Backup Documents 03/23/2021 Item #16G1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 G 1 ~
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. County Attorney Office CAO ., 6±
146) .-R.3
2. Board of County Commissioners Office BOCCqr
3;30)
3. Minutes and Records Clerk of Court's Office
3/014104 rr
4. Send signed copy to Heather Meyer GMD South -
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 Heather Meyer/GMD 239-252-5765
Contact/ Department
Agenda Date Item was March 23,2021 Agenda Item Number 16G1
Approved by the BCC
Type of Document Federal Aviation Administration (FAA) Airport Number of Original .4 A
Attached Coronavirus Response Grant Program(ACRGP) Documents Attached O�
grant applications to request eligible funds under
the Coronavirus Response and Relief
Supplemental Appropriations Act
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable lumnt whit ever is Yes N/A(Not
appropriate. (J('; �(l (Initial) Applicable)
1. Does the document require the chairman's original signature—g� HM
2. Does the document need to be sent to another agency for additional signatures? If yes, HM
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 HM
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 .I#M V /13r
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 HM
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 HM
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 March 23,2021 and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County �j an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for I '1 i ,, an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revise. .24.05;Revised 11/30/12
1 6 G1
MEMORANDUM
Date: March 29, 2021
To: Heather Meyer, Operations Support
Growth Management Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: FAA Airport Coronavirus Response Grant Program (ACRGP) grant
applications to request eligible funds under the Coronavirus Response
and Relief Supplemental Appropriations Act for Marco Island
Executive and ImmokaleeRegional Airports
Attached for further processing are original copies of the documents referenced above,
approved by the Board of County Commissioners (Item #16G1) on March 23, 202
If you have any questions please call me at 252-8406.
Thank you
Attachment (2)
l � GI
OMB Number 4040-0004
Expiration Date; 12/31/2022
Application for Federal Assistance SF-424
*1, Type of Submission: *2. Type of Application *If Revision, select appropriate letter(s):
❑ Preapplication ® New
® Application ❑ Continuation *Other(Specify)
❑ Changed/Corrected Application ❑ Revision
*3. Date Received: 4. Applicant Identifier:
NA MKY(Marco Island Executive)Immokalee, FL
*5b. Federal Entity Identifier: *5b. Federal Award Identifier:
12-0142
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
*a. Legal Name: Collier County Airport Authority
*b. Employer/Taxpayer Identification Number(EIN/TIN): 'c. Organizational DUNS:
59-6000558 07-699-7790
d. Address:
*Street 1: 2005 MAINSAIL DRIVE, STE 1
Street 2:
*City: NAPLES
County/Parish:
*State: FL
Province:
*Country: USA: United States
*Zip/Postal Code 34114
e. Organizational Unit:
Department Name: Division Name:
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: Mr. *First Name: Andrew
Middle Name:
*Last Name: Bennett
Suffix:
Title: Executive Airport Manager
Organizational Affiliation:
*Telephone Number: (239)252-8425 Fax Number:
*Email: Andrew.Bennett@colliercountyfl.gov
16G1
OMB Number: 404C-0004
Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
X.Airport Sponsor
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
*Other(Specify)
*10.Name of Federal Agency:
Federal Aviation Administration
11. Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Improvement Program
*12. Funding Opportunity Number:
NA
*Title:
NA
13. Competition identification Number:
NA
Title:
NA
14.Areas Affected by Project(Cities, Counties,States,etc.):
*15, Descriptive Title of Applicant's Project:
S23,000 for costs related to operations, personnel,cleaning, sanitization,janitorial services,combating the spread of pathogens at
the airport, and debt service payments.
Attach supporting documents as specified in agency instructions.
1 G1
OMB Number: 4040.0004
Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
16. Congressional Districts Of:
'a. Applicant: 14 'b. Program/Project: 19
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
"a. Start Date: NA 'b. End Date: NA
18, Estimated Funding ($):
'a. Federal $23,000.
'b. Applicant $0
'c. State
$0
'd. Local
'e. Other $0
'f. Program Income $0
'g. TOTAL $23,000.
*19, Is Application Subject to Review By State Under Executive Order 12372 Process?
❑ a. This application was made available to the State under the Executive Order 12372 Process for review on
❑ b. Program is subject to E.O. 12372 but has not been selected by the State for review.
Z c, Program is not covered by E. O. 12372
"20, Is the Applicant Delinquent On Any Federal Debt? (If"Yes", provide explanation in attachment.)
❑ Yes Z No
If"Yes", provide explanation and attach
21. 'By signing this application, I certify(1)to the statements contained in the list of certifications"and(2)that the statements
• herein are true,complete and accurate to the best of my knowledge. I also provide the required assurances"and agree to comply
with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject
me to criminal, civil,or administrative penalties. (U. S. Code,Title 218, Section 1001)
"IAGREE
The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or
agency specific instructions.
Authorized Representative:
Prefix: *First Name. enny
Middle Name:
'Last Name: Taylor
Suffix:
`Title: Chairperson-Collier County Airport Authority
'Telephone Number: (239)252-8604 Fax Number:
Email: Penny.Taylor@colliercountyfl.gov
'Signature of Authorized Representative: 'Date Signed:
ATTEST Approved as to form and legality
CR\STAL K.KINZEL,CLERK
BY: Q C . z \
Assistant County A ney
1 Gi
OMB Number. 4040-0004
Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
*1. Type of Submission: *2. Type of Application *If Revision,select appropriate letter(s):
❑ Preapplication ® New
® Application ❑ Continuation *Other(Specify)
❑ Changed/Corrected Application ❑ Revision
*3. Date Received: 4 Applicant Identifier:
NA IMM (Immokalee Regional) Immokalee, FL
*5b. Federal Entity Identifier: *5b. Federal Award Identifier:
12-0031
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
*a. Legal Name: Collier County Airport Authority
*b Employer/Taxpayer Identification Number(EIN/TIN): *c. Organizational DUNS:
59-6000558 07-699-7790
d. Address:
*Street 1: 2005 MAINSAIL DRIVE,STE 1
Street 2:
*City: NAPLES
County/Parish:
*State: FL
Province:
*Country: USA: United States
*Zip/Postal Code 34114
e. Organizational Unit:
Department Name: Division Name:
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: Mr. *First Name: Andrew
Middle Name:
*Last Name: Bennett
Suffix:
Title: Execute Airport Manager
Organizational Affiliation:
*Telephone Number: (239)252-8425 Fax Number:
*Email: Andrew.Bennett@colliercountyfl.gov
16G1
OMB Number 4040-0004
Expiration Date: 12/31/2022
Application for Federal Assistance SF-424
*9.Type of Applicant 1: Select Applicant Type:
X Airport Sponsor
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
*Other(Specify)
*10.Name of Federal Agency:
Federal Aviation Administration
11. Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Improvement Program
*12. Funding Opportunity Number:
NA
*Title:
NA
13.Competition Identification Number:
NA
Title:
NA
14.Areas Affected by Project(Cities, Counties,States,etc.):
*15. Descriptive Title of Applicant's Project
$13,000 for costs related to operations, personnel,cleaning. sanitization,janitorial services, combating the spread of pathogens at
the airport, and debt service payments.
Attach supporting documents as specified in agency instructions.
f,
" Cl
OMB Number: 4040-0004
Expiration Date 12/31/2022
Application for Federal Assistance SF-424
16. Congressional Districts Of:
*a.Applicant: 14 'b. Program/Project: 25
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project
*a. Start Date: NA *b. End Date: NA
18. Estimated Funding($):
*a. Federal $13,000
"b. Applicant $0
"c. State
$0
"d. Local
"e. Other $0
"f. Program Income $0
"g. TOTAL $13,000.
*19. Is Application Subject to Review By State Under Executive Order 12372 Process?
❑ a. This application was made available to the State under the Executive Order 12372 Process for review on
❑ b. Program is subject to E.O. 12372 but has not been selected by the State for review.
• c. Program is not covered by E.O. 12372
*20. Is the Applicant Delinquent On Any Federal Debt? (If"Yes",provide explanation in attachment.)
❑ Yes ® No
If"Yes", provide explanation and attach
21. By signing this application, I certify(1)to the statements contained in the list of certifications'"and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances"and agree to comply
with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject
me to criminal,civil,or administrative penalties. (U. S. Code,Title 218, Section 1001)
• ""IAGREE
**The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or
agency specific instructions.
Authorized Representative:
Prefix: • rsi Name: ny
Middle Name:
'Last Name: Taylor
Suffix:
'Title, Chairperson-Collier County Airport Authority
'Telephone Number: (239)252-8604 Fax Number:
* Email: Penny.Taylor@colliercountyfl.gov
Sinft ur f,Authorized Representati ve: *Date
tiQ\r��
C'RYSt LK KINZEL,CLERK Approvd ua feJa adCIVInty
•
LO
'� ssistant au ttorncy