Backup Documents 01/27/2009 Item #16D 4
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
16D4
Print on pmk paper. Attach to orig!nal document Original J(Jcumcnt~ should be hand delivered to the Board 01licc. The completed routing slip ,md original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines # I through #4 as appropriate for additional signatures, dates. and/or infonnation needed. If the document is already complete with the
exccntion of the Chainnan's sienature, draw a line throu8:h routine: lines # 1 thlOUl!h #4, comoJete the checklist and forward to Sue Filson (Iine#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
l.Frank Ramsey Housing and Human Service -::ff-- 1127/09
2. Chairman Donna Fiala BCC
3.
4.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary cont<rt is the holder of the original document pending BCe approval, 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, incllliing Sue Filson, need to cmtael stall tilT additional or missing
information. All original documents needing the Bec Chairman's signalure are to be delivered to the Bee office only after the Bee has acted to approve the
item.)
Name of Primary Staff Frank Ramsey. Housing Manager Phone Number 252-2336
Contact
Agenda Date Item was 0112712009 Agenda ltem Number 16D-4
Approved by the BCC
Type of Document Agreement Number of Originai I
Attached Documents Attached
I.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark UNIA" in the Not Appiicable column. whichever is
a TO riate.
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. This includes signature pages Ii-om ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fu I!y executed by al! parties except the BCe
Chairman and Clerk to the Board and ossibl. State Officials.)
AI! handwritten strike-through and revisions have been initialed by the County Attorney's
Office and al! other arties exce t the BCe Chairman and the Cierk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the fmal ne otiated contract date whichever is a licablc.
"Sign heTel' tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In most cases (some contracts are an cxception)l the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCe approval.
Some docwnents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware or our deadlines!
The document was approved by lhe BeC on 0112712009 and all changes made during
the meeting have been incorporated in the attached document. The Count)' Attorney's
Office has reviewed the chan es, if a licable.
Yes
(Initial)
NIA(Not
A licable)
2.
3.
4.
5.
6.
'11--
-;-11
'7t
t'
nla
'11-.
-1/-
l: Forms! County Forms! BCe Forms! Original Documents Routing Slip WWS Original 9.03.04. Revised 1.26.05. Revised 2.24.05
MEMORANDUM
Date:
January 28, 2009
To:
Frank Ramsey, Housing Manager
Housing & Human Services Department
From:
Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re:
Agreement w/Habitat for Humanity for SHIP
Acquisition-Rehabilition/New Construction
Enclosed please find one (I) copy of the document, as referenced above
(Agenda Item #16D4), which were appTOved by the Board of County
Commissioners on Tuesday, January 27, 2009.
The Minutes and Records Department has retained the original for
the Board's Records.
If you should have any questions, please contact me at 252-8411.
Thank you.
Enclosures
16n14
AGREEMENT BETWEEN COLLIER COUNTY 1 6 D 4
AND
HABITAT FOR HUMANITY OF COLLIER COUNTY, INC.
SHIP ACOUISITION-REHABILITA TION/NEW CONSTRUCTION
nf'l\
This Agreement ("Agreement"), effective this -Hih day of January, 2009, is made by and
belween Collier County, a political subdivision of the State of Florida, hereinafler referred to as
"COUNTY," and Habitat for Humanity of Collier County, Inc., a private not-for-profit
corporation, exisling under the laws of the State of Florida, having its principal office at 11145
Tamiami Trail East, Naples, Florida, 34113, hereinafter referred to as "SPONSOR."
RECITALS:
WHEREAS, the COUNTY is a participanl in the State Housing Initiatives Partnership
(SHIP) Program; and
WHEREAS, pursuanl to the SHIP Program, the COUNTY is undertaking certain
activities to primarily benefit housing for very low - low - and moderate income persons and
neighborhoods; and
WHEREAS, the Local Housing Assistance Plan (LHAP) Fiscal Year 2007-2010 was
adopted on April 24, 2007 through Resolution No. 2007-96; and
WHEREAS, Ihrough Resolution No. 2008-212 the Board of County Commissioners
("Board") adopled a revision to the three-year LHAP amending a strategy that outlines the
intended use of SHIP funds for fiscal years 2007-2008, 2008-2009 and 2009-20 I 0; and
WHEREAS, Ihe Board linds that Ihe activities undertaken in connection with this
Agreement constitute valid and worthwhile County purposes, and as such, thai SPONSOR
should be duly funded or reimbursed for Ihe expenses as set forth herein.
WITNESSETH:
NOW, THEREFORE, in consideration of Ihe mutual promises and covenants herein
contained, it is agreed by the Parlies as follows:
I. All of the Recitals are true and correct and are hereby expressly incorporated herein by
reference as if set forth fully below.
Page 1 of 17
II. DEFINITIONS 1 6 D 4
(I) "COUNTY" means Collier County, and where applicable, its aulhorized
representative(s ).
(2) "SHIP" means the State Housing Initiatives Partnership Program of Collier County,
S 420.907-.9079, Florida Statutes.
(3) "SPONSOR" means Habital for Humanity ofCollicr County, Inc.
(4) "Very low - low -- and moderate income pcrsons" means thc definition set by ~
420.9071. Florida Statutes.
(5) "Project" means the work contemplated to be performed as sel forth in Exhibit "A."
(6) "Florida Housing Finance Corporation" means the agcncy governing Ihe SHIP
Program.
II. SCOPE OF SERVICES
The SPONSOR shall, in a satisfactory and proper manncr, as determined by COUNTY,
perform the tasks necessary to conducl the program outlined in Exhibit "A," and shall submit
each request for advancemenl and/or reimbursement of funds using Exhibit "B," all of which arc
attached hereto and made a part hereof. The SPONSOR may requcsl advance funds for
acquisition of eligible property with the required documcntation. Payments for eligible work
tasks and/or activities may be made directly to the provider of Ihe service(s), as approved by
HOUSING AND HUMAN SERVICES, al SPONSOR'S written request.
IV. TIME OF PERFORMANCE
The effeclive date of this Agreement is written abovc, and the serviccs of the SPONSOR
shall be undertaken and completed within twelve (12) months from datc of executed Agrecment.
V. CONSIDERATION AND LIMITATION OF COSTS
The SPONSOR shall be paid by the COUNTY for allowable costs, using SHIP funds,
determincd by COUNTY, in an amount not to exceed TWO HUNDRED FIFTY THOUSAND
AND 00/100 DOLLARS ($250,000.00) for the services described in Exhibit "A." Funding shall
not exceed fifty-thousand dollars per residential unit.
All activities specified in Exhibit "A" shall bc performed by SPONSOR employees, or
shall be solicited under a procedure acceptable to the COUNTY. Contract administration shall
be handled by thc SPONSOR and monitored by the COUNTY, which shall have access to all
records and documents related to the project. Payments for eligible work lasks and/or activitics
Page 2 of 17
.16D4
may be made direclly to the provider of the service(s), as approved by HOUSING AND
HUMAN SERVICES, at SPONSOR'S written request.
VI. NOTICES
All notices required to be given under this Agreement shall be sufficicnt when delivercd
to COUNTY at its office, presenlly located at 3301 E Tamiami Trail, Suite 211, Naplcs. FL
34112, and to the SPONSOR when delivered to its office at the address listcd on page onc (1) of
this Agreement.
VII. SPECIAL CONDITIONS
The SPONSOR agrees to comply with the requirements of the SHIP Program as
described in the !i 420.907 through 420.9079, Florida Statutes, and Chapter 67.37 of thc Florida
Administration Code. All work performed by SPONSOR, any contractor(s) and thcir
subcontractor(s), must conform to the requirements of the following:
I. 2005 Environmental Health & Safety
2. 2004 Florida Building Codc (includes Energy Efficient Code)
3. 2004 Florida Building Code/Fuel Gas
4. 2004 Florida Building Code/Mechanical
5. 2004 Florida Building Code/Plumbing
6. 2004 Florida Building Code/Americans with Disabililies
7. 2005 National Electric Code
8. 2002-01 Building Construction Administrative Code
VIII. GENERAL CONDITIONS
A. IMPLEMENT A nON OF PROJECT ACCORDING TO REQUIRED
PROCEDURES
The SPONSOR shall implement this Agreement in accordance with applicable
Federal, State, and County laws, ordinances and codes. No payments will be made until
approved by COUNTY.
B. AMENDMENTS
This Agreement, along with all exhibits and attachments, may be amended only
by written agreement executed by the governing boards of both partics, except that
COUNTY representative may approve adjustments between line item amounts, scope
clarifications, or an extension of time and schedule provided in Exhibit "A" that do not
Page 3 of 17
16D4
change the project, or exceed Ihe amounl funded by the COUNTY, as staled herein. Any
modifications to this conlract shall be in compliance with the Counly Purchasing Policy
and Adminislrative Procedures in effect at thc time such modificalions are authorized.
c. INDEMNIFICATION
To the maximum extent permitted by Florida law, the SPONSOR shall indemnify
and hold harmless Collier County, its o1licers and cmployees from any and all liabilities,
damages, losses and costs, including, bul not limited to, rcasonable attorneys' fees and
paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally
wrongful conduct of the SPONSOR or anyone employed or utilizcd by the SPONSOR in
the performance of this Agreement. This indemnification obligation shall not be
construed to ncgate, abridge or reduce any other rights or remedics which otherwisc may
be available to an indemnified party or person describcd in this paragraph. This section
does not pertain to any incident arising from the sole negligence of Collier County. Thc
foregoing indemnification shall not constitute a waivcr of sovereign immunity beyond thc
limits set forth in S 768.28, Florida Statutes.
D. TERMINATION
In event of termination for any of the following reasons, all tinished or unfinished
documents, data studies, surveys, drawings, maps, models, photographs, reports prepared,
and capital equipment secured by the SPONSOR with funds under this Agreemcnt shall
be returned to HOUSING AND HUMAN SERVICES or thc COUNTY. In thc cvent of
termination, the SPONSOR shall not be relieved of liability to the COUNTY for damagcs
sustained by the COUNTY by virtue of any breach of the Contract by the SPONSOR,
and the COUNTY may withhold any payment to the SPONSOR for set-otTpurposes until
such time as the exacl amounl of damages due to Ihc COUNTY trom the SPONSOR is
determined.
I. TERMINATION FOR CAUSE
Should the SPONSOR be found to have failed to perform in a manner
satisfactory to the COUNTY as per this Agreement. the COUNTY may
lerminate said agreement immediately for cause; further the COUNTY
may terminate this Agreement for convenience with a scven (7) day
written notice. The COUNTY shall be sole judge of non-perfonnance.
2. TERMINATION FOR CONVENIENCE
Page 4 of 17
16D4
At any timc during the term of this Agreemcnl, either party may, at its
option and for any reason, terminale this Agreement upon ten (10)
working days written notice to the other party. Upon termination, the
COUNTY shall pay the SPONSOR for services rendered pursuant to this
Agreement through and including thc date of termination.
E. INSURANCE. The SPONSOR or Contractor, if applicable, shall provide
insurance as follows:
Commercial General Liabilitv: Coverage shall havc minimum limits of $300,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage
Liability. This shall include Premises and Operations; Independent Contractors; Products
and Completed Operations and Contraclual Liability.
Workers' Compcnsation: Insurance covering all employees meeting Statutory
Limits of Chapter 440, Florida Statutes, and all Federal Government Statulory Limits and
Requirements.
Special Requirements: Collier County shall be lisled as the Certificate Holder and
included as an Additional Insured on the Comprehensive General Liability Policy.
Current, valid insurance policies meeting the requirement hcrein identifIed shall
be maintained by SPONSOR or Contraclor, if applicable, during the duration of this
Agreement. Renewal certifIcates shall be sent to the COUNTY thirty (30) days prior to
any expiration dale. There shall be a thirty (30) day notifIcation to the COUNTY in the
event of cancellation or modification of any stipulated insurance coverage.
SPONSOR or Contractor, if applicable, shall insure that all subcontractors comply
with the same insurance requirements Ihat he is required to meet. The SPONSOR or
same Contractor, if applicable, shall provide COUNTY with certificates of insurancc
meeting the required insurance provisions.
F. INDEPENDENT AGENT AND EMPLOYEES
The SPONSOR agrees that, in all matters relating to this Agreemcnt, it will be
acting as an independenl agent and that its employees are not Collier County employees
and are nol subject to the COUNTY provisions of the law applicable to COUNTY
employccs relative to employment, hours of work, ratcs of compensation, leave.
unemploymcnt compensation and employee benefits.
IX. ADMINISTRATIVE REOUIREMENTS
A. DOCUMENTATION AND RECORD KEEPING
Page 5 of 17
16D4
1. The SPONSOR shall maintain all records required by the COUNTY and
SHIP Regulations.
2. All invoices, plans, surveys, information, documents, maps, and other data
procedures developed, prepared, assembled, or completed by the
SPONSOR for the purpose of this Agreement shall be made available to
the COUNTY by the SPONSOR at any lime upon request by the
COUNTY. Upon completion of all work contemplaled under this
Agreement copies of all documents and records relating to this Agreement
shall be surrendered to COUNTY if requested.
B. PURCHASING
All purchasing for services and goods, including capital equipment, shall be made
by purchase order or by a written contract and in conformity with Ihe procedures
prescribed by Ihe Collier County Purchasing Policy, which are incorporated herein by
reference.
C. REPORTS, AUDITS, AND EVALUATIONS
I. Payments and/or reimbursement will be contingent on the timely receipt
of complete and accurate Request for Payment, attached herein as Exhibit
"8," required by COUNTY, and on the resolution of monitoring or audit
findings identified pursuant to this Agreement.
2. At any time during normal business hours and as often as the COUNTY
or the Florida Housing Finance Corporation may deem necessary, there
shall be made available by Ihe SPONSOR for examination all its records
wilh respect to all malters covered by this Agreement.
3. The SPONSOR, if applicable, agrees to eomply with the requirements of
the Florida Single Audit Act as defined in!i 215.97, Florida Statutes.
D. ADDITIONAL COUNTY AND SHIP REQUIREMENTS
COUNTY shall have the right under this Agreement to suspend or terminate
payments and reimbursement until the SPONSOR complies wilh any additional
conditions that may be imposed by the COUNTY or SHIP at any time. Funds are subject
10 the recapture provisions of!i 420.9075(5)(g), Florida Statutes from eligible persons or
eligible sponsors who default on Ihe terms of a grant award or loan award.
Page 6 of 17
X.
OTHER PROGRAM REQUIREMENTS
A. PROGRAM BENEFICIARIES
One Hundred percenl (100%) of the beneficiaries of the project funded Ihrough
this Agreement must be very low - low - or moderate income persons as required by S
420.9071(10), Florida Statutes. All prospective home buyers of subject property, as
listed on Exhibit "A," shall be qualified by COUNTY staff prior to transfer of title from
SPONSOR to new owner.
l6D4
13. EVALUATION AND MONITORING
The SPONSOR agrees that COUNTY may carry oul periodic monitoring and
evaluation activities as determined necessary by COUNTY and that the conlinuation of
this Agrccmcnl is dependent upon compliance with SHIP regulations. The SPONSOR
shall, upon the requesl of COUNTY, submit inf()rmation and status reports requcsted by
the COUNTY. The SPONSOR shall allow COUNTY to monitor the SPONSOR on site.
Such site visits may be scheduled or unscheduled as determined by COUNTY and
Florida Housing Finance Corporation.
C. CONFLICT OF INTEREST
The SPONSOR covenants that no person who presently exercises any functions
or responsibilities in connection with the Project, has any personal financial interest,
direct or indirect, in the target areas or any parcels therein, which would conflict in any
manner or degree with the performance of this Agreement and that no person having any
conflict of inlerest shall be employed by or subcontracted by the SPONSOR. Any
possible conflict of interest on the part of the SPONSOR or its employees shall be
disclosed in writing to COUNTY provided, however, that this paragraph shall be
interpreled in such a manner so as not to unreasonably impede the statutory requirement
that maximum opportunity be provided for employment of and participation of low and
very low-income residents of the projecl target area.
XI. SEVERABILITY OF PROVISIONS
If any provision of this Agreement is held invalid, the remainder of this Agreement shall
not be afTected thereby if such remainder would then continue to conform 10 the terms and
requirements of applicable law.
XII. ENTIRE UNDERSTANDING
This Agreement and its provIsIOns merge any prior agreements, if any, between the
Page 7 of 17
16D4
parties hereto and conslitutes Ihe entire understanding. The parties hereby acknowledge thai
there have been and are no representations, warranties, covenants, or undertakings other than
those expressly set forth herein.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by their appropriale officials, as of the date first above written.
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BOARD OF COUNTY COMMISSIONERS
COLLIER OUNTY, FLORIDA
d
By'
Sam Durso, M.D., President
Type/print witness name
AL:~!L
Second Witn ss
L1.v-: t)rrvlS b't
Type/print witnes name
Approved as to form and
legal sufficiency:
O~Ir1~
Colleen M. Greene
Assistant County Attorney
Item # j ~D
Agenda \ I ".....liG
Date ~""'I
Date
Rec'
l",,-':!tlf\ cfn'
EXHIBIT "A"
SCOPE OF SERVICES
HABITAT FOR HUMANITY OF COLLIER COUNTY, INC.
16n4
THE SPONSOR AGREES TO:
I. PROJECT SCOPE
This project will provide safe, decent and affordable housing for very low - low. and
moderale income persons in Collier County. This SHIP Program grant in the amount of
Two Hundred Fitly Thousand and 00/100 Dollars ($250,000.00) may be used 10 acquire
and/or rehabililate at least five (5) residential dwelling unils in Collier County to benetlt
very low - low - or moderale income persons as detlned by 9 420.9071, Florida
Statutes. Funding shall not exceed Ilfty-thousand dollars per rcsidential unit and may
include acquisition and/or rehabilitation.
a. Acquisition
SPONSOR may use project funds to finance the acquisition of eligible housing.
Pursuant 109420.9071(12), Florida Statutes, COUNTY may allocate SHIP limds
to eligible sponsors to partially assist in the construction, rehabilitation, or
financing of cli gible housing. Eligible housing is defIned in 9 420.9071 (8),
Florida Statutes.
b. Rehabilitation
SPONSOR may use project lunds to rehabilitale eligible housing. Pursuant to 9
420.9071(12), Florida Statutes, COUNTY may allocate SHIP funds to eligible
sponsors to partially assisl in the construction, rchabilitation, or t1nancing of
eligible housing. Eligible housing is defined in 9 420.9071(8), Florida Statutes.
Eligible work shall be dclermincd by a Bid Specillcation Form prepared by
HOUSING AND HUMAN SERVICES.
2. BUDGET
Total funds available under this Agreement shall not exceed Two Hundred Fifty
Thousand and 00/100 Dollars ($250,000.00) and the maximum award per unil shall be
limited to litty-thousand dollars ($50.000.00). The maximum award per unit may be
allocated between acquisition and rehabilitation.
Page 9 of 17
16n4
'NOTE: SPONSOR may elect to allocate maximum award per unit between acquisition
and rehabilitation. The Bid Specification Form, when prepared and if applicable, will be
attached and incorporated into this Agreement and used to itemize Ihc Rehabilitation
budget.
3. STAFFING
SPONSOR to provide list of staff directly responsible for reporting a nd request for
payment processing.
4. FORMER PROJECTS
Failure to adequalely maintain any former SHIP funded projects may result in the delay
of processing reimbursement requests for ongoing activities or in the forfeiture of future
SHIP funds.
5. WORK SCHEDULE
a. Acquisition
---
Eligible Activity Start Date Target Dates
...
Identi fy Property January 2009 March 2009
----
Purchase Property March 2009 July 2009
- -~-,----- _.
Identify Buyer(s) July 2009 October 2009
Transfer Property October 2009 December 2009
-----
b. Rehabilitation
.._--_.~ _.-
Eligible Activity Start Date Target Dates
...-------,.-.--
Purchase Property January 2009 March 2009
Bid Specification March 2009 May 2009
Complete Rehabilitation May 2009 October 2009
Transfer Property October 2009 December 2009
- ---~_._-- _____n_
NOTE: Target dates are in effect for program monitoring requirements only, and as
such, are used by HOUSING AND HUMAN SERVICES as general target goals rather
than strict performance requirements.
Page 10 of 17
16D4
6. REPORTS
The SPONSOR shall submit detailed monthly progress reports to HOUSING AND
HUMAN SERVICES outlining the status of specific aClivities under the project. Each
report must account for the total activity for which the SPONSOR is paid with SHIP
funds, in part or in whole, and which is required in fulfillment of thcir obligations under
this Agreement. The progress reports shall be submilted on the form Exhibit "C". Thc
progress rcports shall be used as an additional basis for COUNTY'S approval of invoices,
elc for payment.
7. COMPENSATION
The COUNTY shall reimburse the SPONSOR for the perf()rmanee of this Agreement
upon completion or partial completion of the work tasks as accepted and approved by
HOUSING AND HUMAN SERVICES pursuant to the submiltal of monthly progress
reports, but not more frequently than once per month. Progress payments to SPONSOR,
as approved by HOUSING AND HUMAN SERVICES, can be made for any eligible
activity listed in this Agreement. Eligible work tasks and/or activities shall includc, but
not be limitcd to, acquisition of property, rehabilitation ofthc propcrty and resale ofthc
property to an eligiblc person. Payments for cligible work lasks and/or activities may be
made directly 10 the provider of the servicc(s), as approvcd by I lOUSING AND
HUMAN SERVICES, at SPONSOR'S request. Payment will be made upon receipt of a
proper invoice and in compliance with 9218.70, Florida Statutes, otherwise known as
the "Local Government Prompt Payment Act".
END EXHIBIT "A"
Page 11 of 17
EXHIBIT "B"
16D4
COLLIER COUNTY HOUSING AND HUMAN SERVICES
REQUEST FOR PAYMENT
SECTION I: REOUEST FOR PAYMENT
SPONSOR Name:
Habilal for Humanity of Collier County, Inc
SPONSOR Address:
11145 Tamiami Trail East. Naples, Florida 34113
Unit#l:
Project No:
Payment Request #
Dollar Amount Requested: $
SECTION II: STATUS OF FUNDS
I certify that this request for payment has been drawn in accordance with Ihc terms and
conditions of the Agreement between the County and us as the SPONSOR. 1 also certify that the
amount of the Request for Payment is not in excess of current needs.
Signature
Date
Title
(approval authority under $14,999)
(approval required $15,000 and above)
Supervisor
Dept Director
Page 12 of 17
EXHIBIT "B"
16n4
COLLIER COUNTY HOUSING AND HUMAN SERVICES
REQUEST FOR PAYMENT
SECTION I: REQUEST FOR PAYMENT
SPONSOR Name:
Habitat for Humanity of Collier Counly, Inc
SPONSOR Address:
I I 145 Tamiami Trail East, Naples, Florida 341 13
Unit #2:
Project No:
Payment Request #
Dollar Amount Requested: $
SECTION II: STATUS OF FUNDS
I. Total Loan Amount Unit #2 $ $50,000.00
2. Sum of Past Claims Paid on this Accounl $
3. Total Loan Amount Lcss Sum of Past
Claims Paid on this Account
$
4. Amount of Previous Unpaid Rcqucsts $
5. Amount of Today's Request $
6. Current Loan Balance (Initial Loan Amount
Awarded Less Sum of!!lLRequests)
$
7. If applicablc amount held as retainage 10
date by the County, if not relained by the
sub-recipient.
$
I certify that Ihis request for payment has been drawn in accordance with the terms and
conditions of the Agreement between the County and us as the SPONSOR. I also certify that the
amount of the Request for Payment is not in excess of current needs.
Signature
Date
Title
(approval authority under $14,999)
(approval required $15,000 and above)
Supervisor
Dept Director
Page 13 of 17
EXHIBIT "8"
16D4
COLLIER COUNTY HOUSING AND HUMAN SERVICES
REQUEST FOR PAYMENT
SECTION I: REQUEST FOR PAYMENT
SPONSOR Name:
Habitat for Humanity of Collier County, Inc
SPONSOR Address:
11145 Tamiami Trail East, Naples, Florida 34113
Unil#3:
Projecl No:
Payment Request #
Dollar Amount Requested: $
SECTION II: STATUS OF FUNDS
1. Tolal Loan Amount Unit #3 $ $50,000.00
2. Sum of Past Claims Paid on this Account $
, Total Loan Amount Less Sum of Past
.J.
Claims Paid on this Account
$
4. Amount of Previous Unpaid Requests $
5. Amount of Today's Request $
6. Currenl Loan Balance (Initial Loan Amount
Awarded Lcss Sum of;!)LRequests)
$
7. If applicable amount held as relainage to
date by the County, ifnot relained by the
sub-recipient.
$
I certify that this request for payment has been drawn in accordance with the terms and
conditions oflhe Agreement between Ihe County and us as the SPONSOR. I also certify that the
amount of the Request for Payment is not in excess of current needs.
Signature
Date
Title
(approval authority under $14,999)
(approval required $15,000 and above)
Supervisor
Dept Director
Page 14 of 17
EXHIBIT "B"
COLLIER COUNTY HOUSING AND HUMAN SERVICES
REQUEST FOR PAYMENT
16D4
SECTION I: REQUEST I<'OR PAYMENT
SPONSOR Name:
Habital for Humanity ofCoJlier Counly, Inc
SPONSOR Address:
11145 Tamiami Trail Easl, Naples, Florida 34113
Unit #4:
Project No:
Payment Request #
Dollar Amount Requested: $
SECTION II: STATUS OF FUNDS
1. Total Loan Amount Unit #4 $ $50,000.00
2. Sum of Past Claims Paid on this Account $
3. Total Loan Amount Less Sum of Past
Claims Paid on this Account
$
4. Amount of Previous Unpaid Requests $
5. Amount of Today's Request $
6. Current Loan Balance (Initial Loan Amount
Awarded Less Sum ofilllRequests)
$
7. If applicable amount held as retainage to
date by the County. if not retained by the
sub-recipient.
$
I certify thai this request for payment has been drawn in accordance with the terms and
conditions of the Agreement between the County and us as the SPONSOR. 1 also certify that the
amount of the Request for Payment is not in excess of current needs.
Signature
Date
Title
(approval authority under $14,999)
(approval required $15,000 and above)
Supervisor
Dept Director
Page 15 of 17
EXHIBIT "B"
1604
COLLIER COUNTY HOUSING AND HUMAN SERVICES
REQUEST FOR PAYMENT
SECTION I: REOUEST FOR PAYMENT
SPONSOR Name:
Habitat for Humanity of Collier County, Inc
SPONSOR Address:
I I 145 Tamiami Trail East, Naples, Florida 34113
Unit #5:
Project No:
Payment Request #
Dollar Amount Requested: $
SECTION II: STATUS OF FUNDS
1. Total Loan Amounl Unit #5 $ $50,000.00
2. Sum of Past Claims Paid on this Account $
3. Total Loan Amount Less Sum of Past
Claims Paid on this Account
$
4. Amount of Previous Unpaid Requests $
5. Amounl of To day's Request $
6. Current Loan Balance (Initial Loan Amount
Awarded Less Sum ofill.LRequesls)
$
7. If applicable amount held as retainage 10
date by the County, if not retained by the
sub-recipient.
$
I certify that this request for payment has been drawn in accordance with the terms and
conditions ofthe Agreemenl between Ihe County and us as the SPONSOR. [also certify that the
amount of the Request for Payment is not in excess of current needs.
Signature
Date
Title
(approval authority under $ I 4,999)
(approval required $15,000 and above)
Supervisor
Dept Director
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EXHIBIT "C"
16n4
COLLIER COUNTY HOUSING AND HUMAN SERVICES
SHIP MONTHLY PROGRESS REPORT
Complete form for the past month and submit to Housing and Human Services staff by thc 10Ih
day ofthe following month.
Status Report for Month of:
Submittal Date:
SPONSOR Name:
Project N Llmbcr:_~ ~
1. Describe any action taken, relating to this project, during the past month.
2. What events/actions are scheduled for the next two months?
3. Describe any affirmative marketing you have implemented regarding this project.
Please list and attached any recent media coverage of your organization relating to
this project.
4. List any additional data relevant to the outcome measures listed in the Agreement.
5. Identity any potential issues that may cause delay.
Page 17 of 17