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Backup Documents 02/12/2013 Item #16E 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTIN I , TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT 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 c\\( 4L\3 4. BCC Office Board of County Commissioners 5. Minutes and Records Clerk of Court's Office 7)M, 2I[51C� PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary-, mary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. ' g \ Name of Primary Staff , //'' , Phone Number Contact/ Department � � � V �i 7 7 V Agenda Date Item was Agenda Item Number Approved by the BCC ,j ' / 2 ' / J, E — Type of Document Number of Original Attached £eS d -e ke A ---- Documents Attached I 4" PO number or account C cSr�c-"\ -,5 y-\ number if document is to be recorded /cam ` 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? (let 2. Does the document need to be sent to another agency for additional signatures? If yes, provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. r.` ' 3. Original document has been signed/initialed for legal sufficiency. (All documents to be 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 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 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 C" time frame or the BCC's actions are nullified. Be .w.re of our deadlines! 8. The document was approved by the BCC on - Eb(enter date)and all changes made during the meeting have been incorporated in the attached document. The County jv►� + 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 fo n� Chairman's signature. + 1:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revis-: .24.05;Revised 11/30/ 16E5 RESOLUTION NO. 2013 - 33 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, APPROVING A LEASE AGREEMENT BETWEEN COLLIER COUNTY AND UNITED STATES CONGRESSMAN MARIO DIAZ- BALART FOR USE OF OFFICE SPACE WITHIN A COUNTY-OWNED BUILDING. WHEREAS, United States Congressman Mario Diaz-Balart ("Congressman") desires to lease an office space within a building owned by Collier County, a political subdivision of the State of Florida ("Collier County"), located within the Golden Gate Customer Service Center, 4715 Golden Gate Parkway, Naples, Florida 34116. WHEREAS, the Lease Agreement provides for a two-year term at an annual rent of$10, with the option for automatic renewal for additional terms of two years each pending the Congressman's reelection. WHEREAS, the Board of County Commissioners is satisfied that this property may be used for the Congressman and is not needed for County purposes. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: 1. The Board of County Commissioners hereby approves the attached Lease Agreement between Collier County and Congressman Mario Diaz-Balart. 2. The.Chairman of the Board of County Commissioners of Collier County, Florida, is hereby authorized to execute the attached Lease Agreement. ti THIS RESOLUTION ADOPTED this / Z day of , 2013, after motion, second and majority vote. ATTEST: BOARD OF COUN Y COMMISSIONERS DWIGHT E. BROCK, Clerk COLLI R 4 O T , FLORIDA By atitt : . 6 By: • 1-!.4 uty Clerk GEO° t'A/I. HILLER, ESQ. Mat , f CHAIRWOMAN App ov l i"as"o •, and Item# lega iency: Agenda 2.i' ,.- Date bb i�'' N- Date 'L►�S'.� Jeffr:., �� .tzkow Redd Coun'y i 1 ttorney 1-pub :V7 NIINP Lea e E LEASE AGREEMENT THIS LEASE AGREEMENT entered into this /Z day of 1.,� 2013, between Congressman Mario Diaz-Balart, whose mailing address is 8669 NW 36th Street, Suite 100, Doral, Florida, 33166, hereinafter referred to as "LESSEE," and COLLIER COUNTY, a political subdivision of the State of Florida, whose mailing address is 3335 East Tamiami Trail, Suite 101, Naples, Florida 34112, hereinafter referred to as "LESSOR". WITNESSETH In consideration of the mutual covenants contained herein, and other valuable consideration, the parties agree as follows: ARTICLE 1. Demised Premises LESSOR hereby leases to LESSEE and LESSEE hereby leases from LESSOR the conference room which is located at the Golden Gate Community Center, 4715 Golden Gate Parkway, Naples, Florida 34116, hereinafter referred to as the "Demised Premises", situated in the County of Collier and the State of Florida, for the sole purpose of operating a United States government office, a copy of the Demised Premises floor plan is attached hereto and made a part hereof this Lease. ARTICLE 2. Term of Lease LESSEE shall have and hold the Demised Premises for a term of two (2) years, commencing on January 3, 2013 and ending January 2, 2015. LESSEE is granted the option, provided LESSEE is reelected to the same office, and is not in default of any of the terms of this Lease, to automatically renew same for additional terms of two (2) years each which shall reflect the LESSEE'S term of office, under the same terms and conditions as provided herein. LESSEE will be required to notify LESSOR by written notice of LESSEE'S intention to continue occupying the Demised Premises not less than fifteen (15) days after his reelection. Said notice shall be effective upon placement of the notice in an official depository of the United States Post Office, Registered or Certified Mail, Postage Prepaid or by email. LESSOR reserves the right to terminate this Lease, with or without cause, by providing LESSEE with thirty (30) days written notice to the address set forth in Article 14 of this Lease. Said notice shall be effective upon placement of the notice in an official depository of the United States Post Office, Registered or Certified Mail, Postage Prepaid. LESSEE is required by the Federal Government to have the attached Addendum, which is attached hereto and made a part hereof this Lease, executed by the LESSOR. ARTICLE 3. Rent LESSEE hereby covenants and agrees to pay as rent for the Demised Premises the sum of Ten Dollars and 00/100 Cents ($10.00) per annum. The rent for the initial Lease term shall be paid in full thirty(30) days following the execution of this Lease by LESSOR. 16E5 4 In the event LESSEE elects to renew this Lease, as provided for in ARTICLE 2, the rent stated above shall remain the same for the ensuing renewal term and shall be paid in full for the renewal term thereof and shall be paid within thirty (30) days of the commencement of the renewal term. ARTICLE 4. Other Expenses and Charges LESSOR shall pay all costs associated with the Demised Premises including, but not limited to, janitorial services and any and utility charges, except for local and long distance telephone charges, which shall be paid by the LESSEE. Utility charges shall include, but shall not be limited to, electricity, light, heat, air conditioning, power, water, and sewer services used, rendered or supplied thereupon or in connection with the Demised Premises. ARTICLE 5. Modifications to Demised Premises Prior to making any changes, alterations, additions or improvements to the Demised Premises, LESSEE will provide to LESSOR all proposals and plans for alterations, improvements, changes or additions to the Demised Premises for LESSOR'S written approval, specifying in writing the nature and extent of the desired alteration, improvement, change, or addition, along with the contemplated starting and completion time for such project. LESSOR or its designee will then have sixty (60) days within which to approve or deny in writing said request for changes, improvements, alterations or additions. LESSOR shall not unreasonably withhold its consent to required or appropriate alterations, improvements, changes or additions proposed by LESSEE. If after sixty (60) days there has been no response from LESSOR or its designee to said proposals or plans, then such silence shall be deemed as a denial to such request to LESSEE. LESSEE covenants and agrees in connection with any maintenance, repair work, erection, construction, improvement, addition or alteration of any authorized modifications, additions or improvements to the Demised Premises, to observe and comply with all then and future applicable laws, ordinances, rules, regulations, and requirements of the United States of America, State of Florida, County of Collier, and any and all governmental agencies. All alterations, improvements and additions to said Demised Premises shall at once, when made or installed, be deemed as attached to the freehold and to have become property of LESSOR. Prior to the termination of this Lease or any renewal term thereof, or within thirty (30) days thereafter, if LESSOR so directs, LESSEE shall promptly remove the additions, improvements, alterations, fixtures and installations which were placed in, on, or upon the Demised Premises by LESSEE, and repair any damage occasioned to the Demised Premises by such removal; and in default thereof, LESSOR may complete said removals and repairs at LESSEE'S expense. LESSEE covenants and agrees not to use, occupy, suffer or permit said Demised Premises or any part thereof to be used or occupied for any purpose contrary to law or the rules or regulations of any public authority. 2 ARTICLE 6. Access to Demised Premises 16E5 ;4:1 LESSOR, its duly authorized agents, representatives and employees, shall have the right after reasonable notice to LESSEE, to enter into and upon the Demised Premises or any part thereof at all reasonable hours for the purpose of examining the same and making repairs or providing services therein, and for the purposes of inspection for compliance with the provisions of this Lease Agreement. ARTICLE 7. Assignment and Subletting LESSEE covenants and agrees not to assign this Lease or to sublet the whole or any part of the Demised Premises, or to permit any other persons to occupy same without the written consent of LESSOR. ARTICLE 8. Indemnity and Insurance The LESSEE is covered by protection of the Federal Tort Claim Act. ARTICLE 11. Maintenance LESSEE shall keep the Demised Premises clean at all times. ARTICLE 12. Default by LESSEE Failure of LESSEE to comply with any provision or covenant of this Lease shall constitute a default, and LESSOR may, at its option, terminate this Lease after providing written notice to LESSEE, as specified in Article 2 of this Lease, unless the default be cured within the notice period (or such additional time as is reasonably required to correct such default). ARTICLE 13. Default by LESSOR LESSOR shall in no event be charged with default in the performance of any of its obligations hereunder unless and until LESSOR shall have failed to perform such obligations within thirty (30) days (or such additional time as is reasonably required to correct such default) after notice to LESSOR by LESSEE properly specifying wherein LESSOR has failed to perform any such obligations. ARTICLE 14. Notices Any notice which LESSOR or LESSEE may be required to give to the other party shall be in writing to the other party at the following addresses: LESSOR: LESSEE: Board of County Commissioners Congressman Mario Diaz-Balart do Real Property Mgmt. Dept. 8669 NW 36th Street, Suite 101 3335 East Tamiami Trail, Suite 101 Doral, Florida 33166 Naples, Florida 34112 cc: Office of the County Attorney Facilities Management Department Director 3 16E5 ARTICLE 15. Surrender of Premises LESSEE shall deliver up and surrender to LESSOR possession of the Demised Premises at the termination of this Lease, or its earlier termination as herein provided, broom clean and in as good condition and repair as the same shall be at the commencement of the term of this Lease or may have been put by LESSOR or LESSEE during the continuance thereof, ordinary wear and tear and damage by fire or the elements beyond LESSEE'S control excepted. ARTICLE 16. General Provisions LESSEE expressly agrees for itself, its successor and assigns, to refrain from any use of the Demised Premises which would interfere with or adversely affect the operation or maintenance of LESSOR'S standard operations where other operations share common facilities. (a) Rights not specifically granted the LESSEE by this Lease are hereby reserved to the LESSOR. (b) If applicable to this Lease, LESSEE agrees to pay all sales tax imposed on the rental of the Demised Premises where required under law. (c) LESSEE agrees to pay all intangible personal property taxes that may be imposed due to the creation, by this Lease, of a leasehold interest in the Demised Premises or LESSEE'S possession of said leasehold interest in the Demised Premises. ARTICLE 17. Left Blank Intentionally. ARTICLE 18. Radon Gas In compliance with Section 404.056, Florida Statutes, all parties are hereby made aware of the following: Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in Florida. Additional information regarding radon and radon testing may be obtained from your County Public Health Department. ARTICLE 19. Extent of Liens All persons to whom these presents may come are put upon notice of the fact that the interest of the LESSOR in the Demised Premises shall not be subject to liens for improvements made by the LESSEE, and liens for improvements made by the LESSEE are specifically prohibited from attaching to or becoming a lien on the interest of the LESSOR in the Demised Premises or any part of either. This notice is given pursuant to the provisions of and in compliance with Section 713.10, Florida Statutes. 4 ARTICLE 20. Effective Date 16 E 5 1 This Lease shall become effective upon execution by both LESSOR and LESSEE. ARTICLE 21. Governing Law This Lease shall be governed and construed in accordance with the laws of the State of Florida. ARTICLE 22. District Office Lease As a requirement of the United States House of Representatives, attached as an ADDENDUM to this Lease, is the District Office Lease Attachment. IN WITNESS WHEREOF, the parties hereto have hereunder set forth their hands and seals. AS TO THE LESSOR: DATED: .t- /Z" / -3 ATTEST: BOA' 1 OF 0 TY COMMISSIONERS DWIGHT E. BR K, Clerk COLLI I R CO 'Y, FLORIDA x • i i IslIkdputy-Clerk J e ' , I P Mint SS tO r" GEO-GIA A. HILLER, ESQ. , CHAIRWOMAN 10r070/3 DA E, "IP }C-itJgd, uz-( 71 BY: WITNESS (signature) CO `'RESS 'AN ).° ' 0 D /• Z-BALART C')/()-(/arl A. fimoie (print name) - 'a�A`�f fp WI . (signature) N tr.( A. (print name) Appro e« s form and legal sufficiency: , i Jeffrey .,'' 1 ow, County Attorney 5 . . E :9. . . . 16 5 X r / ( ..„ H ❑ / ❑ C II N r - r- C { _E ❑ ❑ ❑ ❑ N ❑ ❑ I I ❑ — \ I ®�� �❑ _ ❑❑ _ / m 1 ° ❑ Vii:.- ❑ ❑ ❑ (---,° y= � F Fl❑ m A J I❑❑ � n ❑ _ ❑ fi 0 ■ ‘,.] 5 A o GOLDEN GATE SERVICE CENTER L ' vvo ISSUE FOR o 0011%,',0 BOARD OF COUNTY COMMISSIONERS Mrie-9z LA o ��. COLLIER COUNTY, FLORIDA Q cauzmu FLOOR PLAN ���\ FACILITIES MANAGEMENT DEPARTMENT ° o-, 0 0 0 (,•,:".` CC; 1w�[®i rnuiaui mnt xnv�[s,a.3nris teal)ns-e9eo e r ro./4 Q oan 03-4S ADDENDUM 6E5 V.S. J-Couse of Representatzves Washington, D.C. 20515 Mstrict Office Lase Attaci ent (Page 1 of 4 113'Congress) 1. Incorporated District Office Lease Attachment. Lessor(Landlord)and Lessee (Member/Member-Elect of the U.S. House of Representatives)agree that this District Office Lease Attachment("Attachment")is incorporated into and made part of the Lease("Lease")and, if applicable,District Office Lease Amendment ("Amendment")to which it is attached. 2. Performance. Lessor expressly acknowledges that neither the U.S. House of Representatives ("House")nor its Officers are liable for the performance of the Lease. Lessor further expressly acknowledges that payments made by the Chief Administrative Officer of the House("CAO")to Lessor to satisfy Lessee's rent obligations under the Lease—which payments are made solely on behalf of Lessee in support of his/her official and representational duties as a Member of the House—shall create no legal obligation or liability on the part of the CAO or the House whatsoever. Lessee shall be solely responsible for the performance of the Lease and Lessor expressly agrees to look solely to Lessee for such performance. 3. Modifications. Any amendment to the Lease must be in writing and signed by the Lessor and Lessee. Lessor and Lessee also understand and acknowledge that the Administrative Counsel for the CAO("Administrative Counsel")must review and give approval of any amendment to the Lease prior to its execution. 4. Compliance with House Rules and Regulations. Lessor and Lessee understand and acknowledge that the Lease shall not be valid,and the CAO will not authorize the disbursement of funds to the Lessor,until the Administrative Counsel has reviewed the Lease to determine that it complies with the Rules of the House and the Regulations of the Committee on House Administration,and approved the Lease by signing on page 4 of this Attachment. 5. Payments. The Lease is a fixed term lease with monthly installments for which payment is due in arrears on or before the end of each calendar month. In the event of a payment dispute, Lessor agrees to contact the Office of Finance of the House at 202-225-7474 to attempt to resolve the dispute before contacting Lessee. 6. Void Provisions. Any provision in the Lease purporting to require the payment of a security deposit shall have no force or effect. Furthermore,any provision in the Lease purporting to vary the dollar amount of the rent specified in the Lease by any cost of living clause, operating expense clause,pro rata expense clause,escalation clause,or any other adjustment or measure during the term of the Lease shall have no force or effect. 7. Certain Charges. The parties agree that any charge for default,early termination or cancellation of the Lease which results from actions taken by or on behalf of the Lessee shall be the sole responsibility of the Lessee,and shall not be paid by the CAO on behalf of the Lessee. 8. Death,Resignation or Removal. In the event Lessee dies,resigns or is removed from office during the term of the Lease,the Clerk of the House may,at his or her sole option,either: (a) terminate the Lease by giving thirty(30)days' prior written notice to Lessor; or(b)assume the obligation of the Lease and continue to occupy the premises for a period not to exceed sixty(60) days following the certification of the election of the Lessee's successor. In the event the Clerk elects to terminate the Lease,the commencement date of such thirty(30)day termination notice shall be the date such notice is delivered to the Lessor or,if mailed,the date on which such notice is postmarked. 16E5 9fouse of Representatives Washington,D.C. 20515 District Office Leese Attedenent (Page 2 of 4—113`"Congress) 9. Term. The term of the Lease may not exceed the constitutional term of the Congress to which the Lessee has been elected. The Lease may be signed by the Member-Elect before taking office. Should the Member-Elect not take office to serve as a Member of the 1 1311'Congress,the Lease will be considered null and void. 10. Early Termination. If either Lessor or Lessee terminates the Lease under the terms of the Lease, the terminating party agrees to promptly file a copy of any termination notice with the Office of Finance,U.S. House of Representatives,B-245 Longworth House Office Building,Washington, D.C.20515,and with the Administrative Counsel,Office of the Chief Administrative Officer, U.S. House of Representatives,217 Ford House Office Building,Washington,D.C.20515. 11. Notification upon Occurrence of Certain Events. Lessor agrees to promptly notify Lessee in writing in the event Lessor sells,transfers,or otherwise disposes of the leased premises; in the event Lessor is placed in bankruptcy proceedings(whether voluntarily or involuntarily); in the event the leased premises is foreclosed upon;or in the event of any similar occurrence. Lessee shall promptly file a copy of any such notice with the Office of Finance,U.S. House of Representatives,B-245 Longworth House Office Building,Washington,D.C.20515. 12. Estoppel Certificates. Lessee agrees to sign an estoppel certificate relating to the leased premises(usually used in instances when the Lessor is selling or refinancing the building)upon the request of the Lessor. Such an estoppel certificate shall not require the review and approval of the Administrative Counsel. 13. Maintenance of Common Areas. Lessor agrees to maintain in good order,at its sole expense, all public and common areas of the building including,but not limited to,all sidewalks,parking areas,lobbies,elevators,escalators,entryways,exits, alleys and other like areas. 14. Maintenance of Structural Components. Lessor also agrees to maintain in good order,repair or replace as needed,at its sole expense,all structural and other components of the premises including, but not limited to,roofs,ceilings,walls(interior and exterior),floors,windows,doors, foundations,fixtures,and all mechanical,plumbing,electrical and air conditioning/heating systems or equipment(including window air conditioning units provided by the Lessor)serving the premises. 15. Lessor Liability for Failure to Maintain. Lessor shall be liable for any damage,either to persons or property,sustained by Lessee or any of his or her employees or guests,caused by Lessor's failure to fulfill its obligations under Sections 13 and 14. 16. Initial Alterations. Lessor shall make any initial alterations to the leased premises,as requested by Lessee and subject to Lessor's consent,which shall not be unreasonably withheld. The cost of such initial alterations shall be included in the annual rental rate. 17. Federal Tort Claims Act. Lessor agrees that the Federal Tort Claims Act,28 U.S.C. §§ 2671- 80,satisfies any and all obligations on the part of the Lessee to purchase private liability insurance. Lessee shall not be required to provide any certificates of insurance to Lessor. 16E51 E5 1 21.5, Rouse of representatives Washington,D.C. 20515 Offkle Lone Attachment (Page 3 of 4—113th Congress) 18. Limitation of Liability. Lessor agrees that neither Lessee nor the House nor any of the House's officers or employees will indemnify or hold harmless Lessor against any liability of Lessor to any third party that may arise during or as a result of the Lease or Lessee's tenancy. 19. Compliance with Laws. Lessor shall be solely responsible for complying with all applicable permitting and zoning ordinances or requirements, and with all local and state building codes, safety codes and handicap accessibility codes(including the Americans with Disabilities Act), both in the common areas of the building and the leased space of the Lessee. 211. Electronic Funds Transfer. Lessor agrees to accept monthly rent payments by Electronic Funds Transfer and agrees to provide the Office of Finance,U.S. House of Representatives,with all banking information necessary to facilitate such payments. 21. Refunds. Lessor shall promptly refund to the CAO,without formal demand,any payment made to the Lessor by the CAO for any period for which rent is not owed because the Lease has ended or been terminated. 22. Conflict. Should any provision of this Attachment be inconsistent with any provision of the attached Lease or attached Amendment,the provisions of this Attachment shall control,and those inconsistent provisions of the Lease or the Amendment shall have no force and effect to the extent of such inconsistency. 23. Construction. Unless the clear meaning requires otherwise,words of feminine,masculine or neuter gender include all other genders and,wherever appropriate, words in the singular include the plural and vice versa. 24. Fair Market Value. The Lease or Amendment is entered into at fair market value as the result of a bona fide,arms-length,marketplace transaction. The Lessor and Lessee certify that the parties are not relatives nor have had,or continue to have,a professional or Iegal relationship (except as a landlord and tenant). 25. District Certification. The Lessee certifies that the office space that is the subject of the Lease is located within the district the Lessee was elected to represent unless otherwise authorized by Regulations of the Committee on House Administration, 26. Counterparts. This Attachment may be executed in any number of counterparts and by facsimile copy,each of which shall be deemed to be an original but all of which together shall be deemed to be one and the same instrument. 27, Section Headings. The section headings of this Attachment are for convenience of reference only and shall not be deemed to limit or affect any of the provisions hereof. [Signature page follows.] • • • 16E5 7J.S. ,fouse of Representatives Washington,D.C. 20515 sstr�t Offhe tee Attachment (Page 4 of 4—113'"Congress) IN WITNESS WHEREOF,the patties have duly executed this District Office Lease Attachment as of the later date written below by the Lessor or the Lessee. Boar. .t County Com ssioners Collier County Florida Congressman Mario Diaz-Balart ame(Lessor) Print Name(Less-- I . OIP 1 / ' `'t tur ssee ature GEORG' ' sl°f, , eESQ. CHAIRWOMAN .z 'z ' 3 l( ri3 Date Date From the Member's Office,who is the point ofcontact for questions? Name __ _ Phone( ) E-mail mailhouse.gov This District Office Lease Attachment and the attached Lease or Amendment have been reviewed and are approved,pursuant to Regulations of the Committee on House Administration. Signed Date ,20, (Administrative Counsel) ATTEST t, DWIGHT E.BROCK,CLERK Apprit •to and legal sufficiency: Atitirs• Jeff r tzkow ►. County tt1 ey At*Fit; Send completed_forms to:Administrruive Counsel,217 Ford House Office Building, Washington,D.C.20515. Copies may also be faxed to 202-225-6999