Backup Documents 12/09/2025 Item #16C 1ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C I
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
excentinn of the ('hair.,,a.,'� A—, ., r...e A ------ U
Route to Addressees (List in routing order)
Office
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Initials
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Date
1.
2.
3. County Attorney Office
County Attorney Office
/
4. BCC Office
Board of County
Commissioners
54, A914
LZ/16
5. Minutes and Records
Clerk of Court's Office
O
rK11v1AKY UU1N l'AUJ1 INYUKMATION `
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
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Name of Primary Staff
Kari Hodgson / PUD — Solid Waste
Phone Number
239-252-2504
Contact / Department
Agenda Date Item was
12/09/2025
Agenda Item Number
16.C.1
Approved by the BCC
Type of Document
Number of Original
1
Attached
f
Documents Attached
PO number or account
number if document is
to be recorded
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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?
KH
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 legal sufficiency. (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.
KH
4.
All handwritten strike -through and revisions have been initialed by the County Attorney's
N/A
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
KH
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
KH
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
KH
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 12/09/2025 and all changes made during
KH
the meeting have been incorporated in the attached document. The County
an Io
Attorne 's Office has reviewed the changes, if applicable.
this li
9.
Initials of attorney verifying that the attached document is the version approved by the
is
BCC, all changes directed by the BCC have been made, and the document is ready for the
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Chairman's signature.
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
16C1
AMENDMENT NO. 3
TO CONTRACT NO. GC919
BETWEEN
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
AND
COLLIER COUNTY BOARD OF COMMISSIONERS
This Amendment to Contract No. GC919, as previously amended, (Contract) is made by and
between the Department of Environmental Protection (Department), an agency of the State of Florida,
and Collier County Board of Commissioners, 3339 Tamiami Trail East, Suite 302, Naples, Florida, 34112
(Contractor), on the date last signed below.
WHEREAS, the Department entered into the Contract with the Contractor to perform compliance
inspections within thejurisdictional (geographical) boundaries of the specified counties, effective June 26,
2017;and
WHEREAS, the parties wish to amend the Contract as set forth herein.
NOW THEREFORE, the parties agree as follows:
1. Paragraph 5A. Compensation is hereby revised to increase the maximum compensation amount of
the Contract from $1,066,261.00 to $1,237,111.45 (an increase of $170,850.45) to allow for continued
services.
2. Attachment E, Contractor Affidavit/Release of Claims Form is hereby deleted in its entirety and
replaced with Attachment E-1 Revised Contractor Certification Release of Claims Form, as attached to
this Amendment and hereby incorporated into the Agreement. All references to Attachment E shall
hereinafter refer to Attachment E-1 Revised Contractor Certification Release of Claims Form.
3. All other terms and conditions of the Contract remain in effect. If and to the extent that any
inconsistency may appear between the Contract and this Amendment, the provisions of this
Amendment shall control.
The parties agree to the terms and conditions of this Amendment and have duly authorized their
respective representatives to sign it on the dates indicated below.
Collier C my Board of Commissioners
.e"
By: �F
Title:Q�c�av�
Date:ev����c
ATTEST
CRYSTAL KINZEL, CLERK
BY, —
Contract No. GC919 Attest as to Chairman
Lu-signature onGy
Rev. 6/18/2024
Florida Department of Environmental Protection
By:
Secretary or Designee
Date:
fppry as t tm legality
t R. Teach, Deputy County Attorney
Amendment No. 3
1of2 04�e
1 6C 1
List of attachments/exhibits included as part of this Contract:
Specify Type /
Letter Description
Attachment E-1 Revised Contractor Certification Release of Claims Form
- REMAINDER OF PAGE INTENTIONALLY LEFT BLANK -
Contract No. GC919 Amendment No. 3
2 of 2
Rev. 6/18/2024
16C1
ATTACHMENT E-1
STATE OF FLORIDA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Revised Contractor Certification / Release of Claims Form
This certification must be completed and signed by the Contractor when requesting final payment for a Florida Department of
Environmental Protection (Department) authorized Task Assignment. Final payment for a Task Assignment will not be released until
this form is accepted by the Department.
The undersigned certifies as follows:
am the
(name of person appearing)
(name of Contractor)
make this statement on its behalf,
of
(title of person appearing)
with the authority to
2. ("the Contractor") entered into an
(name of company or person)
Agreement with the Department to perform certain work under Task Assignment No.
3. Contractor has completed the work in accordance with the aforementioned Task Assignment, including all attachments thereto.
4. All subcontractors have been paid in full.
5. Upon receipt by Contractor from Department of final payment under the aforementioned Task Assignment, Contractor releases
Department from any and all claims of Contractor and any of its subcontractors and vendors that may arise under, or by virtue of,
the Task Assignment, except those claims that may be specifically exempt and set forth under the terms of this Contract. Exemptions
claimed must be attached to this affidavit and reference the Task Assignment number. Any exemptions not attached are waived.
(Signature of Authorized Contractor Representative)
Rev. 4/15/2024