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Backup Documents 09/26/2017 Item #16K18 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 1 6 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 KN 9/26/17 4. BCC Office Board of County Commissioners v- / / Q`7 tA\•—\ 5. Minutes and Records Clerk of Court's Office al Ill 1-pm 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 L.No 11,Assistant County Attorney Phone Number 252-8400 Contact/Department Agenda Date Item was 9/26/17 Agenda Item Number 16-K-18 Approved by the BCC Type of Document Conflict of Interest Waiver Form Number of Original —.One— Attached Attachede,,c.`t-tom Documents Attached C 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 KN 2. Does the document need to be sent to another agency for additional signatures? If yes, KN 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 KN 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 KN 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 KN 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 KN signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip KN 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 9/26/17 and all changes made during the KN N/A is not meeting have been incorporated in the attached document. The County Attorney's an option for Office has reviewed the changes,if applicable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the .'w � N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the t/\ an option for Chairman's signature. this line. [04-COA-01081/1344830/111: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 16K18 CONFLICT OF INTEREST WAIVER FORM Jose Encalada,DOA: 12/29/14 Preferred Materials,Inc. ("PMP')is a current client of Mumaghan&Ferguson,P.A. PMI has asked Murnaghan & Ferguson, P.A. to represent PMI and Collier County, a political subdivision of the State of Florida ("Collier County") jointly in connection with a motor vehicle accident which occurred on December 29,2014,on County Road 850(Corkscrew Road)in Immokalee, Collier County,Florida ("the Accident"). PMI has represented that it will defend and indemnify Collier County in connection with this matter,regardless of whether or not PMI,at a later time,is no longer a defendant or party in the matter due to dismissal,granting of summary judgment,or otherwise,subject to the following understanding. Although the interests of PMI and Collier County in this matter are generally consistent,it is recognized and understood that differences may exist or become evident during the course of our representation. Notwithstanding these possibilities,Collier County and PMI have determined that it is in their individual and mutual interests to have Murnaghan & Ferguson, P.A. represent both PMI and Collier County jointly in connection with the Accident. Additionally,this confirms the agreement of PMI and Collier County that Murnaghan&Ferguson,P.A. may represent Collier County in this matter and continue to represent PMI in other current and subsequent matters. This confirms that PMI and Collier County have each agreed to waive any conflict of interest arising out of our representation of each other in this matter,as well as other matters being handled by Murnaghan&Ferguson,P.A. It is further understood and agreed that Murnaghan & Ferguson, P.A. may freely convey necessary information provided to Murnaghan&Ferguson,P.A.by one client to the other in this matter,and that there will be no secrets as between PMI and Collier County unless both PMI and Collier County expressly agree to the contrary. It is understood and agreed that Murnaghan&Ferguson, P.A. may communicate with each client individually,based solely on the judgment of Murnaghan&Ferguson, P.A. However,both PMI and Collier County will be kept reasonably informed about the status of the Accident and any resulting litigation. We recommend that you seek the advice of independent counsel of your own choice regarding this written consent. If, however, it is the wish of both clients to proceed as directed above, we will undertake the representation of PMI and Collier County jointly,subject to the terms described herein. If you need to edit the terms of this waiver,or wish to discuss any related issues,please contact us at your earliest convenience. If you agree that the foregoing accurately reflects the mutual understanding of the parties,please acknowledge this agreement by signing and returning this letter to Murnaghan& Ferguson,P.A. Preferred Materials,Inc. Collier •ajor political subdivisiof the 41/411- State of • .. By By pDate: 0 (1/e3)i•7. Date: � ,cz.1. — ATTESI Approved as to form an. legality DWIGHT E$ROCK,Cf_ERK � I x C• Kevin Noell, Assistant County Attorney :StY_ . � 1 . _ nphira Anhi 16K18 CONFLICT OF INTEREST WAIVER FORM Edamis Medina, DOA:07/13116 Preferred Materials,Inc. ("PMI") is a current client of Murnaghan&Ferguson,P.A. PMI has asked Murnaghan & Ferguson, P.A. to represent PMI and Collier County, a political subdivision of the State of Florida ("Collier County") jointly in connection with a motor vehicle accident which occurred on July 13,2016,on County Road 850(Corkscrew Road)and Whidden Loop Road in Immokalee,Collier County,Florida ("the Accident"). PMI has represented that it will defend and indemnify Collier County in connection with this matter,regardless of whether or not PMI,at a later time, is no longer a defendant or party in the matter due to dismissal, granting of summary judgment,or otherwise,subject to the following understanding. Although the interests of PMI and Collier County in this matter are generally consistent,it is recognized and understood that differences may exist or become evident during the course of our representation. Notwithstanding these possibilities,Collier County and PMI have determined that it is in their individual and mutual interests to have Murnaghan & Ferguson, P.A. represent both PMI and Collier County jointly in connection with the Accident. Additionally,this confirms the agreement of PMI and Collier County that Murnaghan&Ferguson,P.A. may represent Collier County in this matter and continue to represent PMI in other current and subsequent matters. This confirms that PMI and Collier County have each agreed to waive any conflict of interest arising out of our representation of each other in this matter,as well as other matters being handled by Murnaghan&Ferguson,P.A. It is further understood and agreed that Murnaghan & Ferguson, P.A. may freely convey necessary information provided to Murnaghan&Ferguson,P.A.by one client to the other in this matter,and that there will be no secrets as between PMI and Collier County unless both PMI and Collier County expressly agree to the contrary. It is understood and agreed that Murnaghan&Ferguson,P.A. may communicate with each client individually,based solely on the judgment of Murnaghan&Ferguson, P.A. However,both PMI and Collier County will be kept reasonably informed about the status of the Accident and any resulting litigation. We recommend that you seek the advice of independent counsel of your own choice regarding this written consent. If, however, it is the wish of both clients to proceed as directed above, we will undertake the representation of PMI and Collier County jointly,subject to the terms described herein. If you need to edit the terms of this waiver,or wish to discuss any related issues,please contact us at your earliest convenience. If you agree that the foregoing accurately reflects the mutual understanding of the parties,please acknowledge this agreement by signing and returning this letter to Murnaghan& Ferguson,P.A. Preferred Materials,Inc. Collier C C.410 political subdivisi• of the State of y. .. By By // i • Lam..i.►�,,��, Date., OA/ZIP Date: c��1. Z\ ATTEST: Approved as to f.rm . d legality DWIGHT E. ROCK,CLERK 'Ci4 L+►t.•010'; ', . Kevin Noell, Assistant County Attorney signature on"