Backup Documents 10/14/2014 Item #16D 4 160 4
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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. Peggy Hager Community and Human Act //
Services /DASJ/q
2. County Attorney Office County Attorney Office .3
3. BCC Office Board of County
/S f /3/f? /V
4. Minutes and Records Clerk of Court's Office
'Tm tO(lri(/4 2-35pm
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 Priscilla Doria,Grant oordinator Phone Number 239-252-53
Contact/ Department Community and Hu n Services
Agenda Date Item was October 14,2014 Agenda Item Number 16.D.4
Approved by the BCC
Type of Document 1)Annual Report Certification for SHIP Number of Original 1
Attached 2)Certification of Regulatory Reform Documents Attached 1
Implementation _
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. (Ii i.i`all)) Applicable)
1. Does the document require the chairman's original signature? 10 cos O.1c% 4A L t(,)l J
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 Irl D
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 N
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 ABOVE DATE and all changes made
during the meeting have been incorporated in the attached document. The County fR0'
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 O�
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
160 4
Martha S. Vergara
From: Martha S. Vergara
Sent: Monday, October 20, 2014 3:14 PM
To: Doria, Priscilla
Subject: Certifications
Attachments: Priscilla Doria.pdf
Attached for you Priscilla!!
Thanks,
Martha Vergara, BMR Senior Clerk
Minutes and Records Dept.
Clerk of the Circuit Court
&Value Adjustment Board
Office: (239) 252-7240
1;.tx: (239) 252-8408
E-mail: martha.vergara a,collierclerk.com
1
160 4
Annual Report Certification for
State Housing Initiatives Partnership (SHIP) Program
On Behalf of Collier County, I hereby certify that the annual reporting information submitted electronically to
Florida Housing Finance Corporation for fiscal years 2011/2012, 2012/2013, and 2013/2014 is true and
accurate.
Name of Staff Member responsible for submitting annual report: Kri-r i Sonnta•I
Witness Signature Date ief Elected Official o Ibesignee Signature Date
Tom Henning,Chairman 10) iq)4
Witness Printed Na- e Chief Elected Official or Designee Printed Name
Witness Sign. ure Date
\pproved as to form and legality
Witness ,'rinted Name
•
Assistant County mey (h
Or
ATTEST(Seal)
ATTEST:
Signature Date DWIGHT E.B •CKK CLERK ,
Dope Clerk
Attest as to
signature only
420.9075 (10) Each county or eligible municipality shall submit to the corporation by September 15 of each
year a report of its affordable housing programs and accomplishments through June 30 immediately preceding
submittal of the report. The report shall be certified as accurate and complete by the local government's chief
elected official or his or her designee.
October 2012
6J
160 4
Certification for Regulatory Reform Implementation
State Housing Initiatives Partnership (SHIP) Program
On Behalf of Collier County, I hereby certify that the following information is true and accurate as of the date
of this submission for the following fiscal years: 2011/2012, 2012/2013 and 2013/2014:
1. Permits as defined in s.163.3164 (15) and (16) for affordable housing projects are expedited
to a greater degree than other projects; and
2. There is an ongoing process for review of local policies, ordinances, regulations, and
plan provisions that increase the cost of housing prior to their adoption.
3. The cumulative cost per newly constructed housing per housing unit, from these actions is
estimated to be $0.00.
4. The cumulative cost per rehabilitated housing per housing unit, from these actions is estimated
to be $0.00. �q
t, \
Witness Signature Date Chief Elected Official or o,. ignee Signature Date
Tom Henning,Chairma 1b1141�+
Witness Printed Name Chief Elected Official or Designee Printed Name
Witness Signature Date Approved as to form and legality
Witness Printed ame Ass`St'dnt County ttomey
4 o•
Or ATTEST'
ATTEST (seal) a ' i 1
IIIE.8ROCK,CLERK
.� Ai
Signature Date AttestchRtMi
'signature only,
163.3164(15)of the Florida Statutes: "Development order"means any order granting,denying,or granting
with conditions an application for a development permit.
163.3164(16)of the Florida Statutes: "Development permit" includes any building permit,zoning permit,
subdivision approval,rezoning,certification,special exception,variance,or any other official action of local
government having the effect of permitting the development of land.
October 2012