Backup Documents 06/13/2017 Item #16A8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO U A Q
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT �'1 (J
Print on pink paper. Attach to original document. "I'he completed routing slip and original documents are to he for,iarded 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 (q j 15111
4. BCC Office Board of County PT b`t
Commissioners TA)fl 15/ \ifi 1
5. Minutes and Records Clerk of Court's Office .61(611r1 12:(244r)
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 Kevin Hendricks ✓ Phone Number 5844
Contact/ Department
Agenda Date Item was June 13,2017 i Agenda Item Number 16A8
Approved by the BCC
Type of Document Temporary License and Right of Entry ✓ Number of Original 1 ✓
Attached Documents Attached
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? 5.1'0.1.1.P 0 K KEH
2. Does the document need to be sent to another agency for additional signatures? If yes, KEH
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 KEH
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 KEH
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 KEH
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 6-13-2017 and all changes made during KEH
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 &.) 3
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
6 A8 Ann P. Jennejohn 1
From: Ann P. Jennejohn
Sent: Friday, June 16, 2017 1:07 PM
To: Hendricks, Kevin (KevinHendricks@colliergov.net)
Subject: 06/13/2017 Item #16A8 (Simmonds Temporary License and Right of Entry)
Attachments: 06_13_2017 Item #16A8.pdf
Hi Kevin,
A copy of the Siw►w►onds Electrical Temporary License and Right of Entry,
that was approved by the 13oard this past Tuesday, (Item #16A8), is
attached for your records.
Thank you, have a great weekend!
Ann Jennejohn, Deputy Clerk
Clerk of the Circuit Court
Clerk to the Value Adjustment 13oard
Collier County 13oard Minutes & Records Dept.
239-252-8406 Fax 231-252-8408
1
16A8 6
TEMPORARY LICENSE AND RIGHT OF ENTRY
This Temporary License and Right of Entry is given this 13th day of
June , 20 17 , by COLLIER COUNTY, a political subdivision of the State of
Florida, (hereinafter referred to as "Licensor"), to SIMMONDS ELECTRICAL OF
NAPLES, INC., a Florida corporation, its agents, contractors or assigns, whose mailing
address is 8981 Quality Road, Unit 1, Bonita Springs, Florida 34135-7000 (hereinafter
referred to as "Licensee"), for the express purpose of entry onto Licensor's lands for the
purpose of mobilization and temporary storage of materials and equipment necessary
for the installation of traffic signals at the intersection of 50th Street SW and Golden
Gate Parkway. This Temporary License and Right of Entry onto licensor's land also
includes the right to park vehicles during normal work hours.
ALL RIGHT AND PRIVILEGE given by this Temporary License and Right of
Entry over, under, across and upon those lands depicted in Exhibit "A" shall terminate
upon Licensee's completion of the work contemplated herein.
ENTRY ONTO LICENSOR'S LANDS by Licensee, shall constitute acceptance of
this Temporary License and Right of Entry, and such acceptance shall carry with it the
Licensee's promise to obtain all the required permits prior to performing the work
described above, and, to the extent permitted by Florida law, to indemnify and hold
harmless Licensor from and against any and all claims and demands and causes of
action, which may arise as a result of Licensee's performance or activities for which this
license is given, including, but not limited to, all claims and demands and causes of
action, personal injury, death, or damage to property sustained by any person, firm, or
corporation, including, without limitation, the employees, agents, or Contractors of
Licensee. ADDITIONALLY, Licensee agrees that it shall, at the Licensee's cost, repair
any damage caused to Licensor's property as a result of Licensee's negligence.
The rights and interest granted hereunder are conditioned upon the reasonable
exercise thereof by Licensee. Licensee agrees not to unreasonably interfere with
Licensor's use of the lands depicted in Exhibit "A".
Licensee shall not unreasonably interfere with ingress and egress to Licensor's lands
during the period of construction of the traffic signal improvements at the intersection of
50th Street SW and Golden Gate Parkway.
Licensee's right of entry onto Licensor's lands is contingent upon no other provisions,
conditions, or premises other than those so stated above; and there are no other prior
or contemporaneous written or oral agreements, undertakings, promises, warranties, or
covenants not contained herein.
IN WITNESS WHEREOF, the Licensor has caused these presents to be
executed in its name this 13th day of June , 20 17, and does
hereby affirm that the individual executing same has the authority to act on behalf of the
Licensor, and does intend that the Licensee rely on such authority.
16A8
AS TO COUNTY:
DATED: June 13, 2017
ATTEST: BOARD O NTY COMMISSIONERS
DWIGHT E. BROCK, Clerk COLLI 0 'NTY, FLORID
V .:Atile ► ac . BY. /-
Attest a� �� .� i i ��erk PENNY T OR, CHA OVAN
,signature only.,
AS TO OWNER: SIMMONDS ELECTRICAL OF NAPLES,
INC., a Florida Corporation
DATED: 05/08/2017
Z BY: �f
Witness (Signature) (Signature)
Kim Sasak E.B. Simmonds
Name (Print or Type) (print name)
!`r j President
Witness . ature) (corporate title)
Cindy Sir mons
Name (Print or Type)
Approved as to form and legality:
Assistant County Attorney
Item#
Agenda -\3__\"-1
Date
Date t/,._\ —��
Rec'd
. .�� C
•
Deputy •rk
16A8
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