Backup Documents 02/10/2015 Item #16F1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16F 1
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.
**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.
2.
3. County Attorney Office County Attorney Office
4. BCC Office Board of County
Commissioners \A4 P/7/ i` \3\\C
5. Minutes and Records Clerk of Court's Office
43115 2: ,
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 \ Phone Number
Contact/ Department fJ vt \ cis • (1 \'t
Agenda Date Item was Agenda Item Number
Approved by the BCC a� �� S c l 1
Type of Document Number of Original
Attached AS S 1 `}t) rn 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)
1. Does the document require the chairman's original signature?c - ' w.t4 7
2. Does the document need to be sent to another agency for additional sig atures? If yes,
provide the Contact Information(Name;Agency; Address; Phone)on an attached sheet. Ni A
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.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
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 n �o
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 input into SIRE. A ,,
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 3i.olry(enter date)and all changes made
during the meeting have been incorporated in the attached document. The County
4I7
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by th• -TR
BCC, all changes directed by the BCC have been made,and the document is ready fo he
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
16F I
MEMORANDUM
Date: February 16, 2016
To: Paula Fleischman, Impact Fee Coordinator
Business Management & Budget, CDES
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Assignment of Impact Fee Credits
Enclosed please find one copy of the document referenced above (Agenda Item
#16A27), approved by the Board of County Commissioners on Tuesday, February 10,
2015.
The Minutes & Records Department has retained the original for public record.
If you have any questions, please contact me at 252-7240.
Thank you.
Enclosure
Enclosure (1)
16F I
ASSIGNMENT OF IMPACT FEE CREDITS
THIS ASSIGNMENT OF IMPACT FEE CREDITS is made and between the First
Congregational Church ("Assignor"), crry M.a-►TR -55 0x ci RjI,I ( Assignee"), and Collier
County, for the purpose of transferring all or a portion of the remaining Impact Fee Credits held by
Assignor arising out of Resolution No. 08-355.
Assignor wishes to convey to Assignee certain Impact Fees Credits granted through the
Agreement. The attached Exhibit itemizes the types and amounts of the Impact Fee Credit
transferred to the Assignee.
In consideration of assenting to this Assignment, with its increased administration burden,
Assignor and Assignee hereby jointly and severally indemnify and hold harmless Collier County
against any and all present and future claims of whatever kind arising out of the transfer and ultimate
use of these Impact Fee Credits, including but not limited to administrative errors by Collier County
staff. Prior to payment of the impact fee, Assignee shall notify the County that a credit is available
by submitting the then-current County approved Impact Fee Credit Consent Form.
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their
appropriate representatives, as of the date first above written.
DATE: 0/--`2" -a°i5 ASSIGNOR:
By: Z.i c , i /
STATE OF
C"et Print Name/Title: iC€e t/ 1,,,PS CQJcc g
COUNTY OF/ Cl._
The foregoing instrument was acknowledged before me this 2 qday Ofi Or n t. vet/ 20 icy kr
L e5/�- tO/c- -er as /f.tfv,.er,-e►�af for At5�ego, re'Co„�./ Ch, yr o is
personally known to me or has produced f - 0 ro v ei-� 4 s,.,p as identification.
(Notary Seal) ,/►�v�i�� /
-- "' :tore o Publi �
4'"" JENNIFER HAYES h h 1_ J�q( 4
+: (1 :EF+ MY COMMISSION#�FF 079628
xrr
:.tee EXPIRES:February 3,2017 Print,type,or stamp name of Notary Public
/.R ..' Bonded Thru Notary Pubic Underwriters r
DATE: 6/-a 2- (:)/5 ASSIGNEE:
By: Yu - i
Print N /Title: Cro Vr G/nurk.S.v tCJCi JSo,k.
STATE OF fi 0 r .
COUNTY OF L 5.f.__ \\
The foregoing instrument was acknowledged before me this a� day ofiS r, ,,,,r 20 15—by
'3 cz ,inNai c (‘ &k y50Y� as Y�C-) IC)4 f$iq/Lr-,5_3 ,-.c cL.-rp< who is
perso'lially known to me or has produced ✓ as,identification.
f
(Notary Seal) ,`> '
Signa ure of No Public
fl,-
MY
Print,type,or stamp name of lyldtary Public
COMMISON#tFF079628EXPIRES:Februa 3,2017
,, Bonded Thru Notary Public Underwriters
1 6F I
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,Clerk COLLIER COUNTY, FLORIDA
-0,11), /7e 8 r3 /
By: L---:l1 By:
4o Cl- • TIM NANCE, CHAIRMAN
Attest as to Chairzia
signature only;
Approved . rs form
and leg.' s fh ' 'icy:
Atli
Jeffrey Al latz ow
County • t)rney
1 6F 1
EXHIBIT
Building Permit# e?2?D.o 1'-; O i O t 3 910 or
Site Development Plan/Plat AR#Number:
Impact Fee Credit Amount: $ 15, a i s. B4-
Impact
`'C'Impact Fee Credit Type(i.e.Road,Park, Schools): 0 AA)
Please issue credit from(choose one): Cash Pre-Payment Ledger or Credit Ledger X