Backup Documents 02/23/2016 Item #16D 8 'ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP1 6 0 8
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.
3. Colleen Greene County Attorney Office C I l l 1. --Ct
4. BCC Office Board of County -1bFby
Commissioners \j 44l/ 2\2 \ L
5. Minutes and Records Clerk of Court's Office i„^\ �{ l �j `t_ (1 3''I'
12111
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 Natali Betan ur Phone Number 239-252-4 59
Contact/ Department
Agenda Date Item was 2/23/16 Agenda Item Number 16D8
Approved by the BCC
Type of Document Amendment Number of Original 1
Attached 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? NB
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.
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 NB
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 NB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 11/10/15 and all changes made during NBA_. N/A
the meeting have been incorporated in the attached document. The County iln '* ,
Attorney's Office has reviewed the changes,if applicable. -1.4111,
9. Initials of attorney verifying that the attached document is the version approved by the NB inn
BCC,all changes directed by the BCC have been made,and the document is ready for bion for
Chairman's signature. ss Sline
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
1608
MEMORANDUM
Date: March 1, 2016
To: Natali Betancur, Operations Analyst
Park & Recreation — Beach & Water
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Contract Amendment #1 "Independent Contractor Agreement with
NCH for Water Safety Instruction Services"
Attached for your records is one (1) copy of the document referenced above, (Item
#16D8) approved by the Board of County Commissioners on Tuesday, February 23,
2016.
The original is being kept by the Board's Minutes & Records Department as a part
of the Board's Official Records.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
1 6 Pg 8
Contract Amendment#1
Independent Contractor Agreement with NCH for Water Safety Instruction Services
This amendment, dated this 013 day of February, 2016 to the referenced agreement shall be by and
between the parties to the original Agreement, NCH Healthcare System, Inc., a Florida not for profit
corportation (to be referred to as "Contractor") and Collier County, Florida, (to be referred to as
"Owner").
Statement of Understanding
RE: Independent Contractor Agreement with NCH for Water Safety Instruction Services
In order to continue the services provided for in the original Contract document referenced above, the
Contractor agrees to amend the Contract as per this Amendment and incorporated herein by reference or
by the modified language below.
Note: Language deleted has been struck thr-eugh. New language has been underlined.
Section 2.Term of Engagement.
The period of this Agreement shall be for a term of twelve (12) months, commencing on March 1, 2015.
The Parties agree to amend this Agreement for one year commencing on March 1, 2016. The Parties
further agree that this Agreement may be renewed for an additional two one-year renewals upon mutual
agreement of both Parties.
All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF,the parties have each,respectively,by an authorized person or agent,have
executed this Amendment on the date(s)indicated below.
" - Accepted: a I a--3 ,2016
I3wigh .Brock,Clerk OWNER:
BOAI •F COUNTY COMMISSIONERS
B L OF CO IFR lo COUNT , FLORIDA
Contractor's`Fir ;.,Witl} spz[ll. By: / � ,
D•nna Fiala,Chairman
By:
Signature
CONTRACTOR:
Print Name NCH Healthcare Systems, Inc.
Contractor's Second Witness: By: ///
Signature G/ES>4
Signature Print Name and Title ( 20-5)
Print Name
Approved . to Form and Le ality:
110 F—yn
AP. •
ssistant County Attorney
[15-PKR-00528/1235776/1]
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