Backup Documents 03/13/2018 Item #16K7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING 46 K 7
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. 1 he 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 KLN 3/13/18
4. BCC Office Board of County AZ). b•
Commissioners .AVS I
5. Minutes and Records Clerk of Court's Office
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.Noell,Assistant County Attorney Phone Number 252-8400
Contact/Department
Agenda Date Item was 3/13/18 / Agenda Item Number 16-K-7 V
Approved by the BCC ✓
Type of Document Release of Property Damage V 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 • OK KLN
2. Does the document need to be sent to another agency for additio si! .•. - . If yes, KLN
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 KLN
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 KLN
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 KLN
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 KLN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KLN
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 3/13/18 and all changes made during the KLN 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 N/A is not �..�
BCC,all changes directed by the BCC have been made,and the document is ready for the b„ an option for
Chairman's signature. As 1 /this line.
[04-COA-01081/1344830/1]I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05, vised 2. .05;
Revised 11/30/12
MEMORANDUM
Date: March 15, 2018
To: Kevin Noell, Assistant County Attorney
Collier County Attorney's Office
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Release of Property Damage Claim in the lawsuit styled Collier
County Board of County Commissioners v. James Johnson, filed in
the Twentieth Judicial Circuit in and for Collier County, Florida
(Case No. 16-CC-770),
Attached for your records is a copy of the document referenced above (Item #16K7)
approved by the Board of County Commissioners on Tuesday, March 13, 2018.
The original has been held by the Minutes and Records Department for the Board's
Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachment
K
CLAIMANT Lam,First ct..,Nmo
COLLIER COUNTY S2503E15-03-62
RELEASE OF PROPERTY DAMAGE CLAIM
Date Sent 02/15/2018
KNOW ALL MEN BY THESE PRESENTS, I COLLIER COUNTY(hereinafter referred to as Claimant), for the
sole consideration of Four Thousand Seven Hundred Sixty Seven and 10/100 DOLLARS ($4767.10)to be
paid within twenty(20)days of receipt of this unaltered, fully executed release, and forever discharge JAMES
JOHNSON and OCEAN HARBOR CASUALTY(its/their/his/her)agents and servants, and all other persons,
firms, and corporations, associations or partnerships of and from any ail actions, claims and demands
whatsoever for property damage only which Claimant now has, or may hereafter have, account of, or arising
out of, the accident, casualty or event which occurred on or about, the 28 day of March, 2015 at or near,
In as much as all of the Claimants property damage may not now be fully known and hence may be more severe than is
now expected, Claimant agrees, as a further consideration for said sum, that this release applies to all property damage
resulting from said accident, casualty or event, even though now unanticipated, unexpected and unknown, as well as to all
property damage which has already developed and which is known or anticipated.
Claimant, as a further consideration for said sum warrants that no promise or agreement not herein expressed has been
made to Claimant; that in executing this Release, Claimant is not relying upon statement or representation made by the
party or parties hereby released or any said patty's or parties agents. or representatives concerning the nature, extent or
duration of the said damages, and/or legal liability therefore, or concerning any other thing or matter, but is relying solely
upon Claimants own judgement; that the above mentioned sum is received by Claimant in full settlement and satisfaction
of all the aforesaid property damage claim and demands whatsoever, that Claimant is over eighteen years of age and
legally competent to excute this Release and that before signing and sealing this Release, Claimant has fully informed
himself/herself/itself of its contents and meaning and has executed it with full knowledge thereof.
It is understood that neither this release or the payment pursuant hereto shall be construed as an admission of liability, as
such is denied.
•
IN WITNESS WHEREOF, Claimant has read the foregoing, fully understans. its c. e and h.,/ set his/her/its
hand and seal on this I ..71,,i"-1 day of
(Claimant) Andy Solis, Chairman
Board of County Commissioners
Collier County, Florida
ANY PERSON WHO KNOWNINGLY FILES A STATEMENT OF CLAIM CONTAINING ANY FALSE
OR MISLEADING INFORMATION IS SUBJECT TO CRIMINAL AND CIVIL PENALITIES
ATrEST:
DWIGHT E.BROCK,CLERK
'Jay
meal* 114iL
Approvedesto signature only.,
[tern# •
4.01
,r477rirr rilTrrr . Agenda
.) i ) k
Date -
Date -Di
Rec'd
'.\Deputyt,41er(