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2011/2012 Receipt#007221020 2/6/2012 5:08:53 PM Dwight E. Brock Clerk of the Circuit Court 2)ffIICI1 CCC CC C cart;C1R�" Customer Deputy Clerk Clerk Office Location JP MARCHAND BMR CASHIER Collier County Govt. Center KIMLEY-HORN & MinutesandRecords @CollierClerk.co Building F, 4th Floor ASSOCIATES m 3299 Tamiami Trail East, Suite 2601 CATTLEMEN RD STE 239-252-2646 401 200 P.O. Box 413044 SARASOTA, FL 34232-6282 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check#5016 ($25.00) BALANCE DUE $0.00 Note: Disclaimer:All transactions are subject to review/verification.The Clerk reserves the right to correct for clerical errors and to assess or refund charges as needed. C 0 DD11®02©1]®PlhogO 11a Page 1 of 1 Collier County Clerk of Courts Expires f 3299 Tamiami Trail E. (Clerk'd office only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM J. P. Marchand,P.E. January 12,2012 Name Date Kimley-Horn and Associates, Inc. Business Name 2601 Cattlemen Road, Suite 200 Business Address Sarasota Florida 34232 City State Zip Code 941.379.7600 J. P. Marchand, P.E. Business Telephone Contact Person Jp.marchand @kimley-horn.com Lobbyist E-mail Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist,per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: Collier County 1. Name 2.Name 2800 North Horseshoe Drive Address Address Naples 34108 City Zip Code City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier o byist Signature This registration was sworn(or affirmed) and subscribed before me this day of, , 20 , by Personally Known BY: Produced ID Deputy Clerk/Notary Public Type of ID Produced Revised:08/2011 „ Kimley-Horn Suite 2001emen Road and Associates, Inc. Sarasota,FL 34232 TEL 941 379 7600 FAX 941 379 4352 Transmittal Date: January 16,2012 Job Number: 148075000 Project Name: Lobbyist Registration Form To: Collier County Clerk of Courts 3299 Tamiami Trail E. Suite 401,Building F,4th Floor Naples,Florida 34112 We are sending these by ® U.S.Mail ❑ FedEx/UPS ❑ Hand Deliver ❑ Other: We are sending you El Attached ❑ Under separate cover via the following items: ❑ Shop Drawings ❑ Prints/Plans ❑ Samples ❑ Specifications ❑Change Orders ❑ Other: Copies Date No. Description • Lobbyist Registration Form Check#5016 for$25 These are transmitted as checked below: ® For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval ❑ As requested ❑ Approved as noted ❑ Submit ❑ Copies for distribution ❑ For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints Remarks: Copy to: Signed archand,P.E. M:IAdmin\FORMS\KHA Transmittal.doc Teresa L. Polaski To: jp.marchand @kimley-horn.com Subject: Lobbyist registration Hi Mr. Marchand, I received your lobbyist registration and will be processing it but there is a small problem, It is not notarized.Could you submit another form that has been notarized and I will be able to finalize your registration. If you have any questions please contact me.Thank you Teresa L. Polaski, BMR Clerk III Minutes and Records Department 239-252-8411 239-252-8408 fax Teresa.Polaski@collierclerk.com 1 � nt�of llier CLERK OF THE 6-RC IT COURT Dwight E. Brock COLLIER COUNTY OUR OUSE Clerk of Courts Clerk of Courts 3301 TAMIAMI IL E ST Accountant P.O. BOX 4 3044 NAPLES, FLORIDA 4101-3 44 Auditor Custodian of County Funds Mr. Marchand, 't I received your lobbyist registration and payment however, it was not notarized. Please fill out the included form, with notarization and return to our office. If you have any questions please contact me. My direct number is 239-252-8411 Thank you Collier County Clerk of Courts 3299 Tamiami Trail East Suite #401 Naples, FL 34112 C),(Vtat / t Sincerely, Teresa Polaski, BMR III (D° \\1 \\93 Phone (239) 252-2646 Fax (239) 252-2755 Website: www.collierclerk.com Email: collierclerkiacollierclerk.com