Backup Documents 02/28/2017 Item #16A10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO . 1 6 A I 0
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink i ,per• Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the cat is placed on the agenda. All completed routing slips and original documents must he received in the County Attorney Office no later
than Monday 1 eceding the Board meeting.
**NEW** ROUTING SLIP
Complete room .Imes tr 1 through#2 as appropriate for additional signatures.dates,and/or information needed. If the document is already complete with the
exce.tion of th, .hairman's signature,draw a line through routing_lines#1 through#2,complete the checklist,and forward to the CountAttorney Office
Route to A ddressce(s) (List in routing order) Office Initials Date
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3. Count' Attorney Office 'County Attorney Office
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71/7( 7
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4. BCC )lfice Board of County
Commissioners \1144)/ S\Ak-
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5. Minut,s and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Nomially the i Hilary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees abox, may need to contact staff for additional or missing information.
Phone
Name of Prn i•itty Staff N\t 1,1ssa myttaz Cim D Phone Number
22 227 q ,
Contact/ D( )artment
Agenda Dan. Item wasAgenda Item Number
A.•roved b\ the BCC 2128/17 1910 16 A ii
Type of Doc ment Qijt F. CAM to 0-teil Number of Original
I
Attached Documents Attached
PO number( account
number if do ament is 1,2)1 _ j m3211_ (4 410 3 0
to be record(' t
INSTRUCTIONS & CHECKLIST
III Initial ' ,./ Yes column or mark"N/A" in the Not Applicable column,whichever is
a..ro' !ate. Yes N/A(Not
(Initial) Applicable)
IIIDoes t / document require the chairman's original signature? nIA
111 Does t. ,'document need to be sent to another agency for additional signatures? If yes,
.rovid. the Contact Information(Name; Agency;Address; Phone)on an attached sheet. N IA
IOrigin, ' document has been signed/initialed for legal sufficiency. (All documents to be
signed •,y the Chairman,with the exception of most letters,must be reviewed and signed ma
b the t)ffice of the County Attorney.
4. All ha; written strike-through and revisions have been initialed by the County Attorney's
Office .ad all other parties except the BCC Chairman and the Clerk to the Board 4414- N/A
1111 The Ci drinan's signature line date has been entered as the date of BCC approval of the
docum 'at or the final negotiated contract date whichever is applicable. iii)
6. "Sign .are"tabs are placed on the appropriate pages indicating where the Chairman's
si!natt ('and initials are required. tY14
I In most cases(some contracts are an exception),the original document and this routing slip
should ac provided to the County Attorney Office at the time the item is input into SIRE. to
Some a cuments are time sensitive and require forwarding to Tallahassee within a certain
time Fr, ,lic or the BCC's actions are nullified. Be aware of your deadlines!
. .
8. The d,. timent was approved by the BCC on 742111Tenter date)and all changes made
during the meeting have been incorporated in the attached document. The County i I ,i,:, ,,j:i,:i: -,
,_
Attorn 2y's Office has reviewed the changes,if applicable.
9. Initials .,fattorney verifying that the attached document is the version approved by the
BCC,a i changes directed by the BCC have been made,and the document is ready for e --•"7,-;:' 41- -1 ttkj> ,
Chain' ,n's signature 4 •,,,,,../.(k...,,
I:Forms/Count 1 arms/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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INSTR 5375615 OR 5369 PG 3061
RECORDED 3/7/2017 4:23 PM PAGES 4
DWGHT E. BROCK, CLERK OF THE CIRCUIT COURT
COLLIER COUNTY FLORIDA
Sales Price: $0 DOC@.70$0.70 REC$35.50
Doc Stamps: .70
Prepared without opinion of title by& return to:
Timothy J.Cotter, P.A.
599 9'h Street North #3I3 1 6 A .1. n
Naples. FL 34102
File No: 16-122
(Space above for recording information)
UTILITY FACILITIES QUIT CLAIM DEED AND BILL OF SALE
THIS QUIT CLAIM DEED made this D: day of ,Q.o r"), between BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AS THE GOVERNING BODY OF
COLLIER COUNTY AND AS THE EX-OFFICIO GOVERNING BOARD OF THE COLLIER
COUNTY WATER-SEWER DISTRICT (hereinafter collectively referred to as "Grantor"), and
GORDON R. JENKINS, his successors and assigns, (hereinafter referred to as "Grantee").
WITNESSETH:
That said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good and
valuable consideration to said Grantor in hand paid by said Grantee, the receipt whereof is hereby
acknowledged, hereby quit claims, remises and releases to the said Grantee, and Grantee's heirs,
successors and assigns forever, all potable water facilities located and lying in, on, over and under the
following described land, for operation, relocation, installation, repair and/or maintenance of said
facilities, system(s)or portion(s)thereof,all situate and lying and being in Collier County, Florida,to wit:
(See Exhibit "A" attached hereto and incorporated by reference herein.)
(Exhibit"B"attached hereto is a sketch or other graphic representation
that depicts the physical location of the utility systems being conveyed.)
and said Grantor does hereby remise, release, and quitclaim to the said Grantee, and Grantee's heirs
assigns forever, all the right, title, interest, claim and demand which grantor has in and to the said utility
facilities and/or system(s)or portion(s)thereof', be they realty, personalty, or mixed.
The purpose of this quit-claim deed and bill of sale is to convey back to Grantee all potable water utility
facilities contained in Official Records Book 5181, Page 509, of the Public Records of Collier County,
Florida.
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IN WITNESS WHEREOF, Grantor has caused these presents to be executed in its name by the Board of
County Commissioners acting by the Chairman or Vice of said Board, the day and year first above
written.
GRANTOR:
BOARD OF COUNTY COMMISSIONERS
I97,14Lif.E'.-Brock, Clerk COLLIER COUNTY, FLORIDA
-.7.• • • , • -
It
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By: 4
ktest as to Chairman's PEWt4Y TA ri R, CH ' MAN
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signature only.
.Atyth•oved as to form and legality:
Scott A. Stone, Assistant County Attorney
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EX1-111311'A
Lot 21,Block 3,of PINE RIDGE SECOND EXTENSION,according to the Plat thereof
as recorded in Plat Book 10,Page 86,of the Public Records of Collier County,Florida.
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