Backup Documents 12/11/2018 Item #16A16 1_6 A /6
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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(Nfice
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 ea I a--
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 OfficeWki Q 1a/fa
4. BCC Office Board of County QS
Commissioners y\A Clerk of Court's Office \
'21��
5. Minutes and Records �1 ,
VUU t4 l I' Ion 3 O4(
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 a Phone Number
Contact/ Department 2 GO sS�.t.l► ) 239-`252 -5'SC,-7
Agenda Date Item was 1 Z- 11- I g Agenda Item Number 16 ' A
Approved by the BCC
Type of Document Number of Original
Attached ( l(a At AvnQ'Ack merit Documents Attached
PO number or account
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)
I. Does the document require the chairman's�si• inal s' nature? X
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.
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
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on I Z1I I (enter date)and all changes made
during the meeting have been incorporated in the attached document. The County k opU
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 •-
Chairman's signature.
�`- - 1_ ycoVrs clrt c,%.
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
16A16
MEMORANDUM
Date: December 11, 2018
To: Zachary Easton
Department of Environmental Protection, Water Restoration Assistance
From: Liz Gosselin
Collier County Government, Stormwater Planning
Re: DEP Agreement No. LP11030—Amendment#1
Naples Park Area Infrastructure Optimization for Stormwater, Water and
Sewer (Phase 2)
Please find attached two (2) copies of the Amendment #1 signed by the Collier County BCC
Chairman (BCC 12/11/18 - Agenda Item 16A16).
After DEP's signatures are completed, please send back a fully executed copy to me at the
addresses below:
Collier County Government
Stormwater Management Section
2685 South Horseshoe Drive, Suite #103
Naples, FL 34104
If you have any questions, please contact me at(239) 525-5867
Thank you.
16A16
County ofCollier
CLERK OF THE CIRCUIrT COURT
COLLIER COUNTY C URTHO\JSE
3315 TAMIAMI TRL E STE 102 Crystal K. Kinzel-Clekrof Circµit Cowl P.O.BOX 413044
NAPLES,FL 34112-5324 NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor • Custodian of County Funds
December 12, 2018
FDEP
Attn: Zachary Easton
Division of Water Restoration Assistance
3900 Commonwealth Blvd.
MS 3602
Tallahassee, Florida 32399
Re: FDEP Amendment #1 to Agreement #LP11030 between Collier County and
Florida Deparetment of Environmental Protection
Transmitted herewith are two (2) original agreements of the above referenced document,
as adopted by the Collier County Board of County Commissioners of Collier County,
Florida on Tuesday, December 11, 2018, during Regular Session.
Once fully executed, return one original agreement to our office for the Board's
Records, for your convience an envelope has been provided.
Very truly yours,
CRYSTAL K. KINZEL, CLERK
)1\--jakk_
Martha Vergara, Deputy_Clerk
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
6
16A16
AMENDMENT NO. 1
TO AGREEMENT NO. LP11030
BETWEEN
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
AND
COLLIER COUNTY
This Amendment to Agreement No.LP 11030(Agreement)is made by and between the Department of Environmental
Protection (Department), an agency of the State of Florida, and Collier County. (Grantee), on the date last signed
below.
WHEREAS,the Department entered into the Agreement with the Grantee for Naples Park Area/Basin Infrastructure
Phase 11,effective December 29,2016;
WHEREAS,the Grantee has requested a revision in the scope of work,a reallocation of the budget for the project,
and an extension of the Agreement;an extension is needed because more time is needed to complete the construction
task;and,
WHEREAS, certain provisions of the Agreement need revision and several provisions need to be added to the
Agreement.
NOW THEREFORE,the parties agree as follows:
1. The Agreement is effective until June 30,2021. The reimbursement period for this Agreement begins on
July 1,2016 and ends at the expiration of the Agreement. The Department and the Grantee shall continue to
perform their respective duties during this extension period pursuant to the same terms and conditions
provided in the Agreement.
2. Section 17.of the Agreement is hereby deleted in its entirety and replaced with the following:
CONTACTS:
The Department's Grant Manager(which may also be referred to as the Department's Project Manager)for
this Agreement is identified below:
Zachary Easton,or Successor
Florida Department of Environmental Protection
Division of Water Restoration Assistance
3900 Commonwealth Blvd.,MS#3602
Tallahassee,Florida 32399
Telephone No.: (850)245-2949
E-mail Address: Zachary.Easton@ndep.state.fl.us
The Grantee's Grant Manager at the time of execution for this Agreement is identified below:
Liz Gosselin,or Successor
Collier County
Stormwater Management
2685 South Horseshoe Drive,Unit 103
Naples,Florida 34104
Telephone No.: (239)252-5867
E-mail Address: Liz.Gosselin@colliercountyfl.gov
DEP Agreement No.LP 11030,Amendment No. 1,Page 1 of 3
�EJ
16A16 .
If a different Grant Manager is designated by either party after execution of this Agreement, notice of the
name and contact information of the new Grant Manager will be submitted in writing to the other party and
maintained in the respective parties' records. A change of Grant Manager does not require a formal
amendment or change order to the Agreement.
3. Section 26.is hereby deleted and replaced with Attachment F,Public Records Requirements.
4. Section 27.of the Agreement is deleted and replaced as follows:
SCRUTINIZED COMPANIES:
A. Grantee certifies that it and its subcontractors are not on the Scrutinized Companies that Boycott
Israel List. Pursuant to Section 287.135, F.S., the Department may immediately terminate this
Agreement at its sole option if the Grantee or its subcontractors are found to have submitted a false
certification;or if the Grantee,or its subcontractors are placed on the Scrutinized Companies that
Boycott Israel List or is engaged in the boycott of Israel during the term of the Agreement.
B. If this Agreement is for more than one million dollars, the Grantee certifies that it and its
subcontractors are also not on the Scrutinized Companies with Activities in Sudan, Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List, or engaged with business
operations in Cuba or Syria as identified in Section 287.135,F.S.Pursuant to Section 287.135,F.S.,
the Department may immediately terminate this Agreement at its sole option if the Grantee, its
affiliates,or its subcontractors are found to have submitted a false certification;or if the Grantee,its
affiliates,or its subcontractors are placed on the Scrutinized Companies that Boycott the Scrutinized
Companies with Activities in Sudan List, or Scrutinized Companies with Activities in the Iran
Petroleum Energy Sector List,or engaged with business operations in Cuba or Syria during the term
of the Agreement.
C. The Grantee agrees to observe the above requirements for applicable subcontracts entered into for
the performance of work under this Agreement.
D. As provided in Subsection 287.135(8), F.S., if federal law ceases to authorize these contracting
prohibitions then they shall become inoperative.
5. Section 31. is added to the Agreement as follows:
REFUND OF PAYMENTS TO THE DEPARTMENT
Any balance of unobligated funds that have been advanced or paid must be refunded Department.Any funds
paid in excess of the amount to which Grantee or subgrantee is entitled under the terms of the Agreement
must be refunded to Department.
6. Attachment A, Grant Work Plan, is hereby deleted in its entirety and replaced with Attachment A-1,
Revised Grant Work Plan,as attached to this Amendment and hereby incorporated into the Agreement.All
references in the Agreement to Attachment A shall hereinafter refer to Attachment A-1, Revised Grant
Work Plan.
7. Attachment B, Disbursement Request Package, is hereby deleted in its entirety and replaced with
Attachment B-1, Payment Request Summary Form, attached hereto and made a part of the Agreement.
All references in the Agreement to Attachment B, shall hereinafter refer to Attachment B-1, Payment
Request Summary Form.
8. All other terms and conditions of the Agreement remain in effect. If and to the extent that any inconsistency
may appear between the Agreement and this Amendment,the provisions of this Amendment shall control.
DEP Agreement No. LP 1 1030,Amendment No. I, Page 2 of 3
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IN WITNESS WI-IEREOF,the parties have caused this amendment to Agreement LP I 1030 to be duly executed,the
day and year last written below.
COLLIER COUN STATE OF FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
By: ' By'
Chairman Secretary or Designee
Andy Solis n 0a U 1'J h a
Print Name of Authorized Person Trina Vielhauer,Director
Date: `?..,.\N1`", Date: 3 I I`1 11 %
Approved as to form and legality Ect
Zachary Easton,DEP Grant Manager
Jennifer A. Belped �pY`,4
Assistant County Attorney �S Sandra Waters,DEP QC Reviewer
FEID No. 59-6000558
ATTEST
CRYSTAL K"IINZEL CLERK
BY:
Atest as t&O iairman's`
signature on1 :
List of attachments/exhibits included as part of this Amendment:
Letter/
Specify Type Number Description(include number of pages)
Attachment A-1 Revised Grant Work Plan(3 Pages)
Attachment B-1 Payment Request Summary Form(6 Pages)
Attachment F Public Records Requirements
DEP Agreement No.LP 1 1030,Amendment No. 1,Page 3 of 3
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ATTACHMENT A-1
REVISED GRANT WORK PLAN
PROJECT TITLE: Naples Park Area/Basin Infrastructure Phase II
PROJECT LOCATION:The Project will be located within the Naples Park community,which is located
west of Tamiami Trail North to the Gulf of Mexico,and between Vanderbilt Beach Road and 1 l 1 th Avenue
North in Collier County, Florida. See Figure 1 for a location map.
PROJECT BACKGROUND: This multi-year program integrates stormwater, water, and wastewater
improvements within the Naples Park Community in Collier County (Grantee). The Community, which
began developing in the 1950s,encompasses twenty-one(21)streets.The goal of the overall program is to
target one(1)to two(2)streets per phase to address water,stormwater,and wastewater issues.
The stormwater collection system historically consisted of roadside ditches and driveways with a culvert
pipe to allow stormwater to flow under and through the driveway. Most of these culverts and piping are too
small, are installed at improper elevation, and/or have reached the end of their functional lifespan.
Significant sections of the streets, within the Community experience flooding during normal rainfall
conditions due to the inefficiency of the internal street side collection and conveyance system.
The potable water system was installed over 40 years ago,and the asbestos cement based piping has reached
the end of its functional life. Due to the pipe's age and environment,there is an increasing number of water
main leaks and breaks, which directly affects the Collier County Water and Sewer District's ability to
supply uninterrupted service to its customers. There are a limited number of isolation valves in this area,
which restricts operational control during maintenance of the distribution system. The system also lacks a
sufficient number of fire hydrants which impacts the fire protection in the area.The sewer system was also
installed over 40 years ago and the vitrified clay pipe gravity sewer system needs to be replaced.
Replacement is needed to mitigate incidents of sanitary system overflows in environmentally sensitive areas
and to continue the effectiveness of the wastewater collection infrastructure.
Funding for Phase I of this program, which included improvements within 107th Avenue North and 110th
Avenue North was previously awarded as part of the FY2015-2016 Legislative Appropriations. Phase II of
this program will include stormwater,water,and wastewater improvements within 95th Avenue North and
96th Avenue North,within the Naples Park Community.
PROJECT DESCRIPTION: The Project will address stormwater, water, and wastewater distribution
issues within 95th Avenue North and 96th Avenue North. The stormwater improvements will provide
improved stormwater runoff collection and conveyance,a reduction in flooding and water quality incidents
by removing deteriorated culverts, the installation of perforated pipes and sedimentation traps, and
reconstructing the roadside stormwater management system.The water improvements will mitigate potable
water service interruptions to residents and businesses in Naples Park by removing old asbestos-concrete
pipes and installing new PVC pipes;provide a more efficient distribution system by upgrading the diameter
of pipes; improve the local fire protection system by replacing old hydrants and installing additional
hydrants in the area; and provide increased protection of the water distribution system by installing
backflow preventers for each service connection. The wastewater improvements will include the
replacement of old clay pipes with PVC pipes, replacement of old force mains, and rehabilitation and
replacement of pump stations. The wastewater improvements will provide increased efficiency of the
wastewater collection system, and mitigate incidents of sanitary system overflows in environmentally
sensitive areas. The Project is the second phase of approximately ten (10) to twelve (12) phases to be
completed within the next ten(10)to twelve(12)years as local funding becomes available.
DEP Agreement No. LP 11030,Attachment A-1, Page 1 of 3
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TASKS:
All documentation should be submitted electronically unless otherwise indicated.
Task 1: Construction
Deliverables:The Grantee will construct Water,Stormwater,and Wastewater improvements in accordance
with the construction contract documents.
The (Water) improvements will include the installation of new water mains that will replace asbestos-
concrete pipes. The water mains will be replaced with 6-inch and 8-inch PVC pipe along with additional
fire hydrants to meet current Insurance Services Office standards for urban firefighting and to assure
delivery of potable water to residents.The(Stormwater)improvements will include removal of deteriorated
culverts, installation of perforated pipes and sedimentation traps, and reconstruction of roadside swales.
The (Wastewater) improvements will include the replacement of wastewater gravity mains, force mains,
and pump stations.The installation of new wastewater mains will replace outdated PVC and clay pipes.
Documentation:The Grantee will submit with each payment request a signed acceptance of the completed
work to date by the Grantee and the Engineer's Certification of Payment Request.
Performance Standard: The Department's Grant Manager will review the documentation to verify that
the deliverables are provided as described above.Upon review and written acceptance by the Department's
Grant Manager of all deliverables under this task,the Grantee may proceed with payment request submittal.
Payment Request Schedule: The Grantee may submit a payment request for cost reimbursement no more
frequently than monthly.
PROJECT TIMELINE& BUDGET DETAIL: The tasks must be completed by, and all documentation
received by, the corresponding task end date.
Task Budget Budget Task Start Task End
No. Task Title Category Amount Date Date
I Construction Contractual $750,000 07/01/2016 12/31/2020
Services
Total: $750,000
Note that,per paragraph 4 of the agreement,authorization for continuation and completion of work and any
associated payments may be rescinded, with proper notice, at the discretion of the Department if the
Legislature reduces or eliminates appropriations.Extending the contract end date carries the risk that funds
for this project may become unavailable in the future.This should be a consideration for the Grantee with
this and future requests for extension.
DEP Agreement No. LPI 1030,Attachment A-1, Page 2 of 3
ON31
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Figure 1: Location Map
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DEP Agreement No. LP1 1030, Attachment A-1, Page 3 of 3
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ATTACHMENT B-I
PAYMENT REQUEST SUMMARY FORM
DEP Agreement No. Payment Request No. Request Date:
Grantee:
(Name&Mailing Address)
Grantee's Grant Manager
Task No(s). Task Amount(s)Requested: S
GRANT EXPENDITURES SUMMARY SECTION
TOTAL
PREVIOUS MATCHING TOTAL
AUTHORIZED TASKS AMOIINTOFTHIS PAYMENT CUMULATIVE, FUNDS FOR THIS CUMULATIVE
REQUEST PAYMENT
REQUESTS REQUEST MATCHING FUNDS
REQUESTS
"task 1: S - S - S - S - S -
"task 2: S - S - S - S - S -
Task 3: S - S - S - S - S -
Task 4: S - S - S - S - S -
Task 5: S - S - S - S - S -
Task 6: $ - S - S - S - S -
Task 7: S - S - S - S - S -
Task 8: S - S - S - S - S -
Task 9: S - S - S - S - S -
TOTAL AMOUNT S S S S S
TOTAL BUDGET
(ALL TASKS) S S
LESS TOTAL CUMULATIVE S S
PAYMENT REQUESTS OF:
TOTAL REMAINING S S
(ALL TASKS)
GRANTEE CERTIFICATION
Complete Grantee's Certification of Payment Request on Page 2 to certify that the amount being requested for reimbursement above was for items that
were charged to and utilized only for the above cited grant activities.
Attachment B-I,DEP Agreement No.LPI 1030,Page I of 62
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Grantee's Certification of Payment Request
,on behalf of
(Print name of Grantee's Grant Manager designated in the Agreement)
,do hereby certify for
(Print name of Grantee)
DEP Agreement No. and Payment Request No. that:
I. The disbursement amount requested is for allowable costs for the project described in Attachment 3 of the Agreement.
2. All costs included in the amount requested have been satisfactorily purchased,performed,received,and applied toward
completing the project;such costs are documented by invoices or other appropriate documentation as required in the Agreement.
3. The Grantee has paid such costs under the terms and provisions of contracts relating directly to the project;and the Grantee is not in
default of any terms or provisions of the contracts.
Grantee's Grant Manager's Signature Grantee's Fiscal Agent Signature
Print Name
Print Name
Telephone Number Telephone Number
Attachment B-1,DEP Agreement No.LPI 1030,Page 2 of 6
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Engineer's Certification
of Payment Request
ONLY SUBMIT IF CONSTRUCTION IS PART OF THE PROJECT
1, ,being the Professional Engineer retained by
(name of Professional Engineer)
,am responsible for overseeing construction of the project
(name of Grantee)
described in the Agreement and do hereby certify that for DEP Agreement No. and Payment Request No. •
I. All permits and approvals required for the construction,which is underway,have been obtained.
2. Payment is in accordance with construction contract provisions.
3. Construction up to the point of this payment request is in compliance with the approved plans and permits.
4. Equipment,materials,labor,and services represented by the construction invoices have been satisfactorily purchased or received and
applied to the project in accordance with construction contract documents filed with and previously approved by the Department of
Environmental Protection.
Signature of Professional Engineer
Firm or Affiliation
(Date) (P.E.Number)
(121
Attachment B-I,DEP Agreement No.LP 11030,Page 3 of 6
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INSTRUCTIONS FOR COMPLETING
PAYMENT REQUEST SUMMARY FORM
DEP AGREEMENT NO.: This is the number on your grant agreement.
PAYMENT REQEUST NUMBER:Number of payment request
REQUEST DATE:Date reqeust is submitted
GRANTEE: Enter the name of the grantee's agency.
MAILING ADDRESS: Enter the address that you want the state warrant sent.
GRANTEE'S GRANT MANAGER: This should he the person identified as grant manager in the grant Agreement.
TASK NO.: This is the number of the task that you arc requesting payment for and/or claiming match for(must agree with the current Grant Work Plan).
TASK AMOUNT REQUESTED: This should match the amount on the"TOTAL TASK BUDGET AMOUNT"line for the"AMOUNT OF TII1S REQUEST"column.
GRANT EXPENDITURES SUMMARY SECTION:
"AMOUNT OF THIS REQUEST"COLUMN: Enter by authorized category of expenditure the amount for which you are requesting reimbursement for this task. This must
agree with the currently approved budget in the current Grant Work Plan of your grant Agreement. Do not claim expenses in a budget category that does not have an approved
budget. Do not claim items that are not specifically identified in the current Grant Work Plan. Enter the column total on the"TOTAL AMOUNT"line. Enter the amount of all
Tasks on the"TOTAL BUDGET(ALL TASKS)" line. Enter the total cumulative amount of this request and all previous payments on the"LESS TOTAL. CUMULATIVE
PAYMENT REQUESTS OF"line. Deduct the"LESS TOTAL CUMULATIVE PAYMENT REQUESTS OF"from the"TOTAL BUDGET(ALL TASKS)"for the amount to enter
on the"TOTAL REMAINING(ALL TASKS)"line.
"PREVIOUS PAYMENT REQUESTS" COLUMN:Enter the total cumulative amount that has been paid in previous requests.Do not include the current reqeusted amount in
this total.Do not enter anything in the shaded areas.
"'TOTAL CUMULATIVE PAYMENT REQUESTS"COLUMN: Enter the cumulative amounts that have been requested to date for reimbursement by budget category. The
final request should show the total of all requests;first through the final request(this amount cannot exceed the approved budget amount for that budget category for the Task(s)
you are reporting on). Enter the column total on the"TOTAL PAYMENT REQUEST"line. Do not enter anything in the shaded areas.
"MATCHING FUNDS"COLUMN: Enter the amount to be claimed as match for the performance period for the Task(s)you are reporting on. This needs to be shown under
specific budget categories according to the currently approved Grant Work Plan. Enter the total on the"TOTAL AMOUNT"line for this column. Enter the match budget amount
on the"TOTAL BUDGET(ALL TASKS)"line for this column. Enter the total cumulative amount of this and any previous match claimed on the"LESS TOTAL CUMULATIVE
PAYMENTS OF"line for this column. Deduct the"LESS TOTAL CUMULATIVE PAYMENTS OF"from the"TOTAL BUDGET(ALL TASKS)"for the amount to enter on the
"TOTAL REMAINING(ALL TASKS)"line.
"TOTAL CUMULATIVE MATCHING FUNDS"COLUMN: Enter the cumulative amounts you have claimed to date for match by budget category. Put the total of all on
the line titled"TOTAL PAYMENT REQUEST." The final request should show the total of all claims, first claim through the final claim,etc. Do not enter anything in the
shaded areas.
GRANTEE'S CERTIFICATION:Must he signed by both the Grantee's Grant Manager as identified in the grant agreement and the Grantee's Fiscal Agent.
ENGINEER'S CERTIFICATION:Must be signed by Professional Engineer when Construction is being reqeusted for reimbursement.
Documentation for match claims must meet the same requirements as those expenditures for reimbursement.
t
Attachment B-I,DEP Agreement No.1.P1 1030,Page 4 of 6
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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
REQUEST FOR PAYMENT-PART II
REIMIBURSEMEN'1'DF:1'AII.
Grantee Name: Payment Request No.: I
DEP Agreement No.:
Local Share or Other
Vendor Name Invoice Invoice Date Invoice Amount Funding or Amount Requested Amount (3) Check Number Task/
Number (1) Number Task/Deliverable
(4)
Not Requested(2)
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $ -
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
Totals: $ - $
(:112)
Attachment B-I,DEP Agreement No.LPI 1030,Page 5 of 6
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Instructions for Completing Request for Payment - Part II
Include the Grantee Name, Payment Request No., and DEP Agreement Number. List vendor invoices that are associated
with the Project by Task/Deliverable.
I Invoice Amount: Amount of Invoice being submitted for reimbursement.
Local Share or Other Funding or Amount Not Requested: Portion of invoice paid for by Grantee,that is not
2 being requested for reimbursement by this grant
Requested Amount: Subtract Grantee's Local Share or Other Funding or Amount Not Requested(2)from Invoice
3 Amount(1).
Deliverable Number: Must identify completed deliverable(s) for each invoice. If invoice covers multiple
deliverables, that invoice would be listed multiple times,a line item for each deliverable with any portion not
4 applicable to that Task/Deliverable identified under(2).
Submittal Instructions
Instructions for E-mailing:
The program now accepts reimbursement requests electronically, please E-mail to Water and Springs Restoration
Program. When scanning please be sure that the minimum scan resolution must be 300 DPI (dots per inch). When
reimbursement requests are sent electronically, please do not also send a hard copy by postal mail.
Please redact all sensitive financial information from the invoices and other supporting documentation
to be submitted with this Payment Request Form.
Remit Payment Request by E-mail to: WSRPCa dep.state.fl.us
Be sure the E-mail payment request includes the following:
Cc: Department's Grant Manager
Subject: Project Number_Disbursement Number: example—LP 14025_Disb 1
Attachments:
1) Attachment B-1 Payment Request Summary
2) Request for Payment Part II Reimbursement Detail
3) Copies of invoices
4) Proof of payment(copies of canceled checks,front and back or EFT verification)
5) Other supporting documentation,as needed
For questions or concerns regarding these forms or if you would like the payment request forms listed above in
electronic format please contact:
Zachary Easton (850)245-2949
Zachary.Easton(c.dep.state.fl.us
tisiV
Attachment B-1,DEP Agreement No. LPl 1030,Page 6 of 6
16A16
ATTACHMENT F,PUBLIC RECORDS REQUIREMENTS
1. Public Records
a. If the Agreement exceeds$35,000.00,and if the Grantee is acting on behalf of the Department in its performance
of services under the Agreement,the Grantee must allow public access to all documents,papers,letters,or other
material, regardless of the physical form, characteristics, or means of transmission, made or received by the
Grantee in conjunction with the Agreement(Public Records),unless the Public Records are exempt from section
24(a)of Article I of the Florida Constitution or section 119.07(1),F.S.
b. The Department may unilaterally terminate the Agreement if the Grantee refuses to allow public access to Public
Records as required by law.
2. Additional Public Records Duties of Section 119.0701,F.S.,If Applicable.
For the purposes of this paragraph,the term"contract"means the"Agreement." If the Grantee is a"contractor"
as defined in section 119.0701(1)(a),F.S.,the following provisions apply and the Contractor shall:
a. Keep and maintain Public Records required by the Department to perform the service.
b. Upon request,provide the Department with a copy of requested Public Records or allow the Public Records to be
inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119,F.S.,
or as otherwise provided by law.
c. A contractor who fails to provide the Public Records to the Department within a reasonable time may be subject
to penalties under section 119.10,F.S.
d. Ensure that Public Records that are exempt or confidential and exempt from Public Records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and following
completion of the contract if the contractor does not transfer the Public Records to the Department.
e. Upon completion of the contract,transfer,at no cost,to the Department all Public Records in possession of the
contractor or keep and maintain Public Records required by the Department to perform the service. If the
contractor transfers all Public Records to the Department upon completion of the contract, the contractor shall
destroy any duplicate Public Records that are exempt or confidential and exempt from Public Records disclosure
requirements. If the contractor keeps and maintains Public Records upon completion of the contract, the
contractor shall meet all applicable requirements for retaining Public Records. All Public Records stored
electronically must be provided to the Department, upon request from the Department's custodian of Public
Records, in a format specified by the Department as compatible with the information technology systems of the
Department.These formatting requirements are satisfied by using the data formats as authorized in the contract
or Microsoft Word,Outlook,Adobe,or Excel,and any software formats the contractor is authorized to access.
f IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, F.S., TO THE CONTRACTOR'S
DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THE
CONTRACT, CONTACT THE DEPARTMENT'S CUSTODIAN OF
PUBLIC RECORDS AT:
Telephone: (850) 245-2118
Email: public.services@dep.state.fl.us
Mailing address: Department of Environmental Protection
ATTN: Office of Ombudsman and Public Services
Public Records Request
3900 Commonwealth Boulevard, MS 49
Tallahassee, Florida 32399
DEP Agreement No.LP 11030,Attachment F, Page 1 of 1