1989-08
8
RECEIVED JAN 2 5 1989
8 BOB MARTINEZ
Governor
.'. '
Sta te of Florida
DEPARTMENT OF NATURAL RESOURCES
J 1M SMITH
Secretary ot State
BOB BUTTERWORTH
Attorney General
Marjory Stoneman Douglas BUIlding
3900 Commonwealth Boulevard
Tallahassee, Florida 32399
GERALD LEWIS
State Comptroller
BILL GUNTER
State Treasurer
TOM GARDNER
Executive Director
DOYLE CONNER
CommissIOner of Agriculture
BETTY CASTOR
CommissIOner of EducatIon
January 20,1989
PLEASE ADDRESS REPLY TO.
5ì9-00~
Mr. Wayne Saunders
City Manager
City of Clermont
Post Office Box 219
Clermont, Florida 32711
Re:
12th St. Recreation Site
LWCF Project No. 12-00289
Dear Mr. Saunders:
Enclosed is a copy of the fully executed state/local
agreement for the above-referenced project.
Enclosed also is information highlighting major state and
federal program requirements, but not addressing them all. You
are encouraged to use this as a guide but also become thoroughly
familiar with the program requirements contained in the Land and
Water Conservation Fund Grants Manual and Chapter 16D-5, Florida
Administrative Code.
Please call with any questions.
488-7896 and Suncom 278-7896.
My numbers are (904)
ß¡;Z/~
Richard A. Halvorsen
Grants Specialist
Office of Recreation Services
Division of Recreation and Parks
RAH/re
"WorkIng together to protect Florida's future"
1" ,
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C --~bý5
(DNR Contract Number)
12-00289
(LWCF Project Number)
FLORIDA DEPARTMENT OF NATURAL RESOURCES
LAND AND CONSERVATION FUND PROGRAM
ACQUISITION PROJECT AGREEMENT
This Project Agreement entered into on this 1'~ day
of ~¿~ -- , 1981, by and between the Florida Department of
Natural Resources, (hereinafter referred to as "Department"), and
the City of Clermont, (hereinafter referred to as "Project
Sponsor"), in furtherance of an approved outdoor recreation
Project.
In consideration of the mutual covenants contained
herein, the Department and Project Sponsor do hereby agree as
follows:
1.
This Agreement shall be performed pursuant to Chapter
16D-5, Part V, Florida Administrative Code, as amended,
(hereinafter referred to as "Rule"), the Land and Water
Conservation Fund (LWCF) Act of 1965, 78 Stat. 897 (1964), as
amended, (hereinafter referred to as "Program" ), and in
accordance with the general provisions for such Agreements
prescribed by the United States Department of the Interior (USDI)
in the LWCF Grants Manual, (hereinafter referred to as "Manual").
The Project Sponsor agrees to become familiar with all
provisions and comply with the Rule, which is incorporated into
this Agreement by reference, as if fully set forth herein.
In
the event a dispute should arise between the parties concerning
the intent of any language herein contained, the same shall be
resolved by the adoption of that meaning which furthers the
intent and purpose of the above referenced Acts of Congress and
the general provisions governing this Agreement as set forth in
the Manual to the extent that said Manual is not inconsistent with
the Rule.
No construction shall be contrary to the requirements
of the Acts of Congress or of the regulations of the Secretary of
the Interior.
Any difference of opinion which may not be resolved
Page 1 of 9
DNR 42-020
Revised 9/15/88
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by provisions of such Acts of Congress and the interpretations
or regulations of the Secretary of the Interior or of the USDI
shall be resolved between the parties by negotiation.
By
acceptance of the grant, the Project Sponsor agrees to comply
with the requirements of Title VI of the Civil Rights Act of
1964 and Section 504 of the Rehabilitation Act of 1973, as
amended.
The Project Sponsor further agrees to cooperate with
the Department in all aspects of compliance with all laws
applicable to use of Program funds.
It is the intention of the
parties hereto that none of the provisions of Section 163.01, F.
S., shall have application to this Agreement.
2.
The Department has found that outdoor recreation is the
primary purpose of the Project known as 12th Street Recreation
Site (LWCF Project number 12-00289), and enters into this
Agreement with the Project Sponsor for acquisition of that real
property, the legal description of which is set forth in Exhibit
A.
3.
The Project Sponsor shall complete acquisition of the
Project site by December 31,1989.
All Project close-out
documentation shall be submitted to the Department prior to
release of Program funds pursuant to requirements of the Rule.
4.
Within three (3) years following the date of final
Project reimbursement, the Project Sponsor will construct, or
cause the construction of, certain outdoor recreation facilities
and improvements upon the acquired real property, which
facilities shall be designed and constructed substantially in
accordance with the conceptual site development plan and the
recreation and support facilities described in the Project
application, which is incorporated into this Agreement by
reference, as if fully set forth herein.
Upon completion of
development, the Project Sponsor shall provide to the Department
an as-built plan for the Project site along with a list
identifying the number and types of recreation and support
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DNR 42-020
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facilties constructed and improvements made.
Any and all
utility lines installed within the park shall be placed
underground.
In the event the Project Sponsor fails to complete
development of the subject property in the manner described in
this Agreement on or before the date specified herein, the
Project Sponsor agrees that upon demand it will return to the
Department the total Program contribution including applicable
interest.
5.
Execution of this Agreement does not relieve the Project
Sponsor of the responsibility to comply with all applicable
federal, state, county, or municipal laws, ordinances or rules nor
is the Project Sponsor relieved of the responsibility to obtain
any permits, management agreements or leases which are required
by the Department or any federal, state, county or municipal
agency.
6.
Upon completion of Project acquisition, the Department
shall transfer, on a reimbursement basis to the Project Sponsor,
such eligible Program funds not to exceed $145,365.00, which will
pay said Program's share of the cost of the Project.
Program fund
limits are based upon the following:
Total Project Cost $ 290,730.00
Program Amount $ 145,365.00
Sponsor Match $ 145,365.00
Type of Match Cash
Program funds may be released at the discretion of the Department,
upon the request of the Project Sponsor's duly authorized Liaison
Agent.
The Project reimbursement request shall include all
documentation required by the Department for a proper preaudit and
postaudit review.
The Department's Contract Manager shall, within
sixty (60) days after receipt of the payment request, review the
submitted documentation and, if complete pursuant to requirements
of the Agreement, approve the request for payment.
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DNR 42-020
Revised 9/15/88
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7.
The Project Sponsor agrees to adhere to the
Department's Grant and Contract Accountability Policy, Chapter
16A-11, Florida Administrative Code, (hereinafter referred to as
"Accountability Policy"), incorporated into this Agreement by
reference as if fully set forth herein.
The Accountability Policy
establishes uniform guidelines and procedures to be utilized by
the Department and the Project Sponsor in accounting for grant
funds disbursed under the Program and sets forth principles for
determining eligible costs, supporting documentation and minimum
reporting requirements.
Expenses, representing the grant amount
and required match, shall be reported to the Department and
summarized on certification forms provided by the Department.
The Project Sponsor shall retain all records supporting Project
costs for three (3) years after the fiscal year in which the
final Program payment was released by the Department except that
such records shall be retained by the Project Sponsor until final
resolution of matters resulting from any litigation, claim, or
audit that started prior to the expiration of the three-year
retention period.
The Department and other authorized
governmental agencies shall have the right to audit such records
throughout the retention period described above.
8.
This Agreement may be canceled by the Department without
prior notice for refusal by the Project Sponsor to allow
public access to all documents, papers, letters, or other
material made or received by the Project Sponsor in conjunction
with the Agreement, subject to the provision of Chapter'l19,
Florida Statutes.
9.
If the Project Sponsor has been granted a Waiver of
Retroactivity and all applicable Manual requirements have been
satisfied, the full Program amount may be reimbursed upon
completion of the Project if such costs are identified in
Paragraph 10 herein as eligible costs incurred prior to
execution of the Agreement.
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10.
The Department and the Project Sponsor fully understand
and agree that there shall be no reimbursement of funds by the
Department for any obligation or expenditure made prior to the
execution of this Agreement with the exception of $145,365.00,
for:
Acquisition of the real property described in Exhibit A.
11.
Competitive open bidding and purchasing for the future
construction of any Project site facilities or improvements
shall comply with all applicable law.
12.
All moneys expended by the Project Sponsor for the
purposes contained herein shall be subject to preaudit review
and approval by the Comptroller of Florida in accordance with
Section 17.03, Florida Statutes.
Supporting documentation for
expenditures shall be provided by the Project Sponsor in
accordance with the Accountability Policy.
13.
The Department and USDI shall have the right, through
its agents, servants, and employees designated for that purpose,
to inspect the site of the Project and the facilities thereon at
any reasonable time.
14.
Following receipt of an audit report identifying any
refund due the Department for non-compliance by the Project
Sponsor with said Agreement, the Project Sponsor will be
allowed sixty (60) days to submit additional pertinent
documentation to offset any amount identified as being due the
Department.
The Department, following a review of the
documentation submitted by the Project Sponsor, will inform the
Project Sponsor of any refund due the Department.
15.
The Department shall have the right to demand a refund,
either in whole or part, of the funds provided to the Project
Sponsor for noncompliance with the terms of this Agreement and
the Project Sponsor upon notification from the Department
agrees to refund and will forthwith pay directly to the
Department the amount of money demanded including applicable
interest.
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16.
If the United States, acting through the USDI, the
Secretary of the Interior, or any other branch of the government
of the United States, acting within the scope of its lawful
authority, should for any reason demand a refund from the
Department, in whole or in part, of the funds provided to the
Project Sponsor under terms of the Agreement, the Project
Sponsor, upon notification from the Department, agrees to refund
and will forthwith repay directly to the Department the amount
of money demanded.
17.
The State of Florida's performance and obligation to
pay under this Agreement is contingent upon an annual
appropriation by the Legislature.
18.
Richard A. Halvorsen,
Grants Specialist, or successor,
hereby designated as the Department's Contract Manager for the
purpose of this Agreement, shall be responsible for ensuring
performance of its terms and conditions and shall approve any
reimbursement request prior to payment.
The Project Sponsor's
Liaison Agent shall act on behalf of the Project Sponsor
relative to the provisions of the Agreement and shall submit
signed quarterly Project status reports on a calendar basis
summarizing acquisition negotiations to date, percentage of
development described in Paragraph 4 herein completed, problems
encountered and other pertinent information.
Photographs
shall be submitted with status reports, when appropriate, to
reflect construction work accomplished.
19.
By acceptance of the provisions of this Agreement, the
Project Sponsor does hereby dedicate the Project site and all
land within the Project boundaries described in Exhibit A, to
the public in perpetuity as an outdoor recreation area available
to the general public for recreation purposes only.
The Project
Sponsor further agrees that the execution of this Agreement by
the Department shall constitute an acceptance of said dedication
on behalf of the general public of the State.
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20.
The Project Sponsor agrees to operate and maintain the
Project site in perpetuity and to operate and maintain the
recreational facilities developed thereon at its own expense for
a,minimum period of twenty-five (25) years or the life of the
facilities, whichever is greater, from the date of their
completion.
The Project site and facilities shall be open for
public use, maintained in accordance with applicable health and
safety standards, and kept in good repair to prevent undue
deterioration and provide for safe public use.
The Project
Sponsor covenants that it has full legal authority and financial
ability to develop, operate and maintain all Project site
facilities and improvements as specified within the terms of this
Agreement.
21.
The Project Sponsor shall not, for any reason, convert
all or any portion of the park for any purpose other than outdoor
recreation without prior approval of the Department and USDI
pursuant to Section 6(f)(3) of the LWCF Act.
If a conversion
is approved, the Project Sponsor agrees to provide at its sole
expense, without further contribution from the Program,
replacement property of equal or greater value, quality, size
and utility to that which was converted for other purposes.
This replacement shall be in close proximity to the property
converted and meet with Department and USDI approval.
In lieu
of such replacement, the Project Sponsor shall return to the
Department the entire Program contribution with any interest
required by the USDI.
22.
Should the Project Sponsor elect to implement a user
fee system for the Project site or for any recreational
facilities within its boundaries, the Project Sponsor shall
impose such fees uniformly upon all users without regard to
age, sex, race, other condition, or the political subdivision in
which the user may reside.
If requested by the Project Sponsor
and authorized by the Department, special allowances may be made
for certain classes or groups of users.
, Page 7 of 9
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23.
The Project Sponsor agrees to provide the Department
with annual attendance reports.
24.
The Project Sponsor shall save and hold harmless and
indemnify the State of Florida against any and all liability,
claims, judgements or costs of whatsoever kind and nature for
injury to or death of any person or persons and for loss or
damage to any property resulting from the use, service,
operation or performance of work under the terms of this
Agreement, resulting in whole or in part from the negligent acts
or omissions of the Project Sponsor, his contractors, or any of
the employees, agents or representatives of the Project Sponsor
or contractors to the extent allowed by law, while executing
obligations contained herein to acquire, construct, operate and
maintain the Project site and facilities.
25.
If the Project Sponsor is subject to the provisions of
Office of Management and Budget (OMB) Circular #A-128, then the
Project Sponsor shall furnish a copy of the required independent
financial and compliance audit to the Department within 30 days
after furnishing the original audit to OMB.
26.
If through any cause the Project Sponsor should fail to
fulfill in a timely manner the obligations under this Agreement
or if the Project Sponsor should violate any of the covenants,
agreements or stipulations of this Agreement, the Department
shall thereafter have the right to terminate this Agreement
without prior notice.
In the event the Department so terminates
this Agreement for such violation, the Department is not
required to compensate the Project Sponsor for any expenses
incurred.
27.
The Project Sponsor and Department mutually agree to the
following special terms and conditions incorporated as part of
this Agreement:
N/A
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28.
This Agreement has been delivered in the State of Florida
and shall be construed in accordance with the laws of Florida.
Any action hereon or in connection herewith shall be brought in
Leon County, Florida.
IN WITNESS WHEREOF, the parties have caused these presents to
be duly executed, the day and year first above written.
Attest:
L RESOURCES
~ 'th, f2.u;~
Ney C. Landrum, Director
Division of Recreation and Parks
State Liaison Officer
(Its Agent for this Purpose)
CITY OF CLERMONT
Attest:
~ iì¡. ~
~~~~
By:
Name~
TITLE: City Manager
(Its Agent for this Purpose)
DATE:12-30-88
~~
Depa ment Contract Admihistrator
Approved as to Form and Legality:
Department Attorney
~
Project Sponsor
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SCALE ,-. ZOOO'
..
Lake
Minnehaha
LAKE
MINNEHAHA
LOCATION
MAP
DESCRIPTION:
Blocks 134 anð 135 according to the map of the town
site of Clermont as recorded in Plat Book 3, Page 5,
Public Records of Lake County, Florida; and the South
310.00 feet of Government Lot 7, section 23, Township 22
South, Range 25 East; and also the North 430.00 feet of
Government Lot 2, Section 26, Township 22 South, Range 26
East. All lying and situated in Lake County, Florida.
SUBJECT TO all easements, rights-of-way
and rescricti=s -'~
£1","\1
of record.
Lake scaled from aerial.
FLOR~A DEPARTMENT OF NATURAL RttOURCES
LAND AND WATER CONSERVATION FUND
ACQUISITION PROJECT IMPLEMENTATION
Purpose: This document will provide the sponsor OT a Tunded Land and
Water Conservation Fund Program (LWCF) grant project instructions Tor
implementation as well as inTormation regarding program requirements.
Introduction: The grant is a joint venture between the sponsor, DNR and
National Park Service (NPS), the Tederal administering agency Tor the
program, Tor the purpose OT acquiring an outdoor recreation area Tor
general public use. To accomplish this task, DNR has entered into a
contract with the NPS similar to the agreement between DNR and the
sponsor. ThereTore, it is important that the sponsor adhere to the terms
OT its agreement with the state which incorporates many OT the Tederal
program requirements. The Tollowing instructions are divided into topical
areas related to the grant implementation process which, iT closely
Tollowed, will ensure adherence by the sponsor to the conditions OT the
grant award.
1.
Proiect Commencement and Proqress
Upon receiving the executed grant agreement, start negotiations
immediately so the project time Trames identiTied in the agreement
will be met.
A.
Page 1 oT 4
GENERAL INSTRUCTIONS
1 .
CareTully read the entire grant agreement to become aware
OT grant conditions and program requirements. (Remember
that the LWCF grant program rule (160-5, Part V, F.A.C.)
is part OT the grant agreement.)
2.
IT you do not have a copy OT the Tederal Land and Water
Conservation Fund Grants Manual (loose leaT book), order
one immediately. Write: Superintendent OT Documents,
U.S. Government Printing OTTice, Washington, D.C. 20402,
Tor LWCF GRANTS MANUAL, Document #024-016-81001-5. Send
money order or check Tor speedy service as use OT a
purchase order may cause delays OT up to six months. The
cost OT $45 also entitles the recipient to receive copies
OT all updates.
3.
Set up an independent Tile Tor the project so that copies
OT correspondence, cancelled checks, etc. are easy to
Tind in the event that the project is audited by DNR.
4.
Assure that all necessary Tunds are available, as the
project is Tunded on a reimbursement basis. IT donated
land value will be utilized as matching, then be certain
that the appraised value OT the matching parcel will
equal or exceed the value OT the parcel to be purchased.
IT not, then make certain that SuTTicient Tunds are
available to cover the diTTerence.
5.
Keep up with project progress. The acquisition should be
completed no later than 90 days prior to the completion
date speciTied in the project agreement. IT there is
good cause, circumstances leading to delays were beyond
sponsor control and the property is nearing closure, a
short time extension may be requested. Coordinate this
closely with the DNR Project Manager. Any time extension
should be requested no later than 90 days beTore the
completion date speciTied in the project agreement, as
approval and processing are time-consuming and must be
completed prior to the expiration OT the agreement.
6.
IT the negotiated price is less than the lowest approved
appraisal or any property is donated, develop a "Waiver
oT Right to Just Compensation" to be signed by the
property owner at closure.
B.
7.
As soo4lÞas negotiations are comPI~ed' prepare the
"Notice of Limitation of Use" statement. Attach the
~tatement and a copy of the project agreement and project
boundary map to the project site deed at closure and
file in public property records.
8.
If residents or businesses are located on the project
site, requirements of the Uniform Relocation Act (P.L.
91-646) must be met before the project can be closed out.
(See LWCF Grants Manual.) Coordinate closely with DNR.
9.
Immediately after closure install a permanent project
sign crediting, by full name, the Land and Water
Conservation Fund Program, U. S. Department of the
Interior, National Park Service and the Florida
Department of Natural Resources.
DOCUMENTATION TO BE SUBMITTED TO DNR
1 .
Quarterly Status Reports should be sent every 3 months,
starting at the end of the quarter in which the project
agreement was executed. Scheduled dates for mailing are:
January 1, April 1, July 1, and October 1. The first
status report should specifically identify the date when
negotiations commenced. The ending status report should
specifically identify the date when title was transferred
and the estimated date when final documentation will be
submitted. Failure to submit required status reports is
a violation of the project agreement.
II.
Prolect Closeout
To close out a project properly and to ensure the final reimbursement
can be released by DNR the following process is extremely important.
A.
B.
Page 2 of 4
GENERAL INSTRUCTIONS
1 .
Be certain that your project file is complete and in
order.
2.
Take photos or slides of permanent project sign.
3.
Be certain that you have the LWCF Manual.
DOCUMENTATION TO BE SUBMITTED TO DNR
Required documents will be submitted at two different times.
Please follow instructions carefully.
1 .
Write to the DNR Project Manager to state that the
acquisition has been completed. Attach the following:
a.
Close-up photo or slide of permanent project sign.
b.
Certification of sponsor possession of LWCF Grants
Manual.
c.
Certification that the "Notice of Limitation of Use"
was filed with the property deed in public property
records.
d.
Florida Recreation and Parks Inventory Form (DNR 42-
065) completed.
e.
Copy of the recorded Warranty Deed or applicable
court order vesting title in the project sponsor.
f.
Copies of closing statement and cancelled checks
(front and back) to seller.
g.
Copy of Title Insurance.
h.
Proof of compliance with Chapter 689, F.S., Section
286.23, F. S., Subsections 375.031(1) and 380.08(2), F. S.
i .
¡"Jr i ~n offer to purchase, i nc l.i ng a "Statement of
Just Compensation," Purchase Agreement/Bill of Sale.
j .
Documentation of condemnation.*
k.
Mean High Water or Ordinary High Water Survey.*
1.
Status Report Statement (If quarterly Status Reports-
were not submitted, as required, please write a
statement giving reasons why.)*
m.
"Waiver of Right to Just Compensation"*
n.
Proof that relocation plan was implemented where
displacement has occurred.*
o.
Proof that occupants of property were furnished
adequate information regarding Title II of the
Uniform Relocation Act.*
p.
Contractual Purchases Schedule (DNR-42-062) completed.
* If applicable for the project
2.
After receiving project closeout authorization from DNR,
submit the following documentation:
a.
Project Completion Certificate (DNR 42-070)
b.
Actual Cost Contract Payment Request
(DNR 15-032 ( 16) )
3.
After Department review and approval of the payment
request, reimbursement will be requested from the
National Park Service. Following receipt by the state, a
state warrant will be requested of the Comptroller and
will be mailed to you after issuance. At that time, the
project will be officially closed out.
I I I .
Post Completion Responsibilities
After the project is completed both the state and project sponsor
have a number of ongoing program compliance responsibilities. These
are identified in the project agreement, program rule (16D-S, Part V,
F.A.C.) and LWCF Grants Manual. DNR must assure that the project
site is operated and maintained in an equitable and safe manner, and
other program requirements are met. The LWCF project sponsor must
also meet program requirements including the following:
A.
B.
Page 3 of 4
GENERAL REQUIREMENTS
1 .
Cooperate with the state in efforts to maintain the State
Comprehensive Outdoor Recreation Plan (e.g., answer
surveys, complete recreation inventory updates, etc.)
2.
Respond to DNR requests for information to update grants
records, sponsor eligibility, etc.
3.
Contact DNR in advance if the possibility arises that any
enclosed or non-recreational facilities are planned for
the project site. This must be approved by NPS.
4.
Develop the site for outdoor recreation and open it for
public use within S years following closure.
5.
Keep LWCF grant project site in use for outdoor
recreation in perpetuity. If any possibility of sale,
lease, trade or non-recreational use of any portion of
the LWCF grant site arises, contact DNR immediately.
CONSTRUCTION
1 .
All construction should conform to a site plan developed
by a certified architect/engineer and be in accord with
C.
8
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the conceptual site plan submitted with the acquisition
application (same project elements).
2.
Ir an archaeological or historic area is accidentally
discovered during construction, cease work in that area
immediately and contact the State Historic Preservation
Orricer (Florida Department or State) tor assistance.
3.
Assure that all utility lines are buried.
4.
Ir necessary erect a new permanent project sign giving
recognition or runding assistance rrom the Land and Water
Conservation Fund, U.S. Department or the Interior
National Park Service and the cooperation or the Florida
Department or Natural Resources.
5.
Conduct a rinal inspection to assure that all work is
complete, the permanent sign is in place, all utility
lines are buried and there are no enclosed racilities at
the project site.
6.
Ir problems exist, make corrections immediately, berore
DNR starr conduct post-completion inspections.
DOCUMENTATION TO BE SUBMITTED TO DNR
1 .
Arter completion or construction, write to the DNR
Project Manager and send the rollowing:
a.
List or constructed project elements, racilities,
etc., signed and dated by Liaison Agent.
b.
As-Built Site Plans (two copies, signed and dated by
both the project engineer/architect and liaison agent.)
c.
Photographs (close-up and readable) or constructed
racilities and acknowledgement sign.
d.
Florida Recreation and Parks Inventory Form
completed.
e.
Provide annual attendance rigures tor the site to DNR
every July. (Covering the preceeding 12 months
attendance.)
D.
OPERATION AND MAINTENANCE
1 .
Keep the site equally open and available to all
regardless or age, sex, race, religion, national origin,
physical or mental handicap, place or residence or other
ractor.
2.
Ir tees are to be charged at the site, coordinate in
advance with DNR.
3.
Maintain the site in a condition sate tor public use.
4.
Ir subsequent phases or construction take place, provide
updated inrormation about the additional racilities to
DNR along with rinal signed and dated site plans.
5.
Assure that no overhead utility lines are erected at the
project site. Ir old overhead lines are to be replaced,
they must be placed underground.
The DNR Project Manager may be reached by
Phone:
(904) 488-3621
488-6321
278-3621
278-6321
Mail:
Florida Department or Natural Resources
Division or Recreation and Parks
Orrice or Recreation Services
3900 Commonwealth Boulevard
Tallahassee, Florida 32303
Page 4 or 4
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F~DA DEPARTMENT OF NA~UR~ RES9IIJES
Division of Recreation and Parks
Land and Water Conservation Fund
ACQUISITION PROJECT CLOSE OUT REVIEW
PROJECT NAME:
NUMBER:
APPLICANT:
Address:
Telephone:
Completion Date:
MATERIALS SUBMITTED FOR REVIEW:
Allowable:
Only cost of property
Rec'd.
Date
Map & Driving instructions for inspection of project site.
Project and sign photos and/or slides.
Florida Recreation & Parks Inventory Form (DNR 41-037).
certification of possession of LWCF Manual.
Contractual Purchases Form (DNR 42-037-062).
Grant Payment Request ~DNR 42-066).
Grantee documentation of condemnation where applicable.
Copies of closing statment and cancelled checks (front & back)
to seller for acquisition project.
Proof that acquired property has been officially dedicated to
recreation for use by the general public in perpetuity.
(Certification of "Notice of Limitation of Use").
Copy of recorded warranty deed or applicable court order vesting
title in project sponsor.
Proof of project sponsor compliance with Section 286.23, F.S.,
Subsections 375.031(1) & 380.08(2), F.S., and Chapter 689, F.S..
Written offer to purchase -- including a "Statement of Just
Compensation", Purchase Agreement/Bill of Sale.
A "Waiver of Right to Just Compensation", if price is less
than lowest approved appraisal.
Relocation plan and other requirements of LWCF Manual where
residents would be displaced. (Compliance with P.L. 91-646).
Proof that occupants of property were furnished adequåte
information - Re: Title II of Public Law 91-646.
Required Status Reports.
Project Completion Certificate.
Project Inspection Report.
Final Inspection.
Inspector:
Rating:
Date:
I have reviewed the project file and all submitted data and approve final payment
for this project:
project Manager
Date
Fiscal Ass~stant
Date
DNR 42-072
8
8
~'I'^'l'¡': OF FLO1l1U^
FLORIDA DEPARTMENT OF NATURAL RESOURCES
Land and Water ConservaLion Fund Program
Project Completion Certificate
PROJECT TITLE:
I hereby certify that the above mentioned project has been
completed in accordance with the Project Agreement between
and the Florida Department
of Natural Resources dated the
day of
19----, and all funds allocated for the project were expended
pursuant to the Project Agreement.
Signed:
Liaison Agent for Land and Water
Conservation Fund Program
(Project Sponsor)
Date:
DNR 42-044
Revised 5/14/85
8
FLORIDJ\ DEI'J\R'J'MENT
OF NATURAL RESOURCES
8
~~'I'^NI )^!{I) 1 ANCLIN ;1': I"()!{ I'I\OI'I':I~l'Y HI':C'OI{)S
lAND l\ND WATER CONSERVATION FUND
Notice of Limitation of Use
The property identified in the attached grant agreement and project boundary
ma.p has been acquired or developed with Federal financial assistance provided
'.
by the National Park Service of the Department of the Interior in accordance
with the Land and Water Conservation Fund Act of 1965, as amended, 16 V.S.C.
Š 460!-5 et~. (1970 ed.).
Pursuant to a requirement of that law, this
prop3rty may not be converted to other than public outdoor recreation uses
(whether by transfer, sale, or in any other manner) without the express written
approval of the Secretary of the Interior.
By law, the Secretary shall approve
such conversion only if he finds it to be in accord with then existing canpre-
hensive statewide outdoor recreation plan and only upon such conditions as he
deems necessary to assure the substitution of other recreation properties of at
least ~al fair market value and of reasonably equivalent usefulness an~ location.
I certify that the Notice of Limitation of
use has been filed in the County Courthouse
with the deed to the Land and Water Conservation
Fund grant project site known as:
LWCF Project Number: 12-00
Signature of Liaison
Typed Name & Title
(Date)
8
STATEMENT OF JUST COAltNSATION
'J'II I 1\
JII1'(lJIII.,1.1011 IIhuuld )/1'
lllcJul.h~d 111 l1
lellt!l
flOlll the
project sponsor to the owner of
the project site prior to
closing on all acquisition projects:
is now in the process or
(Acquiring Agency)
acquiring
property necessary for recreational purposes.
Title records
indicate that you are the record owner(s)
of real property
located in the State of Florida,
County of
more particularly described as
tollows:
(or as attached)
(Either include or attach a legal description -
the survey and boundary map from the application could be used.)
Since your property is within the project area,
to acquire the property for this project.
it lS necessar"
We are prepared to commence negotiations with you for the
purchase of your property subject to any existing Easements or
Restrictions of record and excepting and reserving the following
interests which will not be acquired and for which no value is
included in our estimate of just compensation:
In compliance with Section 301 of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970,
Public Law 91-646,
an estimate of
just compensation in the amount
of $
has been made for the interest to be acquired in
the above-described
(or referenced)
property.
This amount is
based upon a State-approved appraisal prepared under contract
for the
(Acquiring Agency). The appraisal takes into consideratio¡,
the location of your property, its highest and best use, current
land sales of properties similar to your property and other
indicators of value.
The amount is not less than the appraiser's opinion of fair
market value which he determined after a personal inspection
of your property, at which ti~, you or your representative were
given the opportunlty to accompany him.
This amount includes compensation for the land,
improvements,
severance,
if any,
and any other elements of value.
The separate
amounts established for each of these elements are as follows:
.'
STATEMENT OF JUST COMPENSATION -2-
8 8
LAN):
----"--
IMPROVEMENTS:
Buildings
Structures
DAMAGE TO THE REMAINDER:
OTHER:
TOTAL:
Any increase or decrease in the market valuation caused by
the!
public improvement or project for which the property is
to be acquired, or by the likelihood that the project would be
acquired for such improvement or project, other than that
due to physical deterioration within the reasonable control of
the owner,
has been disregarded in making the determination
of just compensation.
The
proposes to purchase your property
(Acqulring Agency)
for the amount indicated above.
In this regard, you will be
contacted by a representative of this agency soon with a view
towards completing the details of the acquisition.
Also,
at
that time, you will be advised as to relocation benefits
available to you or any others that may be using or occupying
the property.
Please note that these benefits are separate
from,
and in addition to, the sum proposed as the purchase
price for your property.
8
8
WAIVER OF RIGIl'l' ']'0 JUST COMI'ENSA'J'JON
With reference to the acquisition of my real property,
County,
Slate of
consir.ting of
Florida:
acres in
( 1 )
I have been informed of all of my rights and benefits
under the Uniform Relocation Assistance and Real Properties
Acquisition Policies Act of 1970
(Public Law 91-646).
( 2 )
I have been provided with a written statement of just
compensation and a written offer to purch'ase for that amount
.Þ
of $
( 3 )
I am accepting the sum of $
in full for sa>A
real
property,
and am satisfied that the price,
even though it is
less than the amount of just compensation and the approved
appraisal of fair market value.
The reasons why I have elected to accept this lesser
amount are as follows:
( 4 )
I do hereby waive all of my right to the amount by
which the just compensation and fair market value exceeds the
purchase price I am accepting.
Dated:
Witness to Signatures
Owner's Signature:
Spouse's Signature:
,
A<Idress:
, .--
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THE CITY OF HIALEAH FLORIDA
SOUTHEAST PARK 'EXPANSION A _1'1
PUBLIC OUT DOOR RECREATION SITE ~
DEVELOPMENT PROJECT AIDED BY
71œ {aMi cwi (jJaiÞA ~..ðe/lil{¡k1'- Fljj{d ;;
FLORIDA DEPTOF NATUQAL QESOUQCE~ J
ADMINISTERED BY THE f'iATIONAL ~QK S:.~V ~
u.~, DEPARTMENT ~b THE INTER~OR
]' FUNDII'G
1 L & WCF, CITYOFHtALEAH 50lz
RECREATION TRUST FUND 50/
¡~ 1. TOTAL PROJECT ~ !:: 9 042 ,',
-~.-- . -- ,- ~~. ..-.....~- <~-'- .: , '
~"";--'" ", "c,.,,-,"',~.,-=r,-,., -'--',
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8
REQUIRED PROJECT SIGN MUST
ACKNOWLEDGE THE LAND &
WATER CONSERVATION FUND
PROGRAM. A large routed
sign is preferred.
Wording is optional,
wood
but
the Land & Water
Conservation Fund Program,
National Park Service
and Florida Department of
Natural Resources must
be named in full.
An
aluminum plaque can be
such as the
attached,
one at right.
A brass
plaque may be attached,
such as the one below.
"
, '
,~~-'
,. '
, .
, "
,-- ,-
:';'5',:.t-\:- "..;,
The State of
Tennessee has made
arrangements for
the development
of
the brass plaque illustrated
at left.
It can be obtained
at a nominal cost from:
CAST CO PRODUCTS
P.O.
Box 497
Petoskey, Mich.
49770
(616)
347-7222
----- -
Todays Date
DIVISION OF RECREATION AND PARKS
FLORIDA RECREATION AND PARKS PUBLIC FACILITY INVENTORY
Please complete all applicable information-
*
NOTE: Asterisks indicate
special instructions on reverse side
Facilities before grant__p_r,olect- j.mprovements:
ACRES (NO.)
) TOTAL
) LAND
) WMER
HUNTING ACRES (NO.)
) TOTAL
) LAND
) WATER
CAMPSITES (NO. )*
) RV/TRAILER SITES
) TENT SITES
) CAßINS/SIIELTERS
) PRIMITIVE ACRES
PICNIC lABLES (NO.)
) TABLES
) SIIELTERS
HIST/ARCH SITES AND AREAS (NO.)*
) MUSEUMS/INTERPRETIVE
BUILDINGS
) HISTORICAL/ARCHAEOLOGICAL
SITES/STRUCTURES
) COMMEMORATIVE STRUCTURES
TRAILS (LENGTH - MILES & TENTHS)*
) IIIKING
) BICYCLE
) INTERPRETIVE/NATURE
) HORSEBACK
) CANOE
) EXERCISE/PARCOURS
) NUMBER OF STATIONS
) MULTIPURPOSE
BEACII AREAS (NO.)
) SALTWATER
) LENGTH (Ln)
) WIDTH (Ln)
) FRESHWATER
) LENGTH (Ln)
) WIDTH (LFT)
FISHING FACILITIES (NO. )*
PIERS (NO.)
) SALTWATER
) LENGTH (LFT)
) FRESIIWATER
) LENGTII (LFT)
ßOARDWALK/CATWALK (NO.)
(
(
(
(
) SALTWATER
) LENGTH (LFT)
) FRESIIWATER
) LENGTH (LFT)
JETTIES (LENGTH)
) SALTWATER (LFT)
) FRESHWATER (LFT)
nOAT RAMPS (NO.)*
Grant Type:
FRDAP
FBIP
LWCF
Site Name
Site Address
County
Name of Water Body
Nearest Highway Intersection-
and
SWIMMING POOLS (NO.)*
) TOTAL POOLS
SWIMMING POOLS (NO.)*
) TOTAL POOLS
LENGTII(LFT) WIIJTlI(LFT)
{ {
( ( )
( ) ( )
( ) ( )
OUTDOOR COURTS (N.Q:l
LENGTH(LFT) WIOTlI(LFT)
1--' {
( ) ( )
( ) ( )
( ) ( )
OUTDOOR COURTS (N°.1
) TENNIS
) BASKETBALL GOALS
) SIIUFIUßOARO
) IIANIJßALL/RAr.r1UUBALL
) HUL TlPURPOSI:
PLAYING FIELDS (NO~
) TENNIS
) BASKETBALL GOALS
) SIIUrFLEBOARU
) IIMlOnALL/RACQUF. mALL
) MUL TlPURPOSF.
PLAYING FIELDS (NO,)
) SALTWATER IU\MPS ( ) MSEBALLlSOfTIJALl
) TOTAL LANES ( ) FOOTBALL/SOCr.ER/lUHìBY
) FRESIIWATER IU\MPS ( ) MULTIPURPOSE
) TOTAL lANES
GOLF COURSES (NO.)*
MARINAS (NO.)
) BASE!JALL/SCJ'lßALL
) FOOTBALL/SOCCER/RUGUY
) r~ULTIPURPOSE
GOLF COURSES (NO.)*
--
(
) SALTWATER (
) SLIPS/MOORINGS (
) DRY STORAGE
) FRESHWATER
) SLIPS/MOORINGS OntER FACILITIES (NO,)
) DRY STORAGE
) 9-IIOLE IŒGULATION COURSE
)18-IIOLE REGULATION COURSE
) PAR J/EXECUTIVE COURSE
) TorAL GOLF IIOLES
) 9-IIOLE REGULATION COURSE
) la-IIOLE REGULAT ION caUIlSF.
) PAR J/EXECUTIVE COU~SE
) TOTAL GOLF IIOLES
OTHER FACILITIES (NO,t
) EQUIPPED PLAY AREAS
) RECREATION CENTERS
) EQUIPPED PLAY AREAS
) RECRrATION CENTERS
, .
Administering City or County Agency-
. .
"
--
Liaison Agent
-----
Phone Number (
)
Facilit ies éI t___,=-umplet ion of gré1l~__proi~c t:
BEACH AREAS (110,) ~CRES_J.!!l!...:l
) SALTWATER ( ) TOTAL 8
) LENGTH (lFT) ( ) LAND
) WIIHlI (LrT) ( ) WATER
) FRESIIWATER
) LENGTIJ (UT)
)WIIHlI (LFT) "UNTlN~_~ÇRES(NO.)
FISItlNG FACILITIES (NO.)* ( ) TOTAL
------ ( ) UINIJ
PIERS (NO.) ( ) WAfER
) SAt TWA1[R
) LENGTII (LFT) CAMPSITES (NO,)<
) FRESIIWATER
) UNGlIl (LFT) ( ) RV/lRAILER SITES
) lENT SITES
ßOARDWALK/CATWALK (NO.) ( ) CAßINS/SIIEl.1EIIS
--- ( ) PRIMITIVE ACRES
( ) SALTWATER
( ) LENGlIl (LFT)
( ) rRESIlWATER PICNIC lABLES (NO,)
( ) LFNG1H (LFT) --,,-,-
( ) TAULES ~
JETT!..E..S (LENGrll) ( ) SIII:LrEIIS ...
) SAI.TWArER (LFT)
) FRESIIWATER (LFT) ItlST/ARCIi SITES ^~~ AREAli~!..:l<
nOAT RAMPS (NO.)*
) MUSEUMS/INTERPRETIVE
BUILOINGS
) HISTORICAL/IIRCIIAEOLOGICAL
SITES/SIRUCTURES
) cormmoRAflVE SIRIJCTURES
---
I SALTWATER RAMPS
) TOTAL LANES
) rnrSIIWATER RIIMPS (
) TOTAL tAIIES
MARINAS (N°:1.
TRAilS (LEIIGTII - MILES & TENIIIS)*
---------
) SAllWllrER (
) SLIPS/MOORINGS (
) DRY STORAGE (
) r RESIIWIITER (
) SLIPS/MOORINGS (
) DRY STOQAGE (
(
) ItJK I NG
) B 'CYCLE
) INTERPRFTIVE/NIIIURE
) IIORSEIJACK
) CAtJ '[
) EXIRCISE/PARCOURS
) NUMBER or SIAflOI'S
) MUt 11 PURPOSE
. ,
GENERAL .!.~ROCTIONS
Provldo lull slto nomo. streel nelll8 end number.
end clly or 'own, II site hes no spec II Ie
stroot ..Idress, Indlcote section, township,
ond rongo. GIve no...s 01 slreets or roods et
neorest Inlorsecllon. II e site Is In IIDre
thon ono county, list 011 01 her counties In
which silo Is locoloo. then 115t Ion seporote
lorlDsI tho ocreogo end locilities 10Cðted
In eorh coun'y.
Round of Iocr<" 10 the n....rest tenth a' en
ecro. SI1<05 s""'ller than one-tenth 01 en
ecre should 1>0 Iistoo oS 0.1 ecr".
(
60 soro tho Inlormollon you provide Is given
In tho conoct unll 01 moosur.....nt. In SOlll8
cooes, Infor,",IIlun on number.ol 'ecilltles Is
requ",too (tonl silos, courts. flolds. etc.l.
In other "d'"", Inlolmotlon on.!.!!.!.ol
faclllllO5 15 roquooled (troll length. elc.l.
In stili olhor Cðses, Inlormellon on ~
nonlbar ond sl,u 15 luquesled lbeoch ereos,
swllNnlng (",Dls, ..t~.).
Consld", I.ocklsh wotor os solheter when
enlerlng d,'lo on boill remps. Inarlnes. pier>.
cohalks, ond othor wotor....-eleted lecllltl....
CLASS I f_I!?-.!IONS
(
01 Mlnl-I'ork/lol lot (serves 2-} block ereel
02 Ibighborho<>d Par k (serves neighborhood I
O} O>nrnunlty f"'rk (sorvos multl-f1olghborhood
ar 0,'1
04 Ubðn-Ulslrlct Park Iwlthln }(J-40mln.
driving Iin., 01 mosl usorsl
05 Roglon"l Park (within 40-60 min. driving
t I".. 01 "... I usursl
01> Slnglelulpooo F.,clll'y le.g.. tennIs
cooll. bOo,t ramp)
II A'IUð I Ie P, u5urvo
11 Slate WI I ,'..,.nu.. Aroa
:I/', ~t"lo no,orvo
15 Slate Pel k
16 Sial.. Hn~r"ilt Ion AI..a
1/ State SI")cl,,1 Foalure Slle
11A Slate Arrh.'o<)IOIjlcal Site
110 Sl.lle 1~)I,'nlc,>1 Silo
IlliSlaloCoolc><jlcal Site
till 51"t.. 1I1'lorlo Slto
10 Slalo I'I'..SOI vo
19 State '",rd,""
CLASSlf ICATIONS Icont I nued I
20 Slale Museum
2Of State Folk Culture Cenler
21 Stale Netural Feelure
22 Slate Scenic end Wild River
2} Slate Recreet lanai Trell
2. Stele Forost
26 Stel.. Envlronlll8nlolly Endangered
Project IEEll
21 SIet.. Conservot Ion & Reereot Ion
leods Project ICARl I
20 Florldo Recreet Ion Develop.....nt
Assistance Progrem Projecl IFI(()Af')
29 Florldo 8oetlng ImprOolell1Ont Progrem
Project (FOIPI
}O Eros Ion Control LIne Project IECl)
41 Weysldo Perk
U \Clldll Ie l4onogÞment Meo
4} Fish I4ønogoment Mee
44 \Coler I4ønagolll8nt lends Project
45 Stelo Io\JseurnllHsrorlcel Site
46 Stal.. College/l:nlverslty
41 Stete 1411110ry R...ervotlon
51 /tit lonol Perk
52 Ibt lonel Recroot Ion Aree
5} /tIllonel Seashore
54 Ibt lanai l4ooument
55 Ibt looel M""",rI el
56 Ibllonal HlslDrlc Site
51 /tit lanai Troll
51H Nallonal Hlsrorlc Trell
51n National necreatlonel Trell
51S Na1l0nal Scenic Trell
56 Ibtlonal \Clld end Sceolc Rlvor
59 F<odorel ll«:F Project
60 Ibl lone I Preserve
62 Ibl lonel Sanctuary
62E Ndtlonal htuedno Sanctuary
62M Notional Mer I no Sanctuory
64 tbtlonol Wlldorn...s Arae
65 Ibllonal Wlldille Refugo
66 tbllonol For...t
6Ð F<odarel I4l1ltery Reservetlon
69 'ndlan ",,',ervnllon
n\
N:r I 1'"1,11
II, ' ~ I " I e ' I
S II"
CAHGORT
F - Fedorel level
S-5tetelovol
C - County levol
M - Municipal levol
( - Other Sp¡,clal Ulstrlct
CN4P SITES
~T/TRAllER S I US - NoMler of camps It as
for recl'e.tlonel vehIcles or trollo....
Iwlth or without woter. electricity. etc.l.
TENT SIT~ - Nunoer a' cempslt... lor
tont coml,lng only twlth or without weta"'.
lands
CNlINS/SIIELTERS - Nunl>er 01 cobl ns/shalters
evolleble lor overnlgh' USO.
,!'!-!.!4.ITIVE CN4PIN:; - lIunl>er of ecr...
deslg"eted for primitive ""ml)lng.
AROlAEOlOG ICAl/HISTOIIC
SITES AND AREAS
~!INHWRETIVE BUILDIN:;S - Nuntlor
01 laclllll... wl'h nO Inlrlnslc historic
or erd,aeologlcel value, built to prOoilde
Inlorpretlvo end/or exhlbltlvo displays
or programs.
AROIAEDlOGICAl/IIISTOIIC SITES/STRUCTlJI.ES -
Nuntler 01 lortilleotioos, battlellelds,
ruins, burial rounds. etc.. with Intrloslc
hlstorlc/ardleeologlcol veloo.
C(M4(14()\ATlVE STROCTlJI.ES - MonOer of
slructures or monulll8nts Ido nat Includo
signs, plaque,. or "",rkers).
~
NOTE: Indlcote total longth of trolls
(mllos and tao'ho 01 mllesl on site.
.!!.!.!\IN:; - Palll used solelT lor beckpack','}
or long distance hiking.
DICTeI,!. - Ooslgnated Iroll or syst... of
"'"5 u...d primarily lor bicycling.
l~rERPRETIVElNATlJI.E - Troll doslgned or
..",'k,>d for Mlure Interprelatlon end study.
~!!IACK - Improved or unimproved Iroll
d"519o~tod and usod primarily lor horse-
Mek riding.
TRAIU Icont Irlled)
~ - Olslooce olong IIOsi cannonly
usod roote on e lIe519nolOO or unllesl9oolo:1
woterwey usod for conoelng.
EXERCISElPARCOlfIS - Course des Ignod gonel ally
for jogging. bot wh Ich mayor may nat hove
exercise statloos. III.tellons ere port 01
coorse. give nu_r.1
~~ - Trell oat deslgnoto:J exclusively
for eny ono 01 the obove ect IvI1l<6.
fiSHIN; fACilITIES
NOTE: list brackish water lecllltl... In
s.lheter ce"'gory.
~ - NunI>or 01 soltwo'er ond Ir...hoalor
IIshlng piers structures }OO 1001 or longerl,
ond their tolel length.
IJOAADIIALKS/CAT~LKS - N,Int..r 01 sell-etor ond
Ir ...hwoter boordwolks end cehlel ks c""nonl y
used lor Ilshlng ond Ihelr tolal lenglh.
~ - length 01 those lecllltl... cannnnly
usod lor IIshlng.
BOAT ~
Nunl>..r of r""'ps. bath Improved lpaved .nd
grevel I, end unlOlprOlled (send ond dirt I onll
nunt.1or 01 lanes (e 2-len8 r"",p can lound> 2
bUD" ot once, etc.I.
~ N; POOt.S
NunDer end she of swimming pools on slle,
Ust length end width 01 eech separalely. 00
nat Include wadl"j I"'°ls.
GOll OOI.IISES
'r
A roguletlon 9-1>ole cwrse hos per }4 or OIOre.
A rogulatlon 10-/)018 course has por 61 or IIIOre.
Courses wltll pors 01 less then ~4 or 61 are
c'",sldered Par} or Executlvo typos. Glwo
nunner 01 eech type of cwrso on<! canbl nod
tntal nuntler of holes et this silo.
,
:1-:'
.,', '
'.,
.'
DEPARTMENT OF NATURAL RESOURCES
ACT~ COST CONTRACT PAYMENT R4iÞEST
. '.
---------------
(Date)
----------------------------
--------------------------
(I.3raY"lt ee)
BillIng Per1od______--------
DNR DIvlslon______----------
( Pt~oJ ect )
Billing #_----------------
DNR PrograM______---------
Pt~CIJ ect Cos. t s
Th i s B 1 11 i Y"lg
CuMulat1ve Project
C.:ost s
-------------
------------------
Contractual Serv1ces
DNR 1:=ï-37 (15)
-------------
------------------
--------------------
--------------
------------------
Salar1es and Wages
DNR 15-33(16)
--------------
------------------
Employee Benefits
( % of Salaries)
--------------
------------------
Materlals and Supplies:
Direct Purchases
DNR 15-03/~ ( 15)
Gt~antee St cock
DNR 15-035 (16)
-,------------
------------------
-------------
------------------
Eq u 1 pme\"lt
DNR 15-035 ( 15)
-------------
------------------
Tt~ave 1
DNR 15-033 ( 15)
-------------
------------------
Donated Real Property
-------------
------------------
IY"ldlt~ect C.:osts
-------------
------------------
TOTAL PROJECT COSTS
-------------
-------------
------------------
------------------
Certlflcat]On: I hereby certlFy
that the ab~ve Expenses were
incurred for the work identlf1ed
as being accoMplished 1n the
attached progress reports.
Certlflcation: I hereby certlfy
that the documentatlon has been
mainta1ned as required to support
the project expenses reported above
and 1S available for aud1t upon
t~eq'-lest .
--------------------------------
------------------------------------
PrOject Admlnistrator/Date
PrOject F1nancial Off1cer/Date
------------------------------------------------------------------------
DNR USE ONLY
~
------------
¡'.
State fund1ng participation
------------------
--------~---------
Total project costs to date
$ ==================
State obligation to date
$
------------------
St at e reta 1 Y"lage
(-----¡'.)
(------------------)
State obllgation remaining
------------------
State funds previously disbursed
(------------------)
State Funds due this billing
$ ==================
Revlewed and Approved by:
---------------------------------------------
DNR Project Adminlstrator/Date
---------------------------------------------
Bureau Ch1ef or Divls1on D1rector/Date
DNR 15-032(15)
(10/85)
'.
. .
DEPARTMENT OF NATURAL RE50URC~~
CONTRACTUAL SERVICES PURCHASES ~C: :C~!J:"::-'
.
.
°0
---------------------
(Date)
--------------------------
--------------------------
(I3ra¡~ltee)
Billing Period______------
DNR Divizion______--------
C f:!¡~'::'J 0;: ~ )
Bi 1] j, ¡-.;;:j
~-----------------
DNn
::JI~':'::: :~a¡,;___-_..---------,-
----------- ---.- ----_..,----,------ -,----------_.---,,-._-------------------------'------------,-,--,. -,-, -. - -,.. "...-..-,---..-.,---------.,---- ---, - --,-_.. ,--- ... . -'-'.".' ,.. --,,-.., ----.----------
Cont r~ct or
Nafl1r:~
Co,~,ti"'actoi~
II~lvoice
Number
Chec:..; or
Voucher \h.liI1ber
and date
rl~I::O.l ec~G
Cost
G~i'"lera 1
De!Zc.~i~ i pt i 01"1
8
----------------------------
-------------------
-------------------
-------------------
---------------------------
----------------------------
-------------------
-------------------
-------------------
---------------------------
----------------------------
-------------------
-------------------
-------------------
---------------------------
----------------------------
-------------------
-------------------
----------~r-------
---------------------------
----------------------------
-------------------
-------------------
-------------------
---------------------------
----------------------------
-------------------
-------------------
-------------------
-_._----------,---,.,_.- ----,---------
----------------------------
-------------------
--- --- --, ---- -'-' - -- ----
- '_'_--__00-"_---'--"----'--- ---
---------------------------
----------------------------
-------------------
-------.----..--,---, ----
00__-------"- ...... n.' --,-.-,-----..----
---""___'.00' ---. -- ,---.-.... -.-,-.. ----.'-.-----
_._-----,-- .-----.,_,.._0 -,-- -,. --,-- ---,----
-------.--,-.------- ,-----....
----------,_._-,---,----,----- --
u_-..-.. 00 '.,---_._,--. '..'--'_. ---,
.--."-""'--.--'---'.- ,-_.--,,--'_..-'--- -----.----
----- -- -,.- --, ----.- _00- -'.-- -. ---- ------
---'----"""-."'..-'--___--'.0.-
-------...,-,-.-- '-------'-
----'-'-'- "-,------_.,,, ---, ,_....,-
..._, -,-....---..----,...., , ... ,.'---,- ......00- - '___'_00__'_-
-- ---, - -. '--'--'_'" --- -- ------ --.- ---- ,- --
-.,.--,--. -.--.--..-.-.-.--.--- --,
--- ----.. -- ---- ,-....- -.-. .--
- _'_00-"'-" '00_--------'-.--'-" ..-...-.. "
-----..,-.-...---, ,.-, 00_,__",---,-",,__"'00_.'_'_--
--. -- -- -.-- --- - ---'.' .-- -- --- ,.-- - ---, ,--- --'
--- ----'.-'--- -- .,----- .--.
-------------------
--.----., ------- ---'---- ,-,-".. ----,-
- ...' -...,. -- ._'-'00" .... -- -' """-."---' ,__..00_,___._,--
---,.---.-----., -- - -----'-..'-'-' -----.--
,-- --.-.--..- _'_""_00__.____.__._00'
--.------.-.--. -...- ,_._,--,-,-
.- ...--- .. '.. ..'- ,--, ..- -------"--
---, ,- ,-.. --- ---... ..-.. ,..-.. _.0_00 ------..,-.--.,
TQ:AL
$-,..---.... _""_00. --'---'.--..-'" --.---
e
..-,..-.-... .,..-. ..----------.----
Certi~ication: I hereby certi~y that
the purchases noted abov~ were used
in accomplishing the proJ~ct.
C(!rti~icatioY'l: :r. ht.:-i~eb',l ce,~tify that bid t..::d::JI,.¡latic.rl5'-.
e¡:ecllted CO1-ltl'~.!.c:t., c'¿-,,-.cellec.1 C:~'Iec:k.s, aY'ld .:;:.t~aï'
pul^c:h as i 1"I!J d c.c: ¡_:r,1C?i.,t ::'1 t :;, '-"':'.' Ii ;.1 ve beeY'! ma i '"It...:: :"I;:"-.!:::', .? ~::;.
ri:?quired tCI 5';:',:;::.-JI-,I't. "::~¡r'. c,~:~;ts l~œpol'~ted .:.:::..:"...';:! .!.I~:r.J ¡:,:^c:.
.:iv'~"1)lable f,::.¡-~ ;::11_(;1"1', :j::",,',;', l"'I~c::¡ue!:St.
- -- -~- ------.---- -- .'--, - --- - --'- 00 ..-, -,------.._--
_".00_'____--'--------'" ..--- __00-- ----, __n.'_-_'----"---------- -."-' ,--,_.--,----
ProJect
Admi'flistrator
(Date)
~:~"::'.J pct;
F:i 1"I'::\1",C i .:.\J
r'~f:i. i~C':~"
!Da'tc: }
DNR
15-037 (t 5)
( 10/8(;)