Backup Documents 03/24/2015 Item #16D2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP,
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 60 2
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
2.
3. County Attorney Office County Attorney Office
Ii
Zb
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4. BCC Office Board of County Commissioners
5. Minutes and Records Clerk of Court's Office Z CS 3 501/
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 Trinity Scott&Tessie Sillery Phone Number 252-5832
Contact/ Department PublicTransit NBHD Enhmt(old atm)
Agenda Date Item was 3-24-2015 Agenda Item Number t b D(2)
Approved by the BCC Item# 14419
Type of Document FTA 5339 FY2013/2014-application Number of Original (I)
Attached Documents Attached
PO number or account
number if document is
to be recorded
Special Instructions: ORIGINAL AND 5 COPIES to be Fedex'd to Michelle Peronto. (our acct. #- )
FDOT/Michelle Peronto
801 North Broadway
Bartow,Fla. 33830
/-gYe3 • S/9 - ,2 55/ 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?
2. Does the document need to be sent to another agency for additional signatures? If yes,
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.
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
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.
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 3/24/2015 and all changes made during
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes, if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the 'lar
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
County of Collier
CLERK OF THE CIRCUIT COURT AL, 24., 4
COLLIER COUNT\SOURNIOUSE
Dwight E. Brock-Clerks of Circuit Court
3315 T,1\1I:1,N11 TRL E STE 102 P.O.BOX 413044
NAPLES, FL 34112-5324 MAPLES, FL 34101-1044
Clerk of Courts • Comptroller • Auditot • Custodian of County
March 27, 2015
FDOT, District One, Procuremnet Office
Attn: Michelle S. Peronto, LAP Coordinator
801 North Broadway Avenue
Bartow, Florida 33830
Re: FTA 5339 FY2013/2014 Grant Application
Transmitted herewith are one (1) original and five (5) copies of the above
referenced document for your records per request, as adopted by the Collier
County Board of County Commissioners of Collier County, Florida on Tuesday,
March 24, 2015, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara, De. ty Clerk
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- NA:vtiw.CollierClcrk.com Email- CollicrClcrk(a collicrcicrk.com
0 2
IA
APPLICATION FOR FEDERAL ASSISTANCE Version 7/03
1.TYPE OF SUBMISSION:
Application—place an x in the box Pre-application—place an x in the box
(]construction []construction
[x]non-construction []non-construction
2.DATE SUBMITTED February 24,2014 Applicant Identifier
3.DATE RECEIVED BY STATE State Application Identifier
4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
5.APPLICANT INFORMATION
Legal Name:Collier County Board of County Commissioners Organizational Unit:
Department:Public Transit&Neighborhood Enhancement
Organizational DUNS:076997790 Division: Public Services
Address:3299 Tamiami Trail East#103 Name and telephone number of person to be contacted on
matters involving this application(give area code)
Street: Prefix: Mrs. First Name:Michelle
City:Naples Middle Name:Edwards
County:Collier Last Name:Arnold _
State:FL Zip Code 34112 Suffix:
Country: USA Email:rni::heilearnol+:'-: : Aliercv_;net
6.EMPLOYER IDENTIFICATION NUMBER(EIN): Phone Number(give area code)
(Replace these boxes with numerals) 239-252-5841
59-6000558
Fax Number(give area code)239-252-6628
8.TYPE OF APPLICATION: 7.TYPE OF APPLICANT:(See back of form for Application
New Continuation x Revision Types)County
If Revision,enter appropriate letter(s)in box(es)
(See back of form for description of letters.)
Other(specify) Other(specify)
10.CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 9.NAME OF FEDERAL AGENCY:
(Replace these boxes with numerals) Federal Transit Administration
20-513
TITLE(Name of Program):Bus&Bus Facilities Program
11.DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:Capital
12.AREAS AFFECTED BY PROJECT(Cities, Counties, States, Assistance to enhance bus stops in the rural area by bringing
etc.):Community of lmmokalee&Rural Collier County them into Americans with Disabilities Act compliance.
13.PROPOSED PROJECT 14.CONGRESSIONAL DISTRICTS OF: 19-Curt Clawson
Start Date:7/1/14 Ending a.Applicant b.Project
Date:
6/30/15
15.ESTIMATED FUNDING: 16.IS APPLICATION SUBJECT TO REVIEW BY STATE
EXECUTIVE ORDER 12372 PROCESS?
a.Federal $217,600 .00 a. Yes. X THIS PREAPPLICATION/APPLICATION WAS
MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
PROCESS FOR REVIEW ON:
b.Applicant $ .00 DATE:
c.State $54,400 .00 b.No. PROGRAM IS NOT COVERED BY E.O. 12372.
d.Local $ 00 PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
e.Other $ 00 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL
• DEBT?
f.Program Income $ 00 Yes. If"Yes"attach an explanation.
• X No _
g.TOTAL $272,000 00
18.TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND
CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE
APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a.Authorized Representative
Prefix:Mr. First Name:Tim Middle Name:
Last Name:Nance Suffix:
b.Title:Chaj aa--- c.Telephone Number(give area code)239-252-8604
d.Signature A zesentative: e.Date Signed:
Previous Ed ion Usable. AuthorizefcicrEocal Reproduction. Standard Form 424(Rev.9-2003);Prescribed by
OMB Circular A-102
ATTEST c • Ap ed as to form an le ality
DWIGHT EE-BROCK, CLERK CA
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— Scutt R. Teach, Deputy County Attorney
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