As previouslyset forth in the Memorandum of Agreement, the Parties agree that unless g g ( and until there is a reasonable degree of certainty that Project will proceed as planned, no S 1 0 A " conveyance of title to real property will occur and no construction funds will be requested or released. 5. Except as modified by this Amendment, the Memorandum of Agreement shall remain in full force and effect. IN WITNESS HEREOF, the parties hereto have set their hands and seals the day and year first written above. COUNTY:civil ATTEST: ...• BOARD OF COUNTY COMMISSIONERS OF CRYS 'AL K. KI 1:;,%1erk COLLIER COUNTY, FLORIDA dti.. -< • l • tIt Clerk & un' t!rnan A • ttes�as to Chairman's signature only Approved as to form and legality: olleen M. Greene Managing Assistant County Attorney FDVA: STATE OF FLORIDA DEPARTMENT OF VETERANS' AFFAIRS ALFRED D Digitally signed by ALFRED D CARTER CARTER Date:2025.09.11 11:26:07 04'0 ' Alfred D. Carter, Chief of Staff FDVA LEGAL REVIEW: Approved as to form and legality: Digitally signed by Andrew Andrew Benard Benard Date:2025.09.11 11:04:46-04'00' Andrew J. Benard, General Counsel Page2of3 0 10A " Exhibit A to Second Amendment Documents prepared by Coastal Engineering Consultants, Inc, (revised Exhibit B to MOA dated March 14, 2023) VA Parcel Legal Description(dated 6/23/25) Boundary Survey (dated 6/6/25) �I! Page 3 of 3 cAo 1OA COASTAL Coastal and Marine Engineering ENGINEERING Environmental and Geological Services CONSULTANTS Land and Marine Survey and Mapping Website: www.coastalengineering.com INC. EXHIBIT"A" "VA PARCEL LEGAL DESCRIPTION A PARCEL OF LAND LYING IN THAT PART OF TRACT A OF GOLDEN GATE UNIT 1, ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 5, PAGES 60 THROUGH 64, AND THAT PART OF TRACT A OF GOLDEN GATE UNIT 8 PART 2 ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 9, PAGES 107-A THROUGH 112, ALL OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTHEAST CORNER OF SAID GOLDEN GATE UNIT 1, RUN S00°29"03"E ALONG THE EAST LINE OF SAID SUBDIVISION FOR A DISTANCE OF 489.28 FEET; THENCE LEAVING SAID LINE S89°30'20"W FOR A DISTANCE OF 15.31 FEET TO THE POINT OF BEGINNING; THENCE S00°33'12"E FOR A DISTANCE OF 17.24 FEET TO THE BEGINNING OF A NON-TANGENT CURVE; THENCE 600.09 FEET ALONG THE ARC OF SAID CURVE TO THE RIGHT HAVING A RADIUS OF 6,988.48 FEET; A CENTRAL ANGLE OF 04°55'12" AND A CHORD DISTANCE OF 599.91 FEET, BEARING S01°02'38"W TO THE BEGINNING OF A NON-TANGENT REVERSE CURVE; THENCE 417.18 FEET ALONG THE ARC OF SAID CURVE TO THE LEFT HAVING A RADIUS OF 7,418.47 FEET; A CENTRAL ANGLE OF 03°13'19" AND A CHORD DISTANCE OF 417.12 FEET, BEARING S00°59'16"W TO A POINT OF NON-TANGENCY; THENCE S00°28'S0"E A DISTANCE OF 272,52 FEET; THENCE N90°00'00"W FOR A DISTANCE OF 460.47 FEET; THENCE N45°00'00"W FOR A DISTANCE OF 357.81 FEET; THENCE N00°00'00"E FOR A DISTANCE OF 722.30 FEET; THENCE N90°00'00"W FOR A DISTANCE OF 360.36 FEET; THENCE N00°00'00"E FOR A DISTANCE OF 832.10 FEET TO THE SOUTH RIGHT OF WAY LINE OF GOLDEN GATE PARKWAY; THENCE ALONG SAID RIGHT-OF-WAY LINE N89°31'01"E FOR A DISTANCE OF 155.78 FEET; THENCE LEAVING SAID RIGHT-OF-WAY LINE S00°00'00"W FOR A DISTANCE OF 685.17 FEET; THENCE N89°30'27"E FOR A DISTANCE OF 332.48 FEET; THENCE NO2°03'40"E FOR A DISTANCE OF 63.11 FEET; THENCE S86°58'47"E FOR A DISTANCE OF 69.02 FEET; THENCE N89°53'11"E FOR A DISTANCE OF 72.43 FEET; THENCE N00°29'40"W FOR A DISTANCE OF 116.67 FEET TO THE SOUTH LINE OF BLOCK I OF SAID GOLDEN GATE UNIT 1; 28421 Bonita Crossings Blvd.,Bonita Springs,FL 34135 1211 North Range Ave.,Suite E,Denham Spr EXHIBIT Phone(239)643-2324•Fax(239)643-1143 Phone E-mail: inforiJceeill.com SERVING COASTAL COMMUNITIES SINCE 1977 rnoA31I11 , 1 0 A COASTAL ENGINEERING CONSULTANTS, INC, THENCE ALONG SAID LINE AND ITS EASTERLY PROLONGATION N89°30'20"E FOR A DISTANCE OF 458.67 FEET TO THE POINT OF BEGINNING. THE ABOVE DESCRIBES AN AREA OF APPROXIMATELY 1,027,716 SQUARE FEET OR 23.59 ACRES OF LAND. COASTAL ENGINEERING CONSULTANTS, INC. FLORIDA BUSINESS AUTHORIZATION NO. LB 2464 ............... Digitally signed by Richard) i,., Ewing *.'• x , 'a DN,,=US,o=Unaffiliated, ss t' ` dnQuallfer=A01410000000192F a9,•e ,„„„, j CAAB486000CA976,cn=Rlchard ,},.�oaoS s )Ewing .... .' �eiirvrd;,." Uate:2026,06.23 10:06:21.04'00' RICHARD J. EWING, V.P. PROFESSIONAL SURVEYOR AND MAPPER FLORIDA CERTIFICATE NO. 5295 NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER CEC FILE NO. 24.321 DATE OF SIGNATURE: 28421 Bonita Crossings Blvd.,Bonita Springs,FL 34135 1211 North Range Ave.,Suite L',Denham Springs,LA 70726 Phone(239)643-2324•Fax(239)643-1143 Phone(225)523-7403 L-mail.infou,cecifl.com SERVING COASTAL COMMUNITIES SINCE 1977 1 0 A 901WY 11801}VV ll 91Y0 4 ATMW4108'1[CriOx V00101r'A11Y103tl 130 3R AD SOWS.=Ifnd r.10•41 ie Ill-a 9tlptVQYoV'60t.I mav111109 -'-_ UCHrn11130 TH'LIl410 0 0 11 0 nu 10Yd'8Y0001V1d111030M0370 SYl03f3H1 wa10.VWtVlilI,tO01.r.r agnA9'nog 11tSSOY3r1Itl0g1 LY8L I 01gv.1( 1VLd}10ewl 31101M1gtl033V L And Y181l131Y0113a10010 V13Vtll (911t89(6Ll1043 1191 Y.yy rp,<00�-. '-' AI �y01661 'd1Wf2 .A 4o I811 In 0nV'YL0000011LL 08930191'9 MOOB1V1d tII00818033L pV Yi(ptW(pft)010441 111111 d03tl31LLlVNH0aVN1tl01(l,10003V'11P}a31KIN301094OY10YM} !1x 10 oo ,....,010d1MUN11X1u1Q1Y1f0'I331M1t1Vd0 A7AHnSAaVON(10fl SINd1l11SS.'r,„.F„ '4":'ti�m.at'atn ASIZT 1L° ylN1rA I"vr� ll°`VOSIVA ON..18f1931MWx(11V0tw ONIl13V3NII` y -[•+:w:iw�k i,..-44i'YaxLeus"tox=1,1 1.=".1 2 ..vA ll�A l�'��ICJN��1�111n'.�a0 ..”01i 333g0V 301d0g00f'74417fgb1At13 lY1J A 1 k � �f 8 3—ri x x e x $ 6164 gA ! fie $ B n nn '. H S i4X a x R xl . k 1 !I ti - : e ili @ gYi 1 b 41 l'$ 0 - e.` Qgq99p6p633pp77�`�nn i X pa g y xxx b,gxxgpxxl aa}xjto 3 7 3 3 9 9 Y NNJ�]G.9'J9 q ' xa "1 �WWWxx 1tla { 11d33t yx i I i OMNI Z06.6 $ e gg77 it Y i ;PAilig8 iig §A1 A k68EO6Y��$§fl$! `b- e i t (O1NA31009 a31110311 0'U'8 (1Vld Ned)009 1VO13 31V18 777iii li * d133 ? la sir 3.011C009 1. .,r____ g ,' .,----2—.._LL.,—.==___s,._.____.., ,,,,,.... .t.. ..., , . 0 q 1 y cyYxg dv *� �` ig +° ray ;�x ti. _�1• y''y'•.h , `. 1 1{�9<d gi \ 60 I Li ( ' n`OCLLL 3D000.OR11 1 _ 9 ,/ 1 FI lei O1'Af'3L000AOH1+�` 1 Igo 1 J I \ J 1 T l 11 (( 11411 1 0 A FLORIDA DEPARTMENT OF VETERANS' AFFAIRS COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS MEMORANDUM OF AGREEMENT THIS MEMORANDUM OF AGREEMENT ("MOA"), made and entered into this 25r day of se. r , 2025, by and between the State of Florida, Department of Veterans' Affairs ("F VA"), and the Collier County Board of County Commissioners ("Collier County"), and shall become effective upon the full execution by the Parties. WITNESSETH WHEREAS, FDVA is planning to construct a Florida Department of Veterans' Affairs State Veterans' Nursing Home ("Project") on property that is presently owned by Collier County, as memorialized in the Memorandum of Agreement dated March 14, 2023 between the State of Florida, Department of Veterans' Affairs (FDVA), and Collier County, and as may be amended; and WHEREAS, Collier County wishes to allocate an additional $10 million (Ten Million Dollars) from excess Infrastructure Sales Surtax Funds for the purposes of constructing additional square footage including facilities to be used for adult day health care and outpatient therapy services (the Outpatient Services)to be constructed in conjunction with the Project; and WHEREAS,the acreage to be developed will be a designated portion of land found within the parcel or parcels owned in fee simple absolute, legally described in the VA Parcel Legal Description, Exhibit A, attached hereto and made a part hereof, and includes 23.59 acres. The Sketch, Exhibit B,provides a tentative sketch for the portion(s) of the Project area to be used for the Outpatient Services to memorialize the intent of the parties, acknowledging that this MOA does not determine the final amount of square footage to be utilized for Outpatient Services; and WHEREAS, Collier County pledged $10 million (ten million dollars) in County Infrastructure Sales Surtax Funds to be used for construction and development costs for the Outpatient Services ("Outpatient Services Program Costs") of the County-owned real estate proposed for donation to the Board of Trustees of the Internal Improvement Trust Fund of the State of Florida ("BOTIITF"), if BOTIITF accepts such donation, with the intention that such real property is designated to become the next site for the Project and the Outpatient Services in Collier County; and WHEREAS, given the timing of the Project and the deadlines to request State and Federal authorizations to go forward with the Project, the County is required to transfer the $10 million (ten million dollars) to the State no later than October 1, 2025, and in accordance with the Three Party Escrow Agreement,Exhibit C,between the State of Florida,Department of Veterans' Affairs ("FDVA"),the Collier County Board of County Commissioners ("Collier BCC"), and State of Florida, Department of Financial Services, Division of Treasury ("DFS or Escrow Agent"), for purposes of demonstrating that FDVA has the required matching funds to qualify and be eligible for various State, Federal, and local government authorizations, approvals, and funding for the Outpatient Services,including but not limited to the United States Department of Veterans Affairs; 1 0 A the State of Florida, Department of Environmental Protection, staff for the BOTIITF; the State of Florida,Agency for Health Care Administration; and local governmental entities including but not limited to Collier County, the City of Naples, and any other permitting authorities approving consistency with land use plans and other relevant matters, to preserve and protect the Project funds; and WHEREAS, FDVA and Collier County agree that unless and until there is a reasonable degree of certainty that the Project will proceed as planned,no conveyance of title to real property will occur and no construction funds will be requested or released for the Project or the Outpatient Services. If the Outpatient Services does not proceed for any reason due to inability to meet the conditions precedent and/or contingencies that may arise, FDVA and Collier County agree to approve the release of funds from the Escrow Account,minus any fees due, and plus any accrued interest, returning such funds to Collier County promptly and without delay, subject to the State of Florida Department of Financial Services Escrow Terms and Conditions. NOW THEREFORE,in consideration of the premises and the covenants contained herein, the parties agree to the following: 1. Cooperation between the parties. FDVA and Collier County agree that a high level of cooperation between FDVA and Collier County is required as an essential term of this MOA,that it will demand such as a multi-year Project; that matters of governmental succession are of paramount importance; and that "time is of the essence" since the subject matter of the MOA is development of a new State Veterans' Nursing Home and Outpatient Services that will serve Collier County by providing health care services for eligible Veterans in need of skilled nursing care, and will create new permanent jobs. Therefore,FDVA and Collier County agree to maintain a sense of urgency with each other and all members of the Project team as it develops over time, in order to accommodate the needs of the various parties working toward the successful accomplishment of the Project to develop a ninth State Veterans' Nursing Home, anticipated to open in 2028. 2. Establishment of Escrow Account and Deposit. Collier County shall deposit $10 million (ten million dollars) into an interest-bearing Escrow Account established hereunder for the purposes of the Outpatient Services on or before October 1, 2025. The Escrow Account will be opened pursuant to the Three-Party Escrow Agreement,Exhibit D,that is referenced,incorporated and made a part of this agreement, to be executed by FDVA, Collier County, and DFS. Deposits will be delivered in accordance with instructions provided by the Escrow Agent. A wire transfer or ACH deposit is Collier County's preferred method of payment and should be used whenever possible. Such account will be an asset of FDVA to be used exclusively for the Outpatient Services. FDVA and Collier County agree that this asset must remain undisturbed in the Escrow Account until the Project and the Outpatient Services are ready to proceed. 3. Property Deed. Collier County has provided a copy of its currently recorded County Warranty Deed for the Golf Course Property, Exhibit C, together with the legal description and sketch depicting the estimated square footage for the Outpatient Services, Exhibits A and B, referenced, incorporated, and attached hereto, as part of this MOA. Other deposits to the Escrow Account may be made by Collier County during the life of this Agreement;however,no additional 2IPage (C A.°) 1 0 A Collier County funds beyond the $10 million (ten million dollars) have been committed by the Board of County Commissioners as of the effective date of this Agreement. 4. Escrow Account Funds and Restrictions. Notwithstanding any prior written arrangement by the parties, FDVA's Director of Administration or designee, Collier County's Chairinan of the Board of County Commissioners, and the DFS State Treasury Escrow Agent or designee, shall be the signatories on this Three-Party Escrow Agreement. If, after the Florida Legislature appropriates funding for the Project and Outpatient Services, and all conditions precedent shall have been met so that the site suitability has been determined and other key authorizations have been received, FDVA will request finds from the Escrow Agent for the Outpatient Services,in writing and using the correct Flair code, as verified with the Escrow Agent, to be transferred through a Journal Transfer to the appropriate FDVA Trust Fund, to be used as needed and in appropriate amounts to authorize work as directed by DMS through its Client Agency Agreement with FDVA, in order to have funds available in advance for payment of vendors/contractors for construction, development, and other various Outpatient Services Costs. 5. Appropriations from the Florida Legislature. FDVA and Collier County acknowledge that this multi-year Project will require Fixed Capital Outlay appropriations (the full amount of the appropriations is provided during the initial year) to complete all phases of the design and construction, to become fully-operational Outpatient Services of the State Veterans' Home. The State of Florida's performance and obligation to pay is contingent upon an annual appropriation by the Legislature. The appropriations will be requested as FIXED CAPITAL OUTLAY, STATE NURSING HOME FOR VETERANS' OUTPATIENT SERVICES—DMS MGD, construction is to be managed by the State of Florida Department of Managements Services ("DMS") under a separate agreement with FDVA. Appropriations are typically designated from Federal Grants Trust Fund and from Operations and Maintenance Trust Fund, stating for example: "From the funds in Specific Appropriation Line XXX,the nonrecurring sum of $XXX from the Operations and Maintenance Trust Fund, and $XXX from the Federal Grants Trust Fund, are provided for the completion of the construction of the Outpatient Services portion of the ninth State Veterans'Nursing Home in Collier County." 6. Disbursement. FDVA shall submit a written request to the Escrow Agent for disbursement of funds following Legislative approval of the appropriation(s) for the construction funds which appropriations will be made to and managed by the State of Florida, Department of Management Services ("DMS") for all design, engineering, and construction purposes during all phases of the development of the Outpatient Services. The written request shall include a written notice to Collier County of disbursement of the funds. 7. Escrow Agent Responsibilities. The duties of the Escrow Agent are found in the Three- Party Agreement, Exhibit D. 8. Termination. If the Project and Outpatient Services move forward as planned,termination of this MOA will occur after the opening of the State Veterans' Nursing Home in Collier County and completion of the post-closeout phase for Project#DVA22237500.Either party may terminate this MOA if the either the Project or the Outpatient Services do not proceed for any reason, including the failure of the Florida Legislature or the United States Department of Veterans Affairs to approve the Project or Outpatient Services, or other suitability factors impacting the Donation acceptability, site design and/or engineering issues,or other issues, the timing of which cannot yet 3IPage (iWk() 1 0 A be determined, anticipated to be on or around November 2025 or possibly at a later date. If the Project and Outpatient Services do not proceed for any reason due to inability to meet the conditions precedent and/or contingencies that may arise, FDVA and Collier County agree to approve the release of funds from the Escrow Account, minus any fees due, and plus any accrued interest, returning such funds to Collier County promptly and without delay, subject to the State of Florida Department of Financial Services Escrow Terms and Conditions. FDVA and Collier County will confer frequently so that there are continuing conversations in accordance with paragraph 1. above. 9. Legal Matters. This Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 10. Severability. If any provision of this Escrow Agreement is declared void or unenforceable, the provisions shall be severed from this Agreement, the remainder of the Agreement shall otherwise remain in full force and effect, provided that the overall intent of the parties is not materially vitiated by such severability. IN WITNESS WHEREOF, the parties have duly executed the Agreement on the date(s) below. STATE OF FLORIDA, DEPARTMENT BOARD OF COUNTY COMMISSIONERS OF VETERANS' AFFAIRS OF COLLIER COUNTY, FLORIDA Digitally signed ALFRED—D by ALFRED D , Alfred D. Carter, Cl'"e:cfa` ' f1R Bu L. Saunders, hairman CARTER Date: 2025.09.11 Date: 14:13:22 -04'00' Date: 12,3/ZS FDVA LEGAL REVIEW: ATTEST:.CRYSTAL K. KINZEL, CLERK Approved as to form and legality: Digitally signed by Andrew Andrew Benard Benard By: Date:2025.09.11 11:03:53-04'00' • Andrew Benard, General Counsel 'a t: 4c3 ' L Printe. Attest ' ?.'Chairman's -,,, sigature only Approved as to form and legality: olleen M. Greene Managing Assistant County Attorney 4IPage 1 0 A EXHIBIT A VA PARCEL LEGAL DESCRIPTION (June 23, 2025) 51page i i 1 0 A COASTAL Coastal and Marine Engineering E N G I N E R I N G Environmental and Geological Services CONSULTANTS Land and Marine Survey and Mapping I Website: www.coastalengineering.com 1 1 INC. EXHIBIT"A" "VA PARCEL LEGAL DESCRIPTION A PARCEL OF LAND LYING IN THAT PART OF TRACT A OF GOLDEN GATE UNIT 1, ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 5, PAGES 60 THROUGH 64, AND THAT PART OF TRACT A OF GOLDEN GATE UNIT 8 PART 2 ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 9, PAGES 107-A THROUGH 112, ALL OF THE PUBLIC RECORDS OF COLLIER COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING AT THE NORTHEAST CORNER OF SAID GOLDEN GATE UNIT 1, RUN 500°29'03"E ALONG THE EAST LINE OF SAID SUBDIVISION FOR A DISTANCE OF 489.28 FEET; THENCE LEAVING SAID LINE S89°30'20"W FOR A DISTANCE OF 15.31 FEET TO THE POINT OF BEGINNING; THENCE S00°33'12"E FOR A DISTANCE OF 17.24 FEET TO THE BEGINNING OF A NON-TANGENT CURVE; THENCE 600.09 FEET ALONG THE ARC OF SAID CURVE TO THE RIGHT HAVING A RADIUS OF 6,988.48 FEET; A CENTRAL ANGLE OF 04°55'12" AND A CHORD DISTANCE OF 599.91 FEET, BEARING S01°02'38"W TO THE BEGINNING OF A NON-TANGENT REVERSE CURVE; THENCE 417,18 FEET ALONG THE ARC OF SAID CURVE TO THE LEFT HAVING A RADIUS OF 7,418.47 FEET; A CENTRAL ANGLE OF 03°13'19" AND A CHORD DISTANCE OF 417.12 FEET, BEARING S00°59'16"W TO A POINT OF NON-TANGENCY; THENCE S00°28'50"E A DISTANCE OF 272.52 FEET; THENCE N90°00'00"W FOR A DISTANCE OF 460.47 FEET; THENCE N45°00'00"W FOR A DISTANCE OF 357.81 FEET; THENCE N00°00'00"E FOR A DISTANCE OF 722.30 FEET; THENCE N90°00'00"W FOR A DISTANCE OF 360.36 FEET; THENCE N00°00'00"E FOR A DISTANCE OF 832.10 FEET TO THE SOUTH RIGHT OF WAY LINE OF GOLDEN GATE PARKWAY; THENCE ALONG SAID RIGHT-OF-WAY LINE N89°31'01"E FOR A DISTANCE OF 155.78 FEET; THENCE LEAVING SAID RIGHT-OF-WAY LINE S00°00'00"W FOR A DISTANCE OF 685.17 FEET; THENCE N89°30'27"E FOR A DISTANCE OF 332.48 FEET; THENCE NO2°03'40"E FOR A DISTANCE OF 63.11 FEET; THENCE S86°58'47"E FOR A DISTANCE OF 69.02 FEET; THENCE N89°53'11"E FOR A DISTANCE OF 72.43 FEET; THENCE N00°29'40"W FOR A DISTANCE OF 116.67 FEET TO THE SOUTH LINE OF BLOCK I OF SAID GOLDEN GATE UNIT 1; (,,A0) 28421 Bonita Crossings Blvd..Bonita Springs,FL..34135 1211 North Range Ave.,Suite F,Denham Spr EXHIBIT Phone(239)643-2324•Fax(239)643-I 143 Phone E-mail:intoiikecifl.com SERVING COASTAL COMMUNITIES SINCE 1977i Pc 1 0 A COASTAL ENGINEERING CONSULTANTS, INC. THENCE ALONG SAID LINE AND ITS EASTERLY PROLONGATION N89°30'20"E FOR A DISTANCE OF 458.67 FEET TO THE POINT OF BEGINNING, THE ABOVE DESCRIBES AN AREA OF APPROXIMATELY 1,027,716 SQUARE FEET OR 23.59 ACRES OF LAND. COASTAL ENGINEERING CONSULTANTS, INC. FLORIDA BUSINESS AUTHORIZATION NO, LB 2464 ,,.i+,t.Fo,��;,.A,;••,,• Digitally signed by Richard J F*r "•++^ +,+3 DN:c.US,o�Unafgllaled, * dnQoalifer:.+A014i0000000192F aar ' CAA0486000CA976,cn=Richard 1g ;aify'itid;�` DE.winate:2025.06.23 10:06:21.09'00' RICHARD J. EWING, V.P. PROFESSIONAL SURVEYOR AND MAPPER FLORIDA CERTIFICATE NO. 5295 NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER CEC FILE NO. 24.321 DATE OF SIGNATURE: 28421 Bonita Crossings Blvd.,Bonita Springs,PI,34135 1211 North Range Ave.,Suite E,Denham Springs,I,A 70726 Phone(239)643-2324•Fax(239)643-I 143 Phone(225)523-7403 I?-mail:info9i,ceci[icons SERVING COASTAL COMMUNITIES SINCE 1977 C 1 0 A EXHIBIT B Sketch of Proposed Area for Outpatient Services 6I1'age 10) 1 0 A F f �6J -n 2 �707 C O Z O O T 2 0 � T � O O MdWS --II m a QT TZ S D 8 > 0zZ , NZ P. , N T1,1)11111:tn:o3: IC_ 11 1L11--- a j O .may tin - ,<. . v . • a o 0 u Q m U,CT C G 14 I +�7 `D o°o yty C A W fl �:� Sao�s 6 '' .ilia i h , I ._, 1 ' cn g n y Sx , __ate y . .. , f '77 w i1 fl m m •171,4? �L .4 f1 • 11 rn tso . fo.,a Tm ; 1.Ni iw oa .. i EG) rn .t ' c xr„ • o rn , nn E c • I i < , 1 * , , , C f o q K n , EXHIBIT E t P , t 1OA EXHIBIT C Collier County Warranty Deed i{E 71Page 1 0 A INSTR 5746913 OR 5657 PG 3552 RECORDED 7/31/2019 5:30 PM PAGES 9 CLERK OF THE CIRCUIT COURT AND COMPTROLLER, COLLIER COUNTY FLORIDA DOC@.70 S203,350.00 REC S78.00 INDX $1.00 CONS $29,050,000.00 Prepared without opinion of title by: David N.Morrison Attorney at Law Quarles&Brady LLP 1395 Panther Lane,Suite 300 Naples,FL 34109 239-434-4911 File Number:930538.00006 Parcel Identification Nos: i Gob Considcratinn, 229 00,, 66D.00 [Space Above This Line For Recording natal _.. Warranty Deed (STATUTORY FORM-SECTION 689 02,F S.) This Indenture made as of this 31st day of July,2019 between Robert Vocisano and Mario Vocisano, a Florida general partnership known as Golden Gate Inn,whose address is 4100 Golden Gate Parkway,Naples,FL 341 16,Grantors*,and The Board of County Commissioners of Collier County,Florida,as the governing body of Collier County,whose address is 3335 Tamiami Trail East,Naples,FL 341 12, Grantee*, Witnesseth that Grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable considerations to Grantor in hand paid by Grantee, the receipt whereof is hereby acknowledged,has granted, bargained,and sold to Grantee,and Grantee's heirs and assigns forever,the following described land,situate,lying and being in Collier County,Florida,to-wit: See attached Exhibit"A" Subject to the following exceptions: 1)ad valorem and non ad valorem real property taxes for the year 2019 and subsequent years; 2)zoning,building code and other use restrictions imposed by governmental authority; 3)outstanding oil,gas and mineral interests of record,if any;and 4)restrictions,reservations and easements common to the subdivision. Together with all tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have And To Hold the same in tee simple forever. And Grantor does hereby fully warrant the title to said land,and will defend the same against lawful claims of all persons 'whomsoever. ( •"Grantor"and"Grantee"ore used for srngulor or plural,as context requires " t THIS CONVEYANCE ACCEPTED ar ' EXHIBIT BOARD Of COUNTY cOxipOlssrata Mint,tER COUNTY. FLOitIDA. A• DA'TEpQ O� I't'EFI DoubleTtme 1 0 A OR 5657 PG 3553 In Witness Whereof,Grantor has hereunto set Grantor's hand and seal the day and year first above written. Signed,sealed and delivered in our presence: 4 Witness#1 Signature R ert ocisano,a General Partner of Robert Vocisano and Mario Vocisano,a Florida general partnership known as f I r� I Golden Gate Inn� Y1o )a ,LJe) u1 er Witness#1 Printed Name (g Witness 42 Signature G`'2 (G (16 1,5,4Nd Witness#2 Printed Name COUNTRY of Canada_ PROVINCE of N The foregoing instrument was acknowledged before me this' day of July, 2019 by Robert Vocisano,a General Partner of Robert Vocisano and Mario Vocisano, a Florida general partnership known as Golden Gate Inn, who [0 is personally known or[ ]has produced as identification. [Notary Seal] Andre Martin,•Commissioner,etc, Notary Public Pteekfre a Ontario for Bona Balding 1,Management Company Mahe • Enka November 10,2020 Printed Name: Ati.pQY R2z-t►'V My Commission Expires: 19 - NOV • 9-0.2-0 +I i 3 I I I Warranty Deed(SlonHoy Form)-Page 2 DoubleTlme° 1 0 A OR 5657 PG 3554 • In Witness Whereof,Grantor has hereunto set Grantor's hand and seal the day and year first above written. Signed,sealed and delivered in our presence: • Vei-e 1 (Seal) Witness#1 Signature Mario Vocisano,a General Partner of Robert Vocisano and Mario Vocisano,a Florida general partnership known as Golden Gate Inn / ` Witness#1 Printed Name Witness#2 Signature oLa aver Witness#2 Printed Name COUNTRY of Canada PROVINCE of N The foregoing instrument was acknowledged before me this 3 O day of July,2019 by Mario Vocisano,a General Partner of Robert Vocisano and Mario Vocisano, a Florida general partnership known as Golden Gate Inn, who [iris personally known or[ ]has produced as identification. OILS [Notary Seal] Andre Martin. �Com"�`°�°°`'°"' Notary Public rio For Bona edaLip 8 Management canpw, leveled qq ,,�� E#. D a Nov.ner 19,2020 Printed Name: Q,�,o�t,V lvtA R'C'• =r' My Commission Expires: 19— Ntv — 9,02 cp i Warrantyfined(Statutory Form)•Page 3 poubleTim e �' I 1 0 A OR 5657 Pc 3555 pp COASTAL CECI Grove Services ENGINEERING Coastal end Marine Engineering EnviroCONSULTANTS Land nmentel and Geological Services Mapping Land end Marine Survey and Mapping eigila INC. Webshe'www.coeslalengineering.com A CECI GROUP COMPANY GOLDEN GATE GOLF COURSE CONVEYANCE TO COLLIER COUNTY PARCEL LEGAL DESCRIPTION TRACTS A AND B,GOLDEN GATE-UNIT 1,ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOKS,PAGES 60 TO 64,OF THE PUBLIC RECORDS OF COLLIER COUNTY,FLORIDA. AND TRACT A,GOLDEN GATE-UNIT 8 PART 1,ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 5,PAGES 147 TO 151,AND TRACT A,GOLDEN GATE-UNIT 8 PART 2,ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 9,PAGES 108 TO 112,ALL OF THE PUBLIC RECORDS OF COLLIER COUNTY,FLORIDA. LESS AND EXCEPT PARCEL(1): BEGIN ATA POINT,CORNER NUMBER 1,354.50 FEET SOUTH AND 370.13 FEET EAST OF THE NORTHWEST CORNER OF TRACT"A"OF GOLDEN GATE SUBDIVISION,UNIT B,PART 2,AS SHOWN ON A PLAT THEREOF RECORDED IN PLAT BOOK 9,PAGES 107-112,OF THE PUBLIC RECORDS OF COLLIER COUNTY,FLORIDA; THENCE RUN N.0 DEGREES 15'04"W.16.91 FEET TO CORNER NUMBER 2 ON THE EAST LINE OF AN ACCESS EASEMENT;THENCE RUN N.12 DEGREES 51'43"E.31.94 FEET ALONG SAID EASEMENT TO A POINT OF CURVATURE,THENCE RUN NORTHERLY ALONG THE ARC OF A CURVE TO THE LEFT WHOSE RADIUS IS 577.88 FEET AND WHOSE CENTRAL ANGLE IS 7 DEGREES 47'03',FOR AN ARC DISTANCE OF 78.51 FEET TO CORNER NUMBER 3;THENCE N.89 DEGREES 44'56"E.89.59 FEET TO CORNER NUMBER 4;THENCE S.0 DEGREES 15'04"E.116.40 FEET TO CORNER NUMBER S;THENCE S.89 DEGREES 44'56"W.98.46 FEET TO CORNER NUMBER 6; THENCE S.50 DEGREES 09'46"W.14.20 FEET TO CORNER NUMBER 1 AND THE POINT OF BEGINNING. AND ALSO LESS AND EXCEPT PARCEL(2): A PARCEL OF LAND IN COLLIER COUNTY,FLORIDA,MORE PARTICULARLY DESCRIBED AS FOLLOWS AND BEING A PART OF THE PLAT OF TRACT A OF GOLDEN GATE UNIT 8,PART 2,AS RECORDED IN PLAT BOOK 9, PAGE 107-A,OF THE PUBLIC RECORDS OF COLLIER COUNTY,FLORIDA,MORE PARTICULARLY DESCRIBED AS FOLLOWS: COMMENCING ATTHE NORTHWEST CORNER OF TRACT A;THENCE RUNNING SOUTH A DISTANCE OF 649.27 FEET ALONG THE WEST BOUNDARY OF SAID TRACT A;THENCE RUNNING EAST 336.31 FEET TO A POINT,SAID POINT BEING ALSO DESCRIBED AS THE POINT OF BEGINNING; THENCE RUN NORTH 89'54'21" EAST,A DISTANCE OF 331.15 FEET TO A POINT;THENCE RUN NORTH 0'09'03"EAST A DISTANCE OF 75.04 FEET TO A POINT;THENCE RUN NORTH 23'43'43"EAST A DISTANCE OF 104.18 FEET TO A POINT;THENCE RUN NORTH 3106 S.Horseshoe Drive,Naples,Florida 34104'Phone(239)643-2324'Fas(239)643.1143'E-mall:)ACo,^geicif.com SE/lI"/\'C;('O.a,ST-.aL CO.II.II(,:17TIE.S.SI:\CE r977 EX BIT 1 I � ♦ 1 0 A OR 5657 PG 3556 Golden Gale Golf Course COASTAL ENGINEERING CONSULTANTS,INC. CEC File No.19.059 July 8,2019 Page 2 47'07'42"WEST A DISTANCE OF 196.55 FEET TO A POINT;THENCE RUN SOUTH 89°44'56"WEST A DISTANCE OF 184.50 FEET TO A POINT;THENCE RUN SOUTH 50'09'46"WESTA DISTANCE OF 14.20 FEET TO A POINT;THENCE RUN SOUTH 110 04'09"WEST A DISTANCE OF 113.36 FEET TO A POINT;THENCE RUN SOUTH 3'45'30"WEST A DISTANCE OF 183.92 FEET TO THE POINT OF BEGINNING. AND ALSO LESS AND EXCEPT PARCEL(3) COMMENCING AT THE NORTHWEST CORNER OF TRACT I OF SAID GOLDEN GATE UNIT 1,RUN S 00'31'32"E ALONG THE WEST LINE OF SAID TRACT I FOR A DISTANCE OF 460.24 FEET TO A POINT OF CURVATURE; THENCE 78.16 FEET ALONG THE ARC OF A CURVE TO THE LEFT HAVING A RADIUS OF SD.00 FEET,A CENTRAL ANGLE OF 89'33'45",A CHORD DISTANCE OF 70.44 FEET,BEARING S 45'24'29"E TO A POINT OF TANGENCY AND AN INTERSECTION WITH THE SOUTH LINE OF SAID TRACT I; THENCE ALONG SAID LINE N 89'30'20"E FOR A DISTANCE OF 149.52 FEET TO THE POINT OF BEGINNING; THENCE CONTINUE N 89'30'20"E FOR A DISTANCE OF 143.25 FEET; THENCE LEAVING SAID LINE S 00'29'40"E FOR A DISTANCE OF 116.67 FEET; THENCE S 89'53'11"W FOR A DISTANCE OF 72.43 FEET; THENCE N 86'58'47"W FOR A DISTANCE OF 69.02 FEET; THENCE N 02'03'40"E FOR A DISTANCE OF 48.97 FEET; THENCE N 14'13'43"W FOR A DISTANCE OF 17.31 FEET; THENCE N 00'29'40"W FOR A DISTANCE OF 46.23 FEET TO THE POINT OF BEGINNING; THE ABOVE DESCRIBES AN AREA OF APPROXIMATELY 7,190,871 SQUARE FEET OR 165.08 ACRES OF LAND, COASTAL ENGINEERING CONSULTANTS,INC. FLORIDA B SINESS AUT • '' ION NO.LB 2464 /' RICHARD J.EWING, PROFESSIONALSURVEYO:AND MAPPER FLORIDA CERTIFICATE N•,5295 NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER CEC FILE NO.19.059 DATE OF SIGNATURE: *7- / "/9 3106 S.Horseshoe Drive,Naples,Florida 34104'Phalle(239)643.2324'Fax(239)643.1143'E.meil:info/aced SERVING COASTAL COMMUNITIES SINCE 1977 10A I --z--- gr N _ ox 17f LL 2 1'.u, , r ,,, ,,,, , , „, , u„E Tii Erq g l'i g p ?P', `i, ii 1: - .R i: re.tiag yob _ 31 X N Z 2 2 7 1 Z ; .ii d N ' 2 ii gw l axN� N§Ui Pew o 0 ' 11R P. wz r p xX }p, 8 8 N t�'1 Y M fw 0 Q LLO U ai �i n �i v�i m �°o m m $i m o W w a V k ! '4W X a" $$$S$$9$$$BS,$$$k�d,8$g$$gg a`n w aR nu. 0..0. .dTdT--r�00_o -NodN66gg$ LLQ �� 41 y � n O 7' &iNN,,,,,,NtVNNNNN4wKfv tVN o,. 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CT) Q � � u u_¢ ¢o 3a w °° zr zt' p N z (0 O - Ian x Q W r V x rz � 0 J 0 m _ Zce 0 0 L o Ei ~ YQ za ,L9'91.6 J Wz UO 0 ffi Z In 3,A4,8ze00So O 0 1 et mWa W � ? �i O � U J W o mFil1g g g1RgT V 2s .` P a ate" z pQ E $ g eo s . Wc45 lig P / 6,,, W $ e E 0. b Iii qq p Z 4 / ,4Z 094 3„ze,�e000s 1- z , � 0 x 0 RERAI 0 i,,,,, ,... ,, +.n 09SE Dd LS9S ao n ,r;' 1 0 A EXHIBIT D Three Party Escrow Agreement 8IPage ,• 1 0 A 1 Exhibit D (Referenced, incorporated, and attached to FDVA-Collier BCC Adult Day Health Care and Outpatient Services Memorandum of Agreement) THREE PARTY ESCROW AGREEMENT THIS AGREEMENT is made and entered into by and between the State of Florida, Department of Veterans' Affairs ("FDVA"), the Collier County Board of County Commissioners ("Participant"), and the State of Florida, Department of Financial Services, Division of Treasury ("Escrow Agent"), and shall become effective upon the Agreement's execution by Escrow Agent. WHEREAS, FDVA and Participant are engaged in the following project ("Project"): Project Name: Adult Day Healthcare Building Adjoining FDVA's State Veterans Nursing Home in Collier County/Outpatient Services Project# :. DVA22237500 County: Collier County WHEREAS, FDVA and Participant desire to establish an escrow account for the project. NOW THEREFORE, in consideration of the premises and the covenants contained herein, the parties agree to the following: 1. An initial deposit will be made into an interest-bearing escrow account established hereunder for the purposes of the Project. The escrow account will be opened with the Escrow Agent on behalf of FDVA upon Escrow Agent's receipt and execution of this Agreement. 2. Other deposits to the escrow account may be made during the life of this agreement. 3. Deposits will be delivered in accordance with instructions provided by the Escrow Agent to the FDVA for deposit into the escrow account. A wire transfer or ACH deposit is the preferred method of payment and should be used whenever possible. 4. FDVA's Comptroller or designee shall be the sole signatory on the escrow account with the Escrow Agent and shall have sole authority to authorize withdrawals from the account. Withdrawals will only be made to FDVA or the Participant in EXHIBIT (cA 1OA accordance with the instructions provided to the Escrow Agent by FDVA's Comptroller or designee. 5. Moneys in the escrow account will be invested in accordance with section 17.61, Florida Statutes. The Escrow Agent will invest the moneys expeditiously. Income is only earned on the moneys while invested. There is no guaranteed rate of return. Investments in the escrow account will be assessed a fee in accordance with Section 17.61(4)(b), Florida Statutes. All income of the investments shall accrue to the escrow account, 6. Unless instructed otherwise by FDVA, all interest accumulated in the escrow account shall remain in the account for the purposes of the Project. 7. The Escrow Agent agrees to provide written confirmation of receipt of funds to FDVA. FDVA agrees to provide a copy of such written confirmation to Participant. 8. The Escrow Agent further agrees to provide quarterly reports to FDVA concerning the escrow account. FDVA agrees to provide a copy of such quarterly reports to Participant. 9. The Escrow Agent shall not be liable for any error of judgment or for any act done or omitted by it in good faith, or for anything which it may in good faith do or refrain from doing in connection herewith. 10. Escrow Agent shall have no liability for any claim, cost, expense, damage or loss due to the acts or omissions of FDVA and Participant, nor from any separate agreements between FDVA and Participant, and shall have no responsibility to monitor or enforce any responsibilities herein or in any separate agreements associated with this Agreement between FDVA and Participant. 11. This Agreement shall be governed by and interpreted in accordance with the laws of the State of Florida. 12. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 13. This Agreement shall terminate upon disbursement by the Escrow Agent of all money held by it in the escrow account in accordance with the instructions given by FDVA's Director of Administration or designee and notification from FDVA to Escrow Agent that the account is to be closed. The remainder of this page is blank. 1 0 A IN WITNESS WHEREOF, the parties have duly executed the Agreement on the date(s) below. ALFRED Digitally signed by ALFRED D ref FDVA si na'areCARTER ( g For PARTICIPANT (signature) bate: 2025.09.11 CARTER 11:24:59 -04'00' datiAphia _ Alfred D. Carter, Chief of Staff ur L. Saunders, hairman State of Florida, Department of Board of County Commissioners of Veterans' Affairs Collier County, Florida 59-3462886 5 9_4D S S1 Federal Employer I.D. Number Federal Employer I.D. Number I f2ti/Z5 Date Date RYSTt1 ; Z ,CLE,RK • For Escrow Agent (signature) Attest as to Chairrsnan's $►gnature.only Printed Name and Title Date Appr ye to form and 1 ality Assistant County Att rney ia1