Backup Documents 04/26/2016 Item #16E 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 b E 2
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 V -'-`."per
`^'G V2g-
Complete
routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is alreadyic mplete 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
V-\\VLsr.\-i "-A\-2_4\i.
4. BCC Office Board of County F
Commissioners VC/ z-k\ t,G
5. Minutes and Records Clerk of Court's Office
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 issing information.
Name of Primary Staff SUE JIM ZIMME AN Phone Number 239-252-2622
Contact/ Department
Agenda Date Item was APRIL 26,2016 Agenda Item Number 16E2
Approved by the BCC
Type of Document BILL OF SALE OF BACKFLOW Number of Original 1
Attached PREVENTION DEVICE Documents Attached
PO number or account :22-
number if document is
to be recorded
'Mp-N'r•C7
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? sJz,
2. Does the document need to be sent to another agency for additional signatures? If yes, .SJZ,
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 sJZ
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 SJZ
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 SJ Z,
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 4/26/16 (enter date)and all changes SJZ
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 thi .'-0<
BCC,all changes directed by the BCC have been made,and the document is ready for e
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
16E Z
4.4" " Memorandum
r FORP 1
TO: Minutes & Records Management
FROM: Sue Zimmerman
Sr. Property Acquisition Specialist
Real Property Management
DATE: April 26, 2016
RE: BLUE SKY'S —4/26/16 BCC Item 16E2
Attached is the original Bill of Sale of Backflow Prevention Device approved by the Board
under Agenda Item 16E2 at today's Board Meeting. Please be kind enough to attest to the
Chairman's signature and then return to our office to obtain the Acceptance signature of Blue
Sky's Co-op before the document is sent for recording.
We will have the original recorded document returned to you for safekeeping and will provide
Blue Sky's with a copy.
Please contact me if you have any questions or comments at Extension 2622. Thank you.
16E 2
MEMORANDUM
Date: April 29, 2016
To: Sue Zimmerman, Property Acquisition Specialist
Facilities Management Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Bill of Sale — Backflow Prevention Device
Blue Sky's BFPD
Attached is the original as referenced above (Item #16E2) approved by the Board
of County Commissioners on Tuesday, April 26, 2016.
Please forward the original after it has been recorded to be kept by the
Board's Minutes and Records Department as part of the Board's Official
Records.
If you have any questions, please contact me at 252-7240.
Thank you.
Attachment
INSTR 5263097 OR 5270 PG 3524 16 E 2 •
PROJECT: Blue Sky's Fire BFPD RECORDED 5/92016 11:45AM PAGES 3
DW GH T E. ®ROCK, CLERK OF THE CIRCUIT COURT
Folio: 24207502866 COLLIER COUNTY FLORIDA
REC$27.00
BILL OF SALE OF BACKFLOW PREVENTION DEVICE
This Bill of Sale is executed this G2 ' day of Ap ri I , 2016, on behalf of
the BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AS THE
GOVERNING BODY OF COLLIER COUNTY AND AS EX-OFFICIO THE GOVERNING BOARD
OF THE COLLIER COUNTY WATER-SEWER DISTRICT, ("Grantor") to BLUE SKY'S CO-OP, INC.,
a Florida not-for-profit corporation, its successors and assigns, ("GRANTEE").
GRANTOR, for and in consideration of Ten Dollars ($10.00) and other good and
valuable consideration from GRANTEE to GRANTOR, receipt of which is hereby
acknowledged, GRANTOR hereby CONVEYS to GRANTEE, its successors and assigns
forever, ownership in and to any and all backflow prevention device(s), and any other
infrastructure or improvements appurtenant thereto or thereunder, associated
therewith and/or connected thereto, attached upstream or downstream of the
backflow prevention device, and all portion(s) thereof lying in, on, over and/or under
the following described land beginning at GRANTEE's property line, for GRANTEE'S
operation, replacement, repairs, maintenance, and/or relocation, lying and being in
Collier County, Florida, as follows:
(Exhibit "A" attached hereto is a sketch or other graphic representation that depicts the
physical location of items being conveyed by this Bill of Sale.)
(Exhibit "B" attached hereto is a device detail for the item being conveyed.)
IN WITNESS WHEREOF, Grantor has caused this Bill of Sale to be executed the
date and year first above written as authorized by the Board of County Commissioners
as the governing body of Collier County and as ex-officio the governing board of the
Collier County Water-Sewer District.
BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, AS THE
GOVERNING BODY OF COLLIER COUNTY AND
ATTEST: AS THE EX-OFFICIO GOVERNING BOARD OF THE
DWIGHT E. BROCK, Clerk COLLIER COUNTY WATER-SEWER DISTRICT
ytt_tta(it
Ali BY: 1149
A est as to Ch irman s Dep `t -rk DONNA FIALA, Chair
sivature 411 This Conveyyaance Approved pprove•�•s, ': '•nd legality: The Board Of County
proved By
Commissioners
By: .4114 Collier County Florida,
Pursuant To A en-la
JEFF A. f LA ► ' , County Attorney Date: 4 91tem No: 14Pa
Accepted 4,y a -ANTEE: BLUE SKY'S CO-OP, INC., a Florida
not-for-•rofit corporation�
By: / /` /
Print: GarI tc ►- ;
Title: T
The foregoing Bill of Sale is acknowledged before me this ` day of
ry , 2016, by 60 • u� ,r c, , as behalf of BLUE
SKY'S CO-OP, INC., who is personally known V OR produced identification
. Type of identification produced:
Notary Public
My Commission Expires: Lk `' '• ' ` °` M`ii / A. Amhru
Sonde°Thru tkarnn Tatar.,
16E 2
EXISTING AUTOMATED •DIMENSIONS ARE
FLUSHING DEVICE EXISTING R.O.W. LINE APPROXIMATE AND ARE
s> REPRESENTATIVE OF
PLAN LOCATIONS.
EXISTING
WI H GAIT
B OX ���� ��ia / EXISTING R.O.W. LINE
2" WATER METER WITH
1 1 EXISTING 8" GATE RPZ BACKFLOW DEVICE
.4VALVE WITH BOX
(END COUNTY I + I_
OWNERSHIP) — EXISTING
_- (yl TRAILER
4 EXISTING 8" TEE
,..1041: k7'46 i-8" FIRE SYSETEM
COMPACT FIRE
-' EXISTING FIRE -� /'� SYSTEM DETECTOR
HYDRANT CHECK (PRIVATE)
� r MJ EXISTING MJ-� -='46 2° WATER
;Po
o ADC /� SERVICE (PRIVATE)
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8" PVC FIRE MAIN
a XISTING 8" HDPE ; /�(PRIVATE)
WATER MAIN I /
8"x6" REDUCER 0 5' t0,
6" PVC FIRE MAIN GRAPHIC SCALE
(PRIVATE)
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RADIO ROAD (CR 856)
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16E2
5'-0'
WILKINS MODEL 4750A, OR COUNTY APPROVED
EQUAL. REDUCED PRESSURE DETECTOR ASSEMBLY----.___ _ 4\,
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RISING STEM AND RESILIENT �.f�.
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REINFORCED 6 M 6 10/10
WELDED WIRE MESH
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WILKINS VALVE SETTER-71-"\-- •
NOTES:
1. ALL ABOVE GROUND PIPE WILL HAVE FLANGED END DUCTILE IRON PIPE, PRESSURE CLASS 350. ALL NUTS
AND BOLTS SHALL BE STAINLESS STEEL.
2. (4) VEHICULAR GUARD POSTS TO BE INSTALLED AROUND METER. CONFIGURATION TO BE ILLUSTRATED ON
CONSTRUCTION DOCUMENTS SUBMITTED FOR REVIEW AND APPROVAL.
3. CONNECTIONS REFER TO ANY OWLET PERMITTING ACCESS TO INTERNAL FIRE SYSTEM (HYDRANTS, ETC).
4. AS THIS UNIT WILL REQUIRE PERIODIC TESTING, FACWTIES REQUIRING CONTINUOUS WATER SERVICE MAY WISH
TO INSTALL PARALLEL UNITS TO PREVENT SERVICE INTERRUPTIONS.
5. ASSEMBLY WILL BE OWNED AND MAINTAINED BY PROPERTY OWNER, STARTING AFTER THE INLINE GATE VALVE
AT THE PROPERTY LINE OR RIGHT-OF-WAY LINE.
6. BACKFLOW DEVICE REQUIRES INITIAL CERTIFICATION BY AN APPROVED CERTIFIED TESTER WITH RESULTS AND
ANNUAL TEST RESULTS SUBMITTED TO THE COUNTY WATER DEPARTMENT
7. ALL PLANTING SHALL BE A MINIMUM OF 3' FROM THE EDGE OF SLAB, AND SHALL PROVIDE A 3' ACCESS
OPENING.
8. ALL ABOVE GROUND PIPING, INCLUDING ASSEMBLY, SHAD. BE PAINTED RUSTOLEUM FEDERAL SAFETY RED.
9. ALL COMPONENTS THAI COME INTO CONTACT MITI DRINKING WATER SHALL CONFORM TO NSF STANDARD 61.
4" THROUGH 10" COMPACT FIRE SYSTEM DETECTOR CHECK
ASSEMBLY DETAIL WITH CONNECTIONS
PERMITTED DOWNSTREAM (WILKINS)
W-1CA REVISED: FEBRUARY 2001 N.T.S.
December 6, 2013 10:40 AMK:\2010\100165.00.00 Blue Sky\0005 Construction Plan Preparation\Rev 03 RECD\Exhibit B.dwg
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(239)597-0575 FAX(239)597-0578
www.consult-rwa.com
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EB7663Certificates
of B6955212�wn X51 495 26E +UMBER 1000165.00.00 NUMBER: OF NFILE
UMBER: EXHIBIT B
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