Backup Documents 06/14/2016 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP' 60
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.
2.
3. County Attorney Office County Attorney Office SRT 6-14-16
4. BCC Office Board of County DC b j
Commissioners /S) 6 -1g- 16
5. Minutes and Records Clerk of Court's Office ��y�
I / 441“0 2� 1 .
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 Michelle Arnold Contact Information 239-252-5841
Contact/ Department
Agenda Date Item was June 14,2016 Agenda Item Number 16D2
Approved by the BCC
Type of Document Resolution authorizing submittal of Federal Number of Original „Gorr �ti
Attached Transit Administration Section 5310 Documents Attached 'r
1.41*5
FY2015/2016 grant application and applicable 01Ast_ fj.,930ke�(1
documents to the Florida Departr}ilt f
Transportation. �/ce fl-
PO number or account n/a
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 J P • SRT
2. Does the document need to be sent to another agency for additt. . res? If yes, SRT
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 SRT
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 SRT
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 SRT
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 SRT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SRT
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 06-14-16 and all changes made during SRT
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 the
BCC, all changes directed by the BCC have been made, and the document is ready for the
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
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County of Collier
CLERK OF THE CICU . COURT
COLLIER COUNTY C( WRTHO SE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock-Clem,{pf Circ;it Court
P.O. BOX 413044
NAPLES,FL 34112-5324 * ;����; NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor • Csrodian of County Funds
I
I
June 15, 2016
FDOT, District One, Procuremnet Office
Attn: Michelle S. Peronto, LAP Coordinator
801 North Broadway Avenue
Bartow, Florida 33830
Re: FDOT Grant Application (Section 5310)
Transmitted herewith are two (2) original applications and two (2) certified resolutions
of the the above referenced document for your records per request, as adopted by the
Collier County Board of County Commissioners of Collier County, Florida on Tuesday,
June 14, 2016, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
r
C
r
Tht-t. i
Martha Vergara, Deputy
rk
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
1602
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1 60 2
RESOLUTION NO. 2016- 1 2 4
A RESOLUTION BY THE BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY,
FLORIDA, AUTHORIZING ITS CHAIRMAN TO SIGN AND SUBMIT A SECTION 5310 GRANT
APPLICATION, INCLUDING ALL RELATED DOCUMENTS AND ASSURANCES, TO THE
FLORIDA DEPARTMENT OF TRANSPORTATION, REVISE AND EXECUTE ANY
REQUIRED DOCUMENTATION, AND TO ACCEPT, ON BEHALF OF THE COUNTY, ANY
SUCH GRANT AWARDED.
WHEREAS, 49 U.S.C.§ 5310 authorizes the Secretary of Transportation to make grants and loans to local
government authorities such as Collier County to help provide mass transportation services to meet the special
needs of elderly individuals and individuals with disabilities; and
WHEREAS, each year, through an application process administered by the Florida Department of
Transportation, the Collier County Transportation Disadvantaged program has obtained funds that are used for
the purchase of vehicles and for the provision of transportation services to the elderly and disabled residents of
Collier County; and
WHEREAS, the Collier County Local Coordinating Board (LCB) has requested that the Collier County
Board of County Commissioners apply this year for Federal Transit Authority 49 U.S.C.§ 5310 funds in order to
purchase vehicles to transport the elderly and disabled residents of Collier County; and
WHEREAS,the Board of County Commissioners of Collier County,Florida,has authority to apply for and
accept grants from the Florida Department of Transportation as authorized by Chapter 341,Florida Statutes,and
by the Federal Transit Administration Act of 1964,as amended.
NOW THEREFORE,BE IT RESOLVED by the Board of County Commissioners,Collier County,
Florida,that:
1. The BOARD authorizes its Chairman to execute, submit and revise any and all
documents necessary to apply for the Federal Transit Administration Section 5310
Grant, including but not limited to executing any required certifications and
assurances such as the Certification and Assurance to FDOT document (a copy of
which documents are attached hereto), approving any budget amendments necessary
to receive and use these grant funds, and to accept the grant funds on behalf of the
County.
2. Any decision to terminate or otherwise not accept the Grant shall first require approval
by the Board of County Commissioners as an agenda item.
3. This Resolution shall be effective immediately upon signature by the Chairman.
This Resolution adopted after motion, second and majority vote favoring same,this 14th day of June,2016.
16D 2
ATTEST: BOAR F COUNTY COMMISSIONERS
DWIGHT E. BROCK,Clerk COLL COUNTY, LORIDA
i' tt t
By .,, L Al�
pu
DONNA FIALA, CHAIR By.
Attest as to tit wit it4w,,.»� 1
signature only. -
Approved as to fo and 1 gality:
rE• 11 d _e-stAil_______
Scott R. Teach
Deputy County Attorney
0
1 6D
2
OMB Number:4040-0004
Expiration Date,3/31/2016
Application for Federal Assistance SF-424
•1.Type of Submission '2.Type of Application: 'If Revision,select<ippropeate letter(s).
Preapplication M New
M Application u Continuation Other(Specify):
Changed/Corrected Application L]Revision 1
3.Date Received: 4 Applicant Identifier.
1
5a.Federal Entity Identifier: 5b.Federal Award Identifier
State Use Only:
6.Date Received by State: 7.State Application Identifier (i {:
8.APPLICANT INFORMATION:• L
a Legal Name: Collier County Board of County _.ommrssionets
•b.Employer/Taxpayer Identification Number(EINITIN): c.Organizational DUNS.
59
603058 0769977900000
d.Address:
Streets: 3239 East Tamiami Trail 4153 — —]
Street2:
'City: Naples
County/Parish
'State: r FL: Florida
Province
'Country: USA: UNITED STATES j
Zip I Postal Code:
e.Organizational Unit
Department Name Division Name:
Publ.ictransit&NBHD Enhancement Public Services
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: Mrs. •First Name: Loos
Middle Name:
*Last Name: Lardeso
Suffix
Title rperaticns Analyst —�
Organizational Affiliation:
Employee _ --..--- ---- ----- —
*Telephone Number: L> 5 J Fax Number 3 .2-- 4 j
Email [yoas Lost=ieso@cc I.l 3ov.r._ _
1 6 0 2
Application for Federal Assistance SF-424
'9.Type of Applicant 1:Select Applicant Type:
-- ll
t:ounty Government ---- v
Type of Applicant 2 Select Applicant Type.
Type of Applicant 3 Select Applicant Type:
'Other(specify).
*10.Name of Federal Agency:
Federal Transit Administration
11.Catalog of Federal Domestic Assistance Number:
20.513
CFDA Title:
Formula Grants for the Enhanced Mobility of Senior and Individuals with Disabilities
•12.Funding Opportunity Number:
•Title
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
Community of Immokalee, Naples, Marco Islen Delete Attachment , View Attachment
15.Descriptive Title of Applicant's Project:
Capital Assistance for replacement of paratransit vehicles that have outlived their useful life
and for fleet expansion.
Attach supporting documents as specified in agency instructions
Add Attachments
(7-;Thi
1
1 6 0 2
Application for Federal Assistance SF-424
16.Congressional Districts Of:
*a.Applicant 1 y 4;., ' 'b Program/Project
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment1 1 -
17.Proposed Project:
'a Start Date: 10/01/3016] •b End Date 09/30/2017
18.Estimated Funding($):
'a.Federal 157,557.60 I
•b.Applicant 57, 199.-70
ATTEST
'c.State 57,191.-70 UtrttIGH .E: BROCK. CLERK
!)r.....___
•d Local . n
•e.Other BYAQ"'�S`\v� " l
'f Program Income Attest a's to,Cbairmanfs-:,-
'g TOTAL =4 7 2J
signature only. _
'
•19.Is Application Subject to Review By State Under Executive Order 12372 Process? J +v
? ' '
e
El a.This application was made available to the State under the Executive Order 12372 Process for review on
® b.Program is subject to E.O. 12372 but has not been selected by the State for review.
El c.Program is not covered by E.O. 12372. r
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment) r
E]Yes 0 No
If"Yes",provide explanation and attach Z
i
1 N4 i
21.'By signing this application,I certify(1)to the statements contained in the list of certifications"and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to ` f/
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may a,
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ,O„ a.
® "t AGREE 9 —4
• The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency .� 4 4'
specific instructions. > A n
n
Authorized Representative: 4
Prefix. Ms. 1 'First Name. Unnna
Middle Name
'Last Name- Fiala
Suffix-
'Title
uffix'Title ,::hair
•Telephone Number. 23r;_7„52- 6i).1 Fax Number
'Email. Donn3Fiala@c 1.1_ergov.net
P_
'Signature of Authorized Representative: ri1:4, *y��,� Date Signed: ta_'q.
ems`\
1 60 2
EXHIBIT A-1: FACTSHEET
Name of Applicant: Collier County Board of County Commissioners
IF GRANT IS AWARDED
CURRENTLY
(Estimates are acceptable.)
1. Number of total one-way trips served by
the agency PER YEAR(for all purposes)* 92,474 92,474
Please include calculations.
2. Number of one-way trips provided to
seniors and individuals with disabilities 66,580 66,580
PER YEAR*
3. Number of individual senior and 997 997
disabled clients PER YEAR
4. Total number of vehicles used to provide
service to seniors and individuals with 23 23
disabilities ACTUAL
5. Number of 5310 vehicles used to
provide service to seniors and individuals
with disabilities eligible for replacement 21 23
ACTUAL (Refer to Vehicle Life Span
chart)
6. Total fleet vehicle miles traveled to
provide service to seniors and individuals 1,110,435 1,110,435
with disabilities PER YEAR
7. Number of days that vehicles are in
operation to provide service to seniors and 7 7
individuals with disabilities AVERAGE
PER WEEK
8. Posted hours of normal operation agency M— F: 4 am— 8:50pm M—F: 4 am— 8:50pm
provides service to seniors and individuals Saturday: 4 am—8:50pm Saturday: 4 am—8:50pm
with disabilities PER WEEK. (This does
not include non-scheduled emergency Sunday: 4:30 am -7:35 pm Sunday: 4:30 am -7:35 pm
availability ) Total (WEEK): 114:05 Total (WEEK): 114:05
* One way passenger trip is the unit of service provided each time a passenger enters the vehicle, is
transported, then exits the vehicle. Each different destination would constitute a passenger trip.
16D 2
EXHIBIT B:
PROPOSED PROJECT DESCRIPTION
1. How will the grant funding be used? Will more hours of service be provided? Will it expand
service to a larger geographic area? Will this funding provide shorter headways? How many
more trips will be provided? Please explain in detail. If this capital request is not for a vehicle,
please describe the purpose of the request.
Collier County is requesting FTA Section 5310 funds to purchase three replacement vehicles
and two additional vehicles for expansion of the spare ratio. The county is also requesting five
two-way communication radios for these vehicles. Historically the two-way radios had been
moved from the old replacement vehicle to the new one and due to the age of the radios they
needed continued repairs which in turn mean the vehicle is down because the radios are
installed in the vehicles. These vehicles and radios will be to continue the existing level of
service which has increased 8 %since last year.
2. If a grant award will be used to maintain services as described in Exhibit A, specifically explain
how it will be used in the context of total service.
The three cutaway vehicles will be used to replace three of our vehicles that have reached their
useful life and the spares will be used as a vehicle breaks or needs to have a preventive
maintenance. With an average of 20 routes a day and a fleet of 24 vehicles of which 55% of it
has reached its useful life the room for failure is very little. By purchasing additional spare
vehicles it will allow the paratransit system to be able to maintain the preventive maintenance
schedule while ensuring that adequate vehicles are available to maintain the level of service.
3. Give a detailed explanation of the need for the vehicle and provide evidence of the need. If this
capital request is not for a vehicle, please describe the need for this request.
According to the Federal guidelines the useful life of a small bus or specialized van which is
the type of vehicles proposed for replacement on this application is 4 years or 100,000 miles.
As the inventory above shows these three vehicles have already surpassed their useful life
based on the mileage. By the time their replacement is received they would each have an
average of 57,606 additional miles. As the Community Transportation Coordinator, we would
like to be able to replace high mileage vehicles. High mileage vehicles require increased
maintenance expenses compared with lower mileage vehicles and for this reason the county is
requesting the purchase of additional spares as well in order to maintain the level of service
being provided.
4. Will a grant award be used to replace existing equipment or purchase additional
vehicles/equipment? Provide details.
The grant award will be used to replace the three existing paratransit vehicles with radios and
also to add two new vehicles with radios as spare of the same size vehicle.
5. Identify vehicles/equipment being replaced and list them on the "Current Vehicle and
Transportation Equipment Inventory" form C-4.
Our current vehicle inventory is supplied elsewhere in this grant application.
160 2
6. Describe agency's maintenance program and include a section on how vehicles will be
maintained without interruptions in service (who, what, where, and when).
"A11 of the preventive maintenance inspections are performed in-house by the County Fleet
Department and scheduled by mileage projections. The Collier Area Transit uses the FDOT
recommended "A, B and C" level inspections using 6,000 mile intervals. The Fleet
Management Division Shop Manager runs daily reports to track and schedule preventive
maintenance (PM) services. Oil changes are performed on the PM schedule. Oil sampling is
done at random or on suspect engines. Coolant is checked regularly by PH strip during PM
inspections and services. Vehicle mileages are recorded each evening while the vehicle is
being fueled by the Fleet Management Division and entered into the FASTER software system.
The Shop Manager tracks the upcoming preventive maintenance inspections through the
FASTER software program. "
The above is from the Collier Area Transit Preventive Maintenance Plan.
7. If vehicles/equipment are proposed to be used by a lessee or private operator under contract to
the applicant, identify the proposed lessee/operator.
a. Include an equitable plan for distribution of vehicles/equipment to lessees and/or private
operators.
No will not be leased. The vehicles will be owned by Collier County but the vendor will be
able to use them for the operations. The vendor is required to insure the vehicles because their
employees will be driving them.
8. Each applicant shall indicate whether they are a government authority or a private non-profit
agency, provide a brief description of the project which includes the counties served, whether
the applicant shall service minority populations and whether the applicant is minority-owned.
Collier County's public transit is governed by the Board of County Commissioners, a local
government agency. Collier Area Paratransit serves the residents of Collier County.
9. Agencies receiving Section 5310 funds must collect both quantitative and qualitative data
(detailed in the Threshold Criteria section on page 7) to capture overarching program
information as part of the Section 5310 annual report, Please outline how your agency will
collect the quantitative and qualitative data required as a Section 5310 sub-recipient. For
example, what will the time frame be/how will it be incorporated into program operations?
What tools will be used to collect the data?
Collier Area Paratransit utilizes Route Match in conjunction with Avail technologies to collect
the necessary quantitative and qualitative data for analysis. The data includes ridership,
geographical, trip and other types of information.
10. Fully explain Your Transportation Program:
a. Service hours, planned service, routes and trip types
The pickup time may be as early as 4:00 AM and the latest pickup time may be as late
as 6:00 PM. Our paratransit has 20 routes that cover trips in the Naples, Everglades
City, Immokalee and Marco Island area. The trip types Collier provides are medical,
OVD
160 2
nutritional, employment, educational or personal.
b. Staffing—include plan for training on vehicle equipment such as wheelchair lifts, etc.
All new drivers are required to complete a training program prior to operating a vehicle.
In addition all drivers must attend monthly safety trainings which include training on
vehicle equipment.
c. Records maintenance—who, what methods, use of databases, spreadsheets etc.
All sensitive records are maintained under lock and key. Other records are kept for
seven years in an archive room or electronically depending on the document i.e.
manifests are in the Route Match Software.
d. Vehicle maintenance—who, what, when and where
All vehicles utilized for the County public transportation system are maintained in safe
and operational condition by the County's Fleet Management Department. The Fleet
Management Department provides for regular preventative maintenance of all vehicles
at the CAT Operations Center located at 8300 Radio Road.
e. CDL requirements
Due to the number of seats and size of these vehicles no CDL certification is necessary.
f. Transportation Operating Procedure (TOP)
Not applicable to Collier County because the 5310 is not the only grant received.
g. Drug free work place
Collier Area Transit has a Substance Abuse Policy in place that includes the
Requirements of the Drug- Free Workplace Act.
11. How do you fund your transit program? What are your funding sources for transit —
state/local/federal/private foundations?
Collier County uses state, federal and local funds for providing the transit program in the
county.
12. If your agency does not receive its entire capital request, can you still proceed with your transit
program?
Yes, however there are no other funds allocated for the replacement of these vehicles.
13. New Agencies: Have you met with the CTC and, if so, how are you providing a service that
they cannot? Provide detailed information supporting this requirement.
Collier County is the CTC and therefore this question is not applicable.
14. Current Agencies: Is your CTC agreement current? If not, why not?
1602
Yes, a copy of the agreement can be found under Exhibit L.
FORM C-3:
LOCAL MATCH FOR THIS APPLICATION
Local match may be derived from any non-U.S. Department of Transportation (USDOT) Federal
Program, State Programs, Local Contributions or Grants.
Applicants may not borrow funds to use as match nor may they place liens on Section 5310-funded
vehicles or equipment. The breakdown of funding for the Section 5310 grant program is 80%
Federal/10% FDOT-State/10% Local for capital projects, meaning the Federal share of eligible capital
costs may not exceed 80% of the total award. State funds may support up to 10% of eligible capital
costs with the remaining 10% being supported by a local match. At the time an order is placed for
vehicles/equipment, the applicant is required to provide a purchase order for its 10% local
match to be paid to the vendor. The required 10% local match must be paid at the time of
delivery.
FORM C-3: LOCAL MATCH FOR THIS APPLICATION
Name of Applicant: Collier County Board of County Commissioners
Sources and amounts of local share for the vehicles/equipment, or mobility management, being
requested:
SOURCE: AMOUNT:
Local Funds $57,194.70
n
Orn4-2.0
(Signature of authorized representative)
Donna Fial. Chair
(Name and title of authorized representative)
ATTEST./ A roved as to f rm yd legality
DWIGHT E.
;, BROttuiCK, CLERKThI
k
BYScott R.Teach,Deputy County Attorney
ALILy__
Attest as to Chairman's o6J
n,,,.►2t11rP only.
160 2
FORM C-5: CAPITAL REQUEST FORM
VEHICLE REQUEST
Name of Agency: Collier County Board of County Commissioners
R or E (a) Quantity Description(b) Estimated
Cost
R 3 23' Standard cutaway diesel vehicles $331,468.20
E 2 23' Standard cutaway diesel vehicles $220,978.80
Sub-total $552,447.00
(a) Replacement(R) or Expansion(E).
(b) Provide a brief description including the length and type vehicle, type of fuel, lift or ramp, number
of seats and wheelchair positions. For example, 22' gasoline bus with lift, 12 ambulatory seats, and 2
wheelchair positions. Do not show the Make. Any bus options that are part of purchasing the bus
itself should be part of the vehicle request and NOT separated out under equipment.
EQUIPMENT REQUEST(c)
If item requested is after-market, it is recommended to gather and retain at least two estimates for the
equipment requested. Purchases must be approved at the local level and follow Procurement
Number Description Estimated Cost
requested
5 Two-way communication mobile radios for $19,500.00
the cutaway vehicles
Sub-total $19,500.00
(c) Show mobile radios and identify the type of radio (i.e. two way radio or stereo radio), computer
hardware/software, etc. under"Equipment Request."
VEHICLE SUBTOTAL $552,447.00+ EQUIPMENT SUBTOTALS 19,500.00=5571,947 (x).
(x) X 80% = 5 457,557.60 [This equals the Federal request. Show this amount on Form 424 in
block 18(a)]
1602
FORM C-6:
CAPITAL REQUEST METHODOLOGY FORM
Complete one request form if all vehicles being requested are the same type and configuration.
Complete another form to request a vehicle of a different type and configuration. Limit of up to
FIVE (5) vehicle requests per applicant.
Information to fill this form out may be found at on the TRIPS website tth; !tip,tiof El:, _; ; and or at
the DMS website utai; ` ;�5i��,�„ 31,x, ,t���:i ,t tie_vni,clu,,,inf4 for small vehicles;
cars or station wagons.
Applicant Agency Name:
Collier County Board of County Commissioners
Contact Person:
Yousi Cardeso, Operations Analyst, 239-252-5886, ousicardesow colliergp\ .n<t
(Name,Title,Telephone Number, and Email)
Vendor Name and Contact info:
Bill Gould, Getaway Bus, LLC, 941-747-5486
(Vendor, Dealer's Name, Telephone Number)
Contract#:
TRIPS-I 1-CA-GB
Brief Vehicle Description:
5 — 23' diesel standard cutaways with lift, 14 ambulatory seats and 6 wheelchair positions
(Example: 3—22'gas cutaways with lift, 12 ambulatory seats and 2 wheelchair positions)
Price Estimation Table: Select only options available in the contract you are interested in. If there
are no choices selected on any given row, we understand that you do not need that option.
Computer users—the rows in yellow have formulas to calculate totals. To make the formulas work,
first fill out the columns of unit cost $ and quantity # and then right click in the yellow cell and
click Update Field.
1 6 0 2
Item* Unit Cost x Quantity
Unit Cost Quantity (Total Cost)
Base Vehicle Type(Make, Model, Size/Length) 64034.25 1 $64,034.25
Vehicle Description: Chevrolet 14200 23'
Floor Plan: Seat Manufacturer Name:
Floor Plan/Ambulatory Seats: May choose more than
one type of seat if needed.
Standard Seat:
Foldaway Seat: 403.2 14 5,644.80
Child Seat:
Other: 840.0 1 840.00
Securement Systems: 3,213.00
Wheelchair Securement: 535.5 6
6 113.40
Seat Belt Extensions: El No ® Yes, if yes quantify
18.9
Stretcher Securement:® No❑ Yes, if yes quantify
Wheelchair Lift(Include Vendor Name and Cost): 3942.75 1 3,942.75
Engine Type: Chevy Diesel 6.6 12,444.6 1 12,444.60
420.00
Paint Scheme: 0 No ®Yes, if yes quantify 420.0 1
Vehicle Subtotal: $90,652.80
Title VI Notice Signs/Plaques:
Equipment: 4,149.60
Other: Cameras and other options
Equipment: 15,687.00
Other: Avail MDT
Equipment Subtotal: $3,900.00
Total: $114,389.40
* Additional items besides those listed on the form can he added by inserting another line or by
submitting a sample copy of the order form for the vehicle filled out to your specifications.
Add up the subtotals from all the Capital Request forms you filled out for this application to arrive
at the total. The Total x 80%= Federal Portion (to be shown in block 18(a)of Form 424).
Totem Federal l'crcent = Federal Portio
$571,947 X $457,557.60
.8 80%