Okaloosa County BOCC — June 7, 2016 — Transportation Disadvantaged Grant Application, Coordinated Review Sheet, and Associated Documents

CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: # Tracking Number: Contractor/Lessee Name: OKALOOSA COUNTY Grant Funded: YESX NO___ Purpose: _Transportation Disadvantaged Trip & Equipment Grant Application Date/Term: 07/01/16 to 06/30/17 1. I GREATER THAN $50,000 Amount: _$565,589 2. ] GREATER THAN $25,000 Department: Growth Management 3. [] $25,000 OR LESS Dept. Monitor Name: Elliot Kampert/J. WILLIS Document has been reviewed and includes any attachments or exhibits. Purchasing Review Procurement requirements are met: Date: SIZSZ/M ing Director or designeey) cé, L/ W TV Ay A— P .~ Risk Management Review Approved as written: A< ) e pate: D= 954 Risk Monc%er or designee County Aftorney Review e [p Q\ oate: 525 1(, Q’ounty Affomey Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager RESOLUTION NO. 16 - A RESOLUTION of the BOARD OF COUNTY COMMISSIONERS of Okaloosa County, hereinafter BOARD, hereby authorizes the execution of a Transportation Disadvantaged Trust Fund Grant Agreement with the Florida Commission for the Transportation Disadvantaged (CTD). WHEREAS, this BOARD is eligible to receive a Transportation Disadvantaged Trust Fund Grant and to undertake a transportation disadvantaged service project as authorized by Section 427.0159, Florida Statutes, and Rule 41-2, Florida Administrative Code. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD THAT: 1. The BOARD has the authority to enter into this grant agreement. 2. The BOARD authorized the Chairman, Vice Chairman, or other designated representative of the Board to file and execute the application on behalf of Okaloosa County with the Florida Commission for the Transportation Disadvantaged. 3. The BOARD’S Registered Agent in Florida shall be the Chairman of the Board of County Commission. The Registered Agent’s address is: 1250 N. Eglin Parkway, Suite 102, Shalimar, FL 32578. 4, The BOARD authorizes the Chairman, or in the Chairman’s absence, the Vice Chairman, to sign any and all agreements, contracts, all assurances, warranties, certifications and any other documents which may be required in connection with the grant application and agreement or subsequent grant related documents. 5. The BOARD authorizes the Contracts and Grants Manager to sign any reimbursement invoices on behalf of the County. DULY PASSED AND ADOPTED THIS Day of , 2016. BOARD OF COUNTY COMMISSIONERS OKALOOSA COUNTY, FLORIDA Charles K. Windes Jr., Chairman ATTEST: Clerk of Circuit Court J. D. Peacock il By: Clerk (N Transportation Disadvantaged oo | [P & Equipment Grant Application Form Disadvantaged Grant Recipient | Okaloosa County Board of County Commissioners Legal Name Federal Employer Identification | 59-6000765 016 Number Registered Address | 1250 N. Eglin Parkway Suite 100 City and State | Shalimar, Florida Zip Code | 32579 Contact Person for this Grant | Marcella Eubanks Phone Number | 8506895000 Format 111-111-1111 E-Mail Address [Required] | meubanks@okaloosaclerk.com Fax Number | 8506895882 Format 111-111-1111 Project Location [County(ies)] | Okaloosa Proposed Project | 7/1/2016 Start Date Plannlng Funds Transferred from Planning Agency 0 Grant Amount - State Allocation [90%)] 508,984 Grant Amount — Local Match [10%)] 56,554 Grant Amount — Proviso [90%)] 0 Grant Amount — Proviso Match [10%] 46.00 Voluntary Dollar Amount 5.00 ocal Match for Voluntary Dollars [In Kind] | , =S out ticipated Capital Equipment Reques Description of Capital Equipment $ Amount =nier Cacital Zguipment Cescroticn If Requeshng Cop:fo! Equtpment Locol Coordlncmng Board Rewew 1S Requ:red This Application Form requesting the purchase of capital equipment has been review by the tntar Nam=2 of LC3 Local Coordinating Board Signature of Local Coordinating Board Chairperson Date I, Charles K. Windes, Jr., Chairman , as the authorized Grant Recipient Representative, hereby certify that the