Backup Documents 02/26/2013 Item #16E 3ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16E3
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 roust be received in the County Attorney Office no later
than Monday preceding the Board meeting.
Complete routing lines #I 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 throu #2, complete the checklist, and forward to the Coun Attorney Office.
Route to Addressees (List in routing order)
Office
Initials
Date
1.
Assistant C un Attorney
Initial)
Applicable)
2.
2/26/13
Agenda Item Number
16 -E -3
3. Colleen M. Greene, ACA
County Attorney Office
2-7 3
4. BCC Office
Board of County
Commissioners
Number of Original
I
5. Minutes and Records
Clerk of Court's Office
Documents Attached
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
Colleen M. Greene
Phone Number
252 -8400
Contact / Department
Assistant C un Attorney
Initial)
Applicable)
Agenda Date Item was
2/26/13
Agenda Item Number
16 -E -3
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
N/A
Type of Document
Property Damage Release Release
Number of Original
I
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
N/A
number if document is
by the Office of the County Attorney.
to be recorded
All handwritten strike - through and revisions have been initialed by the County Attorney's
N/A
INSTRUCTIONS & CHECKLIST
M &R — Please return fully executed copy to Colleen M. Greene, ACA
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Re ' 4 .05; Revised 11/30/12
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is _
Yes
N/A (Not
a ro riate.
Initial)
Applicable)
1.
Does the document require the chairman's original signature?
CMG
2.
Does the document need to be sent to another agency for additional signatures? If yes,
N/A
provide the Contact Information ame;Agency; Address; Phone on an attached sheet.
3.
Original document has been signed/initialed for legal sufficiency. (All documents to be
CMG
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney.
7
All handwritten strike - through and revisions have been initialed by the County Attorney's
N/A
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
CMG
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
CMG
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
N/A
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 2/26/13 and all changes made
CMG
during 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
CMG
BCC, all changes directed by the BCC have been made, and the document is ready for the .
Chairman's signature.
M &R — Please return fully executed copy to Colleen M. Greene, ACA
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Re ' 4 .05; Revised 11/30/12
16E3
MEMORANDUM
Date: March 1, 2013
To: Colleen Greene, ACA
County Attorney's Office
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Property Damage Release
Attached for your records and to further distribute are two original copies of the
agreement referenced above (Item #16E3) approved by the Board of County
Commissioners on February 26, 2013.
The third original will be held on file with the Minutes and Record's Department
in the Board's Official Records.
If you have any questions, please call me at 252 -8411.
Thank you.
Attachment (2)
16E3
PROPERTY DAMAGE RELEASE
Risk Claim Number: 22- 42151201177
IN CONSIDERATION OF payment from COLLIER COUNTY the sum of Nineteen
Thousand Dollars and 00 /100 ($19,000.00), to Claimant, LIZ PFUNDER, and other good and
valuable consideration, LIZ PFUNDER does release and discharge, and by these presents does
for herself, her heirs, executors, successors in interest, administrators and assigns, release, acquit
and forever discharge COLLIER COUNTY, of and from any and all actions, causes of action,
claims or demands for property damage and personal injury, including, but not limited to, repair
costs, loss of use, diminution in value, consequential damage, costs, expenses, and any other
thing whatsoever on account of, or in any way growing out of, damage to Claimant's property as
a result of an accident that happened on or about the 14th day of February, 2012.
Claimant agrees within fourteen days of the commencement of this agreement to
purchase and maintain coverage for the peril of backup of sewers and drains under her
homeowner's insurance policy for as long as she occupies or owns the home. Should the
claimant fail to purchase and maintain this coverage and a loss occur, claimant shall hold
harmless the County and forfeit the right to file a claim for damages against the County. This
provision shall not apply in the event that the cause of the loss is directly attributable to the a
malfunction of the sewer system servicing her home by the County, and whereby the cause can
be directly attributed to the negligence of the County, confirmed through direct observation of
the cause by the Public Utilities staff.
Claimant understands that this settlement release is the compromise of a disputed claim,
and that the payment is not to be construed as an admission of liability on the part of the persons
hereby released by whom liability is expressly denied.
Claimant further state(s), that she has carefully read the foregoing release and knows the
contents thereof, and sign the same by own free act, and that this release contains the entire
agreement between the parties.
[Signature Page to Follow]
Page 1 of 2
16E3
IN WITNESS WHEREOF, Claimant, and the County have signed and sealed this
Property Damage Release which is entered into and made on this cQ -7 day of February, 2013,
as set forth below.
Claimant:
L der
STATE OF rl 6(G
COUNTY OF
I Lip f-
THIS PROPERTY DAMAGE RELEASE BETWEEN CLAIMANT AND COLLIER
COUNTY FLORIDA W,AS SWORN TO and subscribed by LIZ PFUNDER, before me on
s _ dX of , 2013.
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ommissioned 14ame of No Pub . O�ne.L�.Ae�
(Please print, type or stamp)
My Commission expires:
ATTEST: BO
DWIGHT ) E. BIB( K,,,�<,LERK CO
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p t .g- 1Ck By:
ty-Clerk
AnDroved as'to:fbrm and legal sufficiency:
olleen M. Greene
Assistant County Attorney
13 -RMG -00318/11
MO MI
L uced Identification
Type of Identification Produced
COUNTY
lebrgia A. Hiller, Esq.
Chairwoman
Page 2 of 2
Item # 1
Agenda (�
Date
Date
Reca
Wputy-Clerk