Backup Documents 04/23/2013 Item #16A 4ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA Lt
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to oa5ty 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.
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 #I thronoh #2 c lete the ehr+ W if —A f .,—A .„ A— r,,,,...,, A..--- ...,ar.,.-
Route to Addressees (List in routing order)
Office
Initials
Date
1.
appropriate.
(Initial)
Applicable)
2.
4/23/13 V,
Agenda Item Number
16 -A4
3. County Attorney Office.
County Attorney Office
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4. BCC Office
Board of County
Commissioners
b
s 1/ /
l 3 ) 3
5. Minutes and Records
Clerk of Court's Officer
Documents Attached
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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 Stan
John Houldsworth
Phone Number
x -5757
Contact/ Department
appropriate.
(Initial)
Applicable)
Agenda Date Item was
4/23/13 V,
Agenda Item Number
16 -A4
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
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Type of Document
Plat
Number of Original
1
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
signed by the Chairman, with the exception of most letters, must be reviewed and signed
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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
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
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?
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2.
Does the document need to be sent to another agency for additional signatures? If yes,
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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
signed by the Chairman, with the exception of most letters, must be reviewed and signed
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by the Office of the County Attorney.
4.
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
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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.
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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 April 23, 2013 and all changes made
during the meeting have been incorporated in the attached document. The County
V
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 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