Backup Documents 01/12/2016 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 131
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. Michelle Rubbo Community & Human /��
Services (CHS) Division ( LG 5
2. County Attorney Office County Attorney Office
I I IZ�I(ft
3. BCC Office Board of County \
Commissioners ✓�� ��tz���
4. Minutes and Records Clerk of Court's Office $T-t(c0 14:3°
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 Rosa Munoz, CHS Phone Number 252-5713
Contact/ Department
Agenda Date Item was January 12,2016 Agenda Item Number 16D1
Approved by the BCC
Type of Document 1. Amendment#4 to Habitat for Humanity Number of Original s
Attached Agreement(Faith Landing 2013) Documents Attached
PO number or account
number if document is '97`=L-,
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 original signature? Stamped signature ok RM
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 RM
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 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 RM
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 RM
signature and initials are required. _
7. In most cases(some contracts are an exception),the original document and this routing slip RM
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 01/12/16 and all changes made
during the meeting have been incorporated in the attached document. The County ztrlr
Attorney's Office has reviewed the changes,if applicable. � �r' 'kA
9. Initials of attorney verifying that the attached document is the version approved by the �� t
BCC, all changes directed by the BCC have been made, and the document is ready for he 'of��l a #�
Chairman's signature. jiAd k�
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
MEMORANDUM 16131
Date: January 13, 2016
To: Rosa Munoz, Grant Coordinator
Community & Human Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment #4 to Habitat for Humanity Agreement— Faith Landing
Infrastructure Improvements
Grant #B-13-UC-12-0016
Attached are two (2) original amendment to the agreement referenced above, (Item
#16D1) approved by the Board of County Commissioners on Tuesday, January 12,
2016.
An original has been kept by the Minutes and Records Department for the
Official Records of the Board.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
16 0 1
Grant#- B-13-UC-12-0016
CFDAICSFA#- 14.218
Subrecipient — Habitat for Humanity of
Collier County, Inc.
DUNS # - 080676690
FETI # - 59-1834379
Fiscal Year End: 6/30
IDIS Project#467
Monitor End: 12/31/2023
FOURTH AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
HABITAT FOR HUMANITY OF COLLIER COUNTY, INC.
Faith Landing Infrastructure Improvements
This Amendment is entered into this 1a*day o htt&r 2016, by and between HABITAT FOR
HUMANITY OF COLLIER COUNTY, INC., a privat ot-for- fit corporation existing under the laws of
the State of Florida, herein after referred to as SUBRECIPIENT and Collier County, Florida, hereinafter to be
referred to as "COUNTY," collectively stated as the "Parties."
RECITALS
WHEREAS, on January 28th 2014, the COUNTY entered into an Agreement for awarding Community
Development Block Grant Program funds to be used for Faith Landing Infrastructure Improvements
Project(hereinafter referred to as the "Agreement"), which has been subsequently amended multiple times; and
WHEREAS,the Parties desire to amend the Agreement to shift remaining project funds between line items in
order to fully expend awarded funds.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable
consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree to
amend the Agreement as follows:
Words Struck—Through are deleted; Words Underlined are added
III. AGREEMENT AMOUNT
X X
Habitat for Humanity of Collier County,Inc.
Amendment#4
2013-2014 CDBG(CDBG13-03)
Page 1 of 3
1601
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*This Budget was approved administratively because the fund shift did not exceed 10% of a line item and
project component.
** Section III of the January 28, 2014 Agreement requires this Line Item shift to be approved by the Board.
SIGNATURE PAGE TO FOLLOW ON NEXT PAGE
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
Habitat for Humanity of Collier County,Inc.
Amendment#4
2013-2014 CDBG(CDBG13-03)
Page 2 of 3
/c,1 c
1601
IN WITNESS WHEREOF, the Subrecipient and the County,have each, respectively, by an authorized person
or agent, hereunder set their hands and seals on the date first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
DWIG TE.BROCK CLERK cp COLL i-' _ T TY, F ORIDA
`-'
By: �.
rk y TIM NANCE,CHAIRMAN
s t1liatt re only.
HABITAT FOR HUMANITY OF COLLIER
Dated: t 1311k COUNTY,INC.
SEAL) ,y�
By:
Nick Kouloheras,V.P.of Land Development
Approved as to form and legality:
Jennifer A. Belpe io057 `Cj
Assistant County Attorney
Habitat for Humanity of Collier County,Inc.
Amendment#4
2013-2014 CDBG(CDBG13-03)
Page 3 of 3