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Backup Documents 10/13/2015 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING 'LI E n . TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT T 5 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIG: ATURE Print on pink paper. Attach to original document. the completed routing slip and original documents are to he font arded to the C ninny ?not net Of Ike at the lime the item is placed on the agenda, .111 completer)routing slips and original dncumeuh must he t erei%rd in the C'nunl) %ttornes Mice no later s than Monday preceding the Board meeting. ROUTING**NEW** ROUTING SLIP Complete routing lines=I through=2 as appropriate for additional signatures.dates.and or infitrntation needed. If the document h,dreads complete stoh the exception of the Chairman's signature.drat%a line through routing lines=1 through r,2.complete the checklist_and kiustard to the Count% Attorney Office. Route to Addressee(s) list iii rouniulg order Office Initiais Date 1. 3. County Attorney Office County Attorney Office _4i7.0,1)j 1 ® � 4-11c 4. BCC Office Board of County Conmissioners 'r �0\v c 5. Minutes and Records Clerk of Court's Office (© It-E, 6 I(%i442 , PRIMARY CONTACT INFORMATION i Normally the primary contact is the person oho created'prepared the Lxecutive Summary. Pnntaiy contact inhumation is needed in the es eat one or the addressees altos e.mar need to contact staff for additional or missing information. Name of Primary Staff Linda Swisher C Alan McLaughlin Phone Number 239 695-41 a }. Contact Department Ochopee Fire ontrol District Agenda Date Item was 10-13-15 • Agenda Item Number 16E5 Approved by the BCC Type of Document Volunteer Fire Assistance Grant Number of Original � 3 Attached Application Documents Attached PO number or account ' TedEx one original to: edex Account: Matt\l%einell,Fire number if document is VFA Grants Room 159 Resource Manager to be recorded ' Florida Forest Service 1-850-681-5931 3125 Conner Blvd. Tallahassee. Fl 32399-1650 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 Sk-Allvx p o 3. 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. `[ .. ..siA 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 C1 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 �c 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 arc 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 to/land all changes made during the '-ii o meeting have been incorporated in the attached//document. The County Attorney's $i* ! '1'° Office has reviewed the changes,if applicable. X, JV f 9. haitials of attorney verifying that the attached document is the version approved by the _ ('� -` +t7l BCC.all changes directed by the BCC have been made.and the document is ready for the ttr a r rrti Chairman's signature. rottirle3 1:Fortis%County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04.Revised I?6.05.Revised 2.24.05:Revised 11:30%12 CoiIn y f Cd.11ier 6 E5 CLERK OF THE CIRCIT COURT COLLIER COUNTY OUR1HOUSE 3315 TAMIAMI TRL E STE 102 Dwight E.Brock- ,erk of circuit Court P.O.BOX 413044 NAPLES,FL 34112-5324 NAPLES,FL 34101-3044 Clerk of Courts • Comptroller • Auditoustcian of County Funds October 16, 2015 Linda Swisher Ochopee Fire Control & Rescue District 201 Buckner Avenue Ochopee, FL 34139 Re: A Volunteer Fire Assistance Grant application submitted to the State of Florida Forest Service for the Ochopee Fire Control District Linda, Attached for the records of the Ochopee Fire Control District is an original copy of the grant application referenced above, approved by the Board of County Commissioners on Tuesday, October 13, 2015. The second original application was sent via FedEx to the Florida Forest Service in Tallahassee and the remaining application will be held in the Minutes and Records Department for the Board's Official Record. If you need any further information please feel free to contact me at 252-8406. Thank you. DWIGHT E. BROCK, CLERK Ann Jennej ohn, Deputy Clerk Attachment Co Iof Cdllier 16 E 5 CLERK OF THE CRC IT COURT COLLIER COUNTY OUR OUSE 3315 TAMIAMI TRL E STE 102 Dwight E.Brock-dkerk of circuit Court P.O.BOX 413044 NAPLES,FL 34112-5324 NAPLES,FL 34101-3044 Clerk of Courts • Comptroller • Auditor ust tan of County Funds October 15, 2015 Matt Weinell, Fire Resource Manager Florida Department of Agriculture and Consumer Services Florida Forest Service 3125 Conner Boulevard Tallahassee, FL 32399-1650 Mr. Weinell, Attached for further processing is an original Volunteer Fire Assistance Grant application for the Ochopee Fire Control District in Collier County Florida. Respectfully Submitted, DWIGHT E. BROCK, CLERK Ann Jennejohn, Deputy Clerk Attachment Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerk@collierclerk.coln - 165 Pliil AND DETAIN THIS COPY BEFORE AFFIXING TO THE PACKAGE.,NO POUCH NEEDED. me +.F .c of „no 'rf '.I 1111 ° m P' $ I = 2. a co u22'21g .i:g - c CI —0 ,lie. Egggi 1 r 3 ' il m I ❑ cz 2 m r i; Ic-3 �+ ..4, 'y ❑ ; g it. .9a9 Oil ale Bmf yc Ali [� N g '! We „g X O g Z' i L. .5 �o NS'F.Y O .n co u'S'g 'uS -2 u'S g 11 e' 1-1 ej J ❑ ❑ § a Eat 2 m 2 oP gs 4 ❑ 1 «I zg a �s - gr f a 8 ❑ iS� s 36 .- Sm - v mac vi .i' C 5 ❑ - y m�i a �+ S _—I 9 E C 714 a a g O i;�€ W -® - 1 to q r a ct 1,75 4 > a m L%5 ; Esm �s:o m W .!!6 €A i u `9 4 mp iii aC La yz2 ,py, tll2 p 65.1.= gp 1m 422E 1y E1I V m lit W °'"11 1118 mz 6. .i AL gi z'41 E 2 gi 111 Ya a I. z$B a 12v g m rq �' Ti ,1 111 i .. �nIJ) I I 9lig 01 g0 a as %. cm IN _ili _11/1 as a." �. ❑ ❑ w a- CtZi &I el 0 o o r-1 coaH a a 2N E4 .. NO C N E-+ aC . Z o Ln { � U t o [ti O H - 0 O «a CO o o o 40 a A . Yw ,E 1^o NU C.'fz c .5o MI 0 05 i cu ` • i d H E. e Z8 1 ,, a 2`. I H C a Vi ? Q ( m • No tl r-Q E o 1 0 5 �0:. �L o cot al Yg Finac2 8 ¢3 g • r CO P7 6£££'£9t10081 X3P9 09'0081 W03'Xepaa L... .m. _ ... ... .., ... .. r -- ^ tw.•.. 1. 6 E 5 . fi:g .1i Florida Department of Agriculture and Consumer Services =•LL Florida Forest Service ADAM H.PUTNAM VOLUNTEER FIRE ASSISTANCE GRANT APPLICATION COMMISI OVER LEGAL NAME OChopee Fire Control DistrictFORM OF ORGANIZATION:(Municipal,Fire[Astrid,Non-Profit.County) ADDRESS 201 Buckner ave Al MSTU Dependent Fire District CITY Everglades City IF COUNTY,LIST VFD'S BENEFITING FROM GRANT: STATE Florida ZIP 34139 COUNTY Collier COUNTY it EMPLOYER IDENTIFICATION NUMBER(EIN) • 5 9 . 16 0 0 01 51.5 �8 • IS FIRE DEPARTMENT LOCATED IN AN INCORPORATED TOWN? WHAT IS THE FIRE DEPARTMENT ISO RATING?1 4.4x YES (31 NO D IF YES.NAME OF TOWN: 1 Everglades City IS FERE DEPARTMENT NIMS COMPLIANT? YES® NO 0 POPULATION OF TOWN:I 431 v.- CURRENT COOPERATIVE AGREEMENT WITH FFS? YES 'r} NO Q PROTECTED AREA: EST.POPULA77ON:I 4100 SIZE (SQ.MfLCS)t"jYOp DISTANCE OF CLOSEST MUTUAL AID FIRE DEPARTMENT:' C 11 NAME OF FIRE DEPARTMENT:j"Greater Naples Fire rescue NUMBER OF FIREFIGHTERS: PAID:1 25 VOLUNTEERS: 1 t1 HAS APPLICANT RECEIVED GRANT FUNDS FROM ANY SOURCE IN THE PAST 12 MONTHS? YES[ NO� ] NO.OF INCIDENTS PAST YEAR: W71 ILDLAND FIRE' 17 OTHER: 2 IF YES,WHERE? rCtF$late Flon`da Fire S`erviCe NO,OF FIREFIGHTERS CERTIFIED AS: AMOUNT: $ 1,050 WILALAND FIREFIGHTER l 31 WI!-DLAND FIREFIGHTER II i J LIST TOTAL FUNDS RECEIVED FROM OTHER TAXING AUTHORITIES SUCH AS CITY,COUNTY,TAXING DISTRICTS(Pest 12 Months) AMOUNT: $ F10-- LIST _$tr"""`."LIST OF FIREFIGHTING VEHICLES: TYPE MAKE/YR.MODEL PUMP CAPACITY(GPM) WATER CAPACITY(GAL.) — Engine(3) Emergency One 98,05.05 1250 1000 Water Tender Emergency One 2012 1250 2500 Attack/Brush Dodge 5500 250 450 ESTIMATED GRANT FUNDING REQUEST: $14,800 , LIST OF EQUIPMENT OR SUPPLIES TO PURCHASE WITH GRANT FUNDS: FEDERAL $ 7,400 •? NUMBER DESCRIPTION AMOUNT APPLICANT $ 7,400 6 Urban interface protective clothing coats 7,400 COUNTY $ g Urban Interface prolective clothing pants 7,400 TOTAL $ 14,900 (Federal not more than 50%of total. Applicant at least 50%of total in matching funds.) We understand that this is a 50 percent maximum cost-share program(Cooperative Forestry Assistance Act of 1978,PL 95-313),and that funds on deposit up to 50 percent of the actual purchase price of the items approved wit be committed to our project. TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE GOVERNING BODY OF THE APPLICANT HAS DULY AUTHORIZED THIS DOCUMENT. Type Name of Authorized Representative Title Telephone Number: ( 239 ) 8954114 Tim Nance Chairman FAX: ( 239 ) 695-3473 • -or Authorized Representative Date Signed and Submitted Email: a,s,ice_ - ktAkb\ks DACS-f 1464 REV.3/06 ATTESTS Approved as to form and legality DWIGHT E. BROCKIClork ce) - Attest as to ►�t. �'s Assistant County At oo\fy 6E5 Form AD-1047 um, U.S.DEPARTMENT OF AGRICULTURE Certification Regarding ebarment,Suspension, and Other Responsibility Matters-Primary Covered Transactions This certification is required by the regulations implementing Executive Order 12549,Debarment and Suspension, 7 CFR Part 3017,Section 3017,510,Participants'responsibilities. The regulations were published as Pant TV of the January 30, 1989, Federal Reglster(pages 4722-4733). Copies of the regulations maybe obtained by contacting the Department of Agriculture agency offering the proposed covered transaction, {Before completing certification,read instructions on reverse.) (1) The prospective primary participant certifies to the best of its knowledge and belief,that it and its principals: (a) are not presently debarred,suspended,proposed fir debarment,declared ineligible,or voluntarily excluded from covered transactions by any Federal department or agency; (b) have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public(Federal,State or Local)transaction or contract under a public transaction;violation of Federal or State antitrust statutes or commission of embezzlement,theft, forgery,bribery,falsification or destruction of records,making false statements,or receiving stolen property; (c) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal,State or Local)with commission of any of the offenses enumerated in paragraph(I)(b)of this certification;and (d) have not within a three-year period preceding this application/proposal had one or more public transactions(Federal,State or Local)terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. ORGANIZATION NAME [PR/AWARD NUMBER ORPROJECT NAME Collier County Board of County Commissioners Ochapee Fire Control District NAME AND TITLE OF AUTHORIZED REPRESENTATIVE Tim Nance,Chairman SIGNATURE lam® DATE IgA\-s\ s ,. .s .41 ATTEST: Approved as to form and legality 8y: . , Asad: t County A o c 1110/11 a • Attest as fo Ch M .. . man's • signatureonly. • 1 6 E5 Form AD-1047 atoa drmVeresq INSTRUCTIONS FOR CERTIFICATION By signing and submitting this form,the prospective primary participant is providing the certification set out on the reverse side in accordance with these instructions. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction, The prospective participant shall submit an explanation of why it cannot provide the certification set out on this form. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of tact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification,in addition to other remedies available to the Federal Government,the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. " "" N"ineligible,"5. The terms"covered transaction," debarred, suspended, lower tier covered transaction," "participant,""person,""primary covered transaction,""principal,""proposal,"and"voluntarily excluded,"as used in this clause,have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6, The prospective primary participant agrees by submitting this form that,should the proposed covered transaction be entered into,it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,unless authorized by the department or agency entering into this transaction. • 7. The prospective primary participant further agrees by submitting this form that it will include this clause titled"Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions,"provided by the department or agency entering into this covered transaction,without modification,in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification ofa prospective participant in a lower tier covered transaction that it is not debarred,suspended,ineligible,or voluntarily excluded from the covered transaction,unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may,but is not required to, check the No❑procurement List. 9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings, 10. Except for transactions authorized under paragraph 6 of these instructions,if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended,debarred, ineligible,or voluntarily excluded from participation in this transaction,in addition to other remedies available to the Federal Government,the department or agency may terminate this transaction for cause or default, 2 iYJ 1 6 E5 Oh4B Approval No.0348-0040 ASSURANCES--NON-CONSTRUCTION PROGRAMS Note; Certain of these assurances may not be applicable to your project or program, If you have questions,please contact the awarding agency. Further,certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be not i tied. As the duly authorized representative of the applicant I certify that the applicant: 1. I las the legal authority to apply for Federal assistance,and the 7, Will comply,or has already complied,with the requirements of institutional, managerial and financial capability (including funds Titles lI and 111 of the Uniform Relocation Assistance and Real sufficient to pay the non-Federal share of project costs) to ensure Property Acquisition Policies Act of 1970 (PL. 961-646) which proper planning, management and completion of the project provide for fair and equitable treatment of parsons displaced or described it this application. whose property is acquired as a result of Federal or federally assisted programs, These requirements apply to all interests in real property 2. Will give the awarding agency,the Comptroller General of the acquired for project purposes regardless of Federal participation in United States, and if'appropriate, the State, through any authorized purchases, representative,access to and the right to examine all records,books, papers,or documents related to the award;and will establish a proper 8. Will comply with the provisions of the Health Act(5 U.S.C.§§ accounting system in accordance with generally accepted accounting 1501-1508 and 7324-7328) which limit the political activities of standards or agency directives. employees whose principal employment activities are funded in whole or in part with Federal funds. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the 9. Will comply, as applicable,with the provisions of the Davis- appearance of personal or organizational conflict of interest, or Bacon Act (40 U.S.C, §§ 276a to 276a-7), the Copeland Act (40 personal gain. U.S,C. §276c and 18 U.S.C.§§874),and the Contract Work Hours and Safety Standards Act(40 U.S.C, §§ 327-333), regarding labor 4. Will initiate and complete the work within the applicable time standards for federally assisted construction subagreements. frame after receipt of approval of the awarding agency. 10. Will comply, if applicable, with flood insurance purchase 5. Will comply with the Intergovernmental Personnel Act of 1970 requirements of Section 102(a)of the Flood Disaster Protection Act (42 U.S.C. §§ 4728-4763)relating to prescribed standards for merit of 1973 (P.L. 93-234) which requires recipients in a special flood systems for programs funded under one of the nineteen statutes or hazard area to participate in the regulations specified In Appendix A of OPM's Standards for a Merit program and to purchase flood insurance if the total cast of insurable System of Personnel Administration(S C.F.R.900,Subpart F). construction and acquisition of$10,000 or more. 6. Will comply with all Federal statutes relating to 11. Will comply with environmental standards which may he nondiscrimination. These include but arc not limited to;(a)Title V1 prescribed pursuant to the following:(a)institution of environmental of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits quality control measures under the National Environmental Policy discrimination on the basis of race,color or notional origin;(b)Title Act of 1969 (P.L. 91.190) and Executive Order (EO) 11514; (b) IX of the Education Amendments of 1972,as amended(20 U.S.C.§§ notifieatinn of violating facilities pursuant to EO 11738; (c) 1681-1683,and 1685-1686), which prohibits discrimination on the protection of wetlands pursuant to EO 11990;(d)evaluation of flood basis or sex; (c) Section 504 of the Rehabilitation Act of 1973, as hazards in lloodplains in accordance with 130 11988;(e)assurance of amended (29 U.S.C. § 794), which prohibits discrimination on the project consistency with the approved State management program basis of handicaps; (d) the Age Discrimination Act of 1975, as developed under the Coastal Zone Management Act of 1972 (16 amended (42 U.S.C. §§6101-6107), which prohibits discrimination U.S.C. §§ 1451 et seq.); (I) conformity of Federal actions to State on the basis of age; (Clear Air)Implementation Plans under Section 176(c)of the Clear Air Act of 1955, as amended (42 U.S.C. § 7401 et seq.); (g) (e)the Drug Abuse Office and Treatment Act or 1972(PI,.92- protection of underground sources of drinking water under the Safe 255),as amended,relating to nondiscrimination on the basis of drug Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism protection of endangered species under the Endangered Species Act Prevention,Treatment and Rehabilitation Act of 1970(P.L.91-616), of 1973,as amended,(P.L.93-205). as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;(g)§§523 and 527 of the Public Health Service 12. Will comply with the Wild and Scenic Rivers Act of'1968(16 Act of 1912(42 U.S.C.290-dd-3 and 290 ec-3),as amended relating U.S.C. li§1271 et seq.)related to protecting components or potential to confidentiality of alcohol and drug abuse patient records;(h)Title components of the notional wild and scenic rivers system. V111 of the Civil Rights Act of 1968(42 U.S.C. § 3601 et seq.), as V,8-5(02105) emended,relating to nondiscrimination in the sale,rental or financing Authorized for Lora]Reproduction of housing;(1)any other nondiscrimination provisions in the specific Standard Form 4240 (9-03)Prescrlbed by OMB Circular A-102 statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s)which may apply to the application. 6'� 1 research, teaching, or other activities supported by this award of 13. Will assist the awarding agency in assuring compliance with assistance. Section 106 of the National Historic Preservation Act of 1966, as amended(16 U.S.C.470),EO 11593(identification and protection of 16. Will comply with the Lead-Based Paint Poisoning Prevention historic properties),and the Archeological and Historic Preservation Act(42 U.S.C.§§4801 et seq.)which prohibits the use of lead based Act of 1974(16 U.S.C..469a-1 et seq.), paint In construction or rehabilitation ofresidence structures. 14. Will comply with P.L. 93-348 regarding the protection of 17. Will cause to be performed the required financial and human subjects involved in research, development, and related compliance audits in accordance with the Single Audit Act of 1984, activities supported by this award of assistance. 18. Will comply with all applicable requirements of all other 15. Will comply with the Laboratory Animal Welfare Act of 1966 Federal laws, executive orders, regulations and policies governing (P.L. 89.544, as amended, 7 U.S.C.2131 et seq.)pertaining to the this program. care,handling,and treatment of want)blooded animals held for • SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE / 440te.e.„.. Board of County Commissioners Chairman 11rn APPLICANT ORGANIZATION DATA Collier County Board of County Commissioners SUBMITTED 10V2,t • l� V,11-6(02105) Authorized for Local Reproduction) Standard Form 424B (9-03 Prescribed by OMB Circular A-102 Approved as to form and legality DWIGHT E' 37,11:1°U1C1 • ' L,.►; -J.iatant our%ttorney gteSt� �' q� Ona lyj