AGENDA October 27, 2015 LAKE COUNTY BOARD OF …€¦ · LAKE COUNTY BOARD OF COMMISSIONERS...

AGENDA October 27, 2015

LAKE COUNTY BOARD OF COMMISSIONERS

COMMISSIONERS' CHAMBERS LAKE COUNTY COURTHOUSE 1:00 p.m. Convene Meeting Pledge of Allegiance Approve Agenda Clerk’s Correspondence 1:01 p.m. Public Comments 1:06 p.m. Health and Human Services Director Vickie Thompson 1:20 p.m. County Administrator Matthew Huddleston 1:50 p.m. Commissioners Correspondence 2:20 p.m. General Consent Resolution Items 2:30 p.m. Adjourn

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updated

ACTION ITEMS

October 27, 2015 Consent Agenda:

1. Approve County Board meeting minutes from October 13, 2015.

2. Approve claims in the amount of $78,055.48.

3. Approve Health and Human Services claims payments in the following amounts: a. Region III Adult Mental Health Initiative payments $ 56,851.72

b. Administrative payments $ 18,536.19

c. Arrowhead Health Alliance payments $ 5,273.19

4. Approve and authorize the Lake County Board Chair to sign the Public Health Emergency Preparedness (PHEP) Grant Project Agreement with the Carlton-Cook-Lake-St. Louis Community Health Board for the performance period of July 2, 2015 through June 30, 2016. (Correspondence 1)

5. Authorize the Chair of the Board to sign the 2015 State of Minnesota Federal Boating Safety

Supplemental Equipment Grant Agreement. (Correspondence 2)

6. Approve and authorize the Chair of the Board to sign the Grant Agreement between the Minnesota

Department of Public Safety (DPS), Homeland Security and Emergency Management (HSEM) Division

(“State”) and Lake County Sheriff’s Office (“Grantee”) for Grant Program 2014 Operation Stonegarden

(OPSG), in a grant agreement amount of $36,253.00. Effective date is the date the State obtains all

required signatures. Expiration date is August 31, 2016, or until all obligations have been satisfactorily

fulfilled, whichever occurs first. (DPS Grant Agreement No: A-OPSG-2014-LAKESO-0005)

(Correspondence 3)

7. Amend the meeting minutes from August 25, 2015, to correct the vendor name on items #30 and #31,

from CGN to CCI Systems, Inc., as follows:

- Authorize the approval and payment for Hardware from CCI Systems, Inc. for ISP modules for the

Cisco ASR9000 in the amount of $96,100.00 plus shipping and applicable tax.

- Authorize the approval and payment for software and licensing from CCI Systems, Inc. for the Cisco

ASR9000 in the amount of $13,801.20 plus shipping and applicable tax.

8. Amend the meeting minutes from June 23, 2015, to change the vendors on #29, from New Egg,

Amazon & Van Dyke to B&H in order to utilize purchase orders as follows.

- Authorize the purchase of computer equipment for the Lake Connections headquarters to be used

in the Network Operations Center and support staff from B&H in amounts not to exceed the

following: $3,972.29 plus tax and shipping; $5,005.84 plus tax and shipping; $250.00 plus tax and

shipping.

9. Authorize payments of $33,308.26 to Frontier Communications for pole make ready in Two Harbors

(reference 2368453).

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10. Authorize the purchase of squirrel guard materials from Border States Electric in an amount not to

exceed $3,741.00 plus tax and shipping.

11. Approve Homestead classification for Parcel 23-7644-11120 and Parcel 23-7644-11130 for the 2014 assessment year, real estate taxes payable in 2015.This change is to correct a clerical error. (Correspondence 4)

12. Adopt the findings by the Planning Commission and approve Interim Use Permit renewal I-15-006

(Vacation Home Rental) for Jane Shallow at Triangle Lake, Ely, MN. (Correspondence 5A)

13. Adopt the findings by the Planning Commission and approve Interim Use Permit renewal I-15-007

(Vacation Home Rental) for Eric & Diane Lindberg at 5506 Little Marais Road, Finland, MN.

(Correspondence 5B)

14. Approve Highway Department payment to Sinnott Contracting, LLC for Scenic Highway 61 blacktop patches in the amount of $5,000.00. (Correspondence 7)

15. Approve Highway Department payment to PetroChoice for bulk oil in the amount of $3,699.97. (Correspondence 7)

16. Approve and authorize Highway Engineer to sign Northshore Mining Company utility permit for work in right-of-way to be completed on or before October 1, 2017 at designated location of CSAH 3 culvert tributary to the Beaver River. (Correspondence 7)

17. Authorize the purchase of InfiniVault Maintenance from Hybridge Imaging, LLC for a price not to exceed $4,226.55. (Correspondence 8)

18. Approve and authorize the Chair to sign the Memorandum of Agreement between the University of Minnesota and Lake County for providing Extension programs locally and Employing Extension Staff, for a term of three (3) years, beginning on January 1, 2016 and ending on December 31, 2018. (Correspondence 9)

19. Support the Small Cities Development Program (SCDP) pre-application by Lake County for the

Community of Finland, and authorize County Board Chairperson to sign the SCDP Preliminary

Proposal to the Minnesota Department of Employment and Economic Development (DEED) for funding

of these projects on behalf of Lake County. (Correspondence 10)

20. Authorize payment in the amount of $6,711.82 to Innovative Systems for billing system maintenance

and postage for the following invoices:

a Invoice 25611 728.33

b Invoice 25407 $ 5,370.47

c Invoice 25651 $ 613.02

21. Authorize payment in the amount of $3,573.00 to Olsen Thielen for consulting services rendered in

connection with Eligible Telecommunications Carrier (ETC) petition (reference 24023).

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22. Amend the County Board of Commissioners’ meeting minutes from August 11, 2015, motion 03, consent agenda item 18, to reflect an increase on the total amount of Northern Lights Landscaping Invoice 2015-14: Approve the purchase and installation of a standard brick (Versa-Lok) retaining wall from Northern Lights Landscaping for $12,875.11.

23. Authorize payment in the amount of $4,212.00 to Lake County Ambulance Service for emergency

transportation provided for Lake County Jail inmates to Lake View Memorial Hospital. (Correspondence

11)

24. Authorize payment in the amount of $2,500 to North Shore Management Board (NSMB) for Annual

Local Match pledged toward the NSMB Fiscal Year 2016 (July 1, 2015 to June 30, 2016) funding.

(Order # 170019-Lake County, Invoice # 2658). (Correspondence 12)

Resolution Items:

1. Approve the change in employment status of Jessica Dugas, Accounting Technician, due to completion

of trial period effective October 13, 2015. (Correspondence 6)

2. Approve the change in employment status of Renee Fuller, Public Health Nurse, due to completion of

probationary period effective November 4, 2015. (Correspondence ‘New 6’)

3. Approve resolution that with the completion of the requirements of the Lake County Subdivision Ordinance the Lake County Board of Commissioners approves the final plat application, P-15-002, for “Breezy Point on Lake Superior, LLC” and authorizes the Chair to sign the related documents. (Correspondence 13)

updated COMMISSIONERS’ CORRESPONDENCE

October 20 and 27, 2015

#

Name of Department, Entity, or Individual

Type and Date

Subject

Category

(Informational or Request for Board Action?)

On Action Items List?

1.

Lake County Health and Human Services Department

Memo dated October 8, 2015

Approval of Public Health Emergency Preparedness (PHEP) Grant Project Agreement Amendment for July 2015-June 2016

Request for Board Action

Yes

2.

Lake County Sheriff’s Office

Email dated October 13, 2015

Boat and Water Grant


Yes

3.



Homeland Security and Emergency Management (HSEM) Operation Stonegarden Grant (OPSG)


Yes

4.

Lake County Assessor’s Office


Parcel 23-7644-11120, 11130


Yes

5.

Lake County Environmental Services Department / Planning & Zoning


Items requiring board action on October 27, 2015 (following Lake County Planning Commission recommendation) Proposed resolutions: 5A. I-15-006 5B. I-15-007


Yes

6.

Lake County Human Resources Department


Request for Board Action on October 27, 2015. New 6. Revised memo dated October 22, 2015.


Yes

7.

Lake County Highway Department


10/27/15 Road & Bridge Action Requests


Yes

8.

Lake County Information Technology Department


Request for Spending Authorization: Hybridge Imaging InfiniVault Maintenance


Yes

9.

University of Minnesota – Extension


Proposed 2016-2018 Memorandum of Agreement between Lake County and University of Minnesota contract for services for a .75 FTE 4-H Program Coordinator position


Yes

#

Name of Department, Entity, or Individual

Type and Date

Subject

Category

(Informational or Request for Board Action?)

On Action Items List?

10.

Arrowhead Economic Opportunity Agency (AEOA)


Minnesota Department of Employment and Economic Development (DEED) Small Cities Development Program (SCDP), Preliminary Proposal for the Community of Finland


Yes

11.



LCAS invoice


Yes

12.

North Shore Management Board (NSMB)

Letter dated October 20, 2015

NSMB Invoice for Fiscal Year 2016 Funding


Yes

13.

Lake County Environmental Services / Planning and Zoning


P-15-002 – for “Breezy Point on Lake Superior, LLC”

LAKECOUNTYHEALTHAND 1 HUMAN SERVICES

616 Third Avenue Two Harbors, MN 55616

Phone: 218-834-8400 FAX: 218-834-8412 Public Health

Vickie L. Thompson, Director Social Services

Child Support

DATE:

TO:

FROM:

SUBJECT:

Financial Assistance

October 8, 2015

Lake County Board of Commissioners

Vickie L. Thompson, Director

Approval ofPHEP Grant Project Agreement Amendment for July 2015-June 2016

Please consider approval of the following recommendation:

1. Approve and authorize the Lake County Board Chair to sign the Public Health Emergency Preparedness (PHEP) Grant Project Agreement with the Carlton-CookLake-St. Louis Community Health Board for the performance period of July 2, 2015 through June 30, 2016.

Comments: The PREP Grant Project Agreement is for the period of July 1, 2013 -June 30, 2017. This Amendment is for the performance period of July 2, 2015 through June 30,2016, and awards the funding base amount of$19,560.00.

AN EQUAL OPPORTUNITY EMPLOYER

. ·- J

Public Health Emergency Preparednes~ (PHEP)

9rant Project Agreement

Between the

Carlton-Cook-Lake-St. Louis Community Health Board (CHB)

And· Lake County

Funding Period: July 1, 2013 -June 30, 2017

Performance Period: July 1, 2013- June 30, 2014

Funding Amount: Base: $19,000

Performance Period: July 8, 2014- June 30, 2015


Performance Period: July 2, 2015 - June 30, 2016


PUBLIC HEALTH EMERGENCY PREPAREDNESS GRANT AGREEMENT

AMENDMENT

BETWEEN THE CARLTON-COOK-LAKE-ST. LOUIS COMMUNITY HEALTH BOARD

AND LAKE COUNTY HEALTH AND HUMAN SERVICES

JULY 2, 2015- JUNE 30,2016

This GRANT PROJECT AGREEMENT AMENDMENT is by and between Lake County Health and H:uritan Services, (COUNTY) 616 3rd Avenue, Two Harbors, MN 55616 and the Carlton-Cook-Lake-St. Louis Community Health Board (CHB) 404 West Superior Street, Suite 220, Duluth, MN 55802. It is funded by the State of Minnesota, through its Commissioner of Minnesota Department of Health (hereinafter "STATE").

Recitals

The STATE has a grant project agreement with the CHB identified as SWIFf Contract# 65457 SWIFT Original PO# 3000015837 ("Original Grant Project Agreement") to demonstrate measurable and sustainable progress in the implementation and execution of the CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning (hereafter, Preparedness Capabilities). Funding and activities for this agreement authorized under Section 319C ofthe Public Health Service (PHS) Act as amended by the Pandemic and All-Hazards Preparedness Act of 2006 (P APHA). If applicable, contingent supplemental emergency response awards are authorized under 317 (a) and 317 (d) ofthe Public Health Services Act subject to available funding and appropriation requirements and limitations.

1. This Amendment builds upon the activities completed in previous budget periods which were designed to provide a systematic approach to develop, sustain and demonstrate progress toward achieving CDC's Public Health Emergency Preparedness Capabilities. This amendment provides additional federal funding for Budget Period 4 (BP4) based on continuing funding from CDC to carry on progress in achieving the operational capacity and implementation ofthe preparedness capabilities into the COUNTY's on-going agency operations.

2. The CHB and the COUNTY are willing to amend the Original Grant Project Agreement as stated beiow.

Grant Project Agreement Amendment

In this Amendment deleted grant project agreement terms will be struck out and the added grant project agreement terms will be underlined.

REVISION 1. Clause III CONSIDERATION AND TERMS OF PAYMENT is amended as follows:

A. Consideration for all services performed by COUNTY pursuant to this Grant Agreement shall be paid by the CHB as follows:

Grant Proje<:t Agreement Amendment Page 2

1. Compensation. The total obligation of the CHB for all compensation and reimbursement to COUNTY shall not exceed Forty two thousand dollars ($42,000) Sixtv-one thousand, five hundred sixty dollars ($61,560).

Budget Period Award Amounts

Each specific Budget Period award is available only for the specific Budget Period in for which it was awarded. Funds remaining and not fully liquidated at the end of each Budget Period will be cancelled and will not be available to the COUNTY in any subsequent Budget Period.

Award Name Budget Period Award Amount Budget Period 2 Budget Period 2 $19,000

PHEP July 1, 2013-June 30, 2014 Budget Period 3 Budget Period 3 $23,000

PHEP July 8,2014-June 30,2015 Funding Category 2

Budget Period 4 Budget Period 4 $19,560 PREP July 2,2015-June 30, 2016

Funding Category 2

Budget Period 5 Budget Period 5 $ To Be Determined PHEP July 1,2016-June 30,2017

B. Terms of Payment is amended as follows:

1. Payments are to be made fi·om federal funds given to the CHB obtained by the State through Section 319C of the PHS Act, as amended by the P APHA Act amendments thereto. CFDA # 93.069.

2. All financial transactions will be on a reimbursement basis only.

3. Payments shall be made by the CHB promptly after COUNTY'S presentation of invoices for services performed and acceptance of such services by the CHB' S Authorized Representative pursuant to Clause V, except that the CHB reserves the right not to honor invoices that are submitted more than 30 days after the submission date specified below. It is understood and agreed that, in any event, reimbursement by CHB on such submitted and approved reimbursement invoices will occur only when CHB is paid by MDH on its submittal of those invoices to MDH.

4. Invoices shall be submitted in a form prescribed by the CHB and STATE and according to the following schedule:

Each Budget Period ofthis Grant Agreement is subject to the following invoice submission schedule. Invoices and supporting documentation are required to be received at CHB on or before the deadline listed below.

Grant Project Agreement Amendment Page 2

Invoice Submission Schedule

Invoice Due Invoice Activity Period Deadline for receipt atCHB

1st Quarter July 1- September 30 October 15 2nd Quarter Octoberl- December31 January 15

3rd Quarter January 1- March 31 April 15 4th Quarter/ BP Final April 1-June 30 July 15 Invoice

Except as amended herein, the tenus and conditions ofthe Original Grant Agreement and all previous amendments remain in full force and effect.

IN WITNESS WHEREOF, the parties have caused this grant project agreement amendment to be duly executed intending to be bound thereby.

APPROVED:

1. LAKE COUNTY The COUNTY certifies that the appropriate persons(s) have exect1ted

the project agreement amendmefll on behalf of the Grantee as requiral by applicable articles, bylaws, resolutions. or ordinances.

By: _____________ ~

Title:

Date:

2. CARLTON-COOK-LAKE-ST. LOUIS

COMMUNITY HEALTH BOARD Project Agreeme111 amendment approval and certification that STATE

funds have been encumbered as required by Minn. Stat.§§ 16A./5 and 16C.05.

By: ~ = MarvBodie

Title: CHB Board Chair

Grant Project Agreement Amendment Page 2

Laurel Buchanan

From: Sent: To: Cc: Subject:

Steve Vankekerix Tuesday, October 13, 2015 2:11 PM Laurel Buchanan Sharon Lind Boat and Water Grant

2 Attachments: 2015 Lake County Supplemental Boat and Water Equipment Grant Agreement. pdf

Laurel,

I am attaching the Supplemental Boat and Water Equipment Grant for board action.

"Authorize the Chair ofthe Board to sign the 2015 State of Minnesota Federal Boating Safety Supplemental Equipment Grant Agreement."

Thanks for your help. I will drop off the original. Carey and Linda have signed it already.

Steve Van Kekerix Lake County Sheriff's Office 613 3rd Avenue Two Harbors, MN 55616 (218}834-8387 [email protected]

1

t!r -MNDNR

Contract#:

Dept. ID I PC Bus, Unit R29 R2901 Total Amount $8,750,00

Accounting Distribution:

Fund Fin. Dept. ID

3000 R2937715 Fund Fin, Dept. ID 3000 R2937715

Grant Begin Date September 1, 2015

Grantee Name and Address:

Lake Co. Shel'iff 613- 3rd Ave. Two Harbors, MN 55616

Payment Address: (where DNR sends the check)

Lake Co. Auditor 601 - 3rd Ave. Two Harbors, MN 55616

2015 STATE OF MINNESOTA FEDERAL BOATING SAFETY

SUPPLEMENTAL EQUIPMENT GRANT AGREEMENT

ENCUMBRANCE WORKSHEET

Po#: 3aaoo '6 ES~G I Fiscal Year 2016 ProjectiD

R29G4CGSFY15

Approp. ID

R294203 Approp. ID

R294203

Source Type

REIMB Billing Locnlion

R297000221

Category Account 84101501 441302 Category Account

84101501 441302

Grant End Date December 31,2015

Vendor Number

0000195682-001 DUNS 168755742

Total Amount Activity

$6,300.00 A4CG002 Total .Amount Activity

$2,450,00 A4CG004

2015 MN DNR Federal Boating Equipment Grant Page 1

2015 STATE OF MINNESOTA FEDERAL BOATING SAFETY SUPPLEMENTAL EQUIPMENT

GRANT AGREEMENT

This grant agreement is between the State of Minnesota, acting through Jts Commissioner ofNatural Resources, Enforcement Division ("State") and Lake Co. Sheriff, 613- 3rd Ave., Two Harbors, MN 55616 ("Grantee"). The payment address for this grant agreement Is Lake Co. Auditor, 601- 3rd Ave.,.Two Harbors, MN 55616.

Recitals 1. Under Minnesota Statute §84,026 the State is empowered to entel' into this grant. 2. The State will make available supplementary funding In the amount noted in this agreement to cover the cost of the specific items fot• recreational

boating safety, · 3. The Grantee represents that it Is duly qualified and agrees to perform all services descrlbed in this grant agreement to the satisfaction of the State.

Grant Agt·eement 1 Tet'nt of Grant Agt•eemcnt

1.1 Effective date: Septembel' 1, 2015. Once this grant agreement Is fully executed, the Grantee may claim reimbursement for expenditures incurred back to effective date. Reimbursements will only be made for those expenditures made according to the terms of this grant.

1.2 Expimtlou date: Decembet· 31, 2015, or until all obligations have been satisfactol'lly fulfilled, whichever occurs first. Reimbursement invoice requests must also be received by the State no later than December3 i, 2015, An extension beyond that date may be gl'8nted, If requested by the Grantee, and approved in wrltlng by the State's repl'esentative. Requests submitted after December 31, 2015 that have not been granted a pm·chase or reimbursement extension from the State, are not eligible f01· reimbUl'setnent and wlll become the Grantee's sole responsibility.

1.3 Sul'vlval of Tenus. The following clauses survive the expiration or cancellation of this grant agreement: 8. Liability, 9, State Audits, 10. Government Data Practices attd Intellectual Property, 12. Publicity ahd Endorsement, 13. Governing Law, Jurlsdlctlon, and Venue, 15, Data Disclosure and those items in Exhibit A.

2 Grantee's Duties The Grantee, who Is not a state employee, will be reimbursed, as specified In Exhibit A, for the purchase of the items noted there. The Gmntee wlll submit to the State the required documents noted in Exhibit A. The State wlll make available supplementary funding in the amount noted In this agreement to cover the cost of the specific items for recreational boating safety noted in Exhibit "A." See Exhibit "A" of this agreement for the allowable expenditures specific to this gmnt. See Exhibit "B" for specific federal requirements that affect this grant.

Repot•ting Rcquh'emcnts: The Grantee must satisfactorily submit all activity and financial reports by the date(s) requested by the State, unless the State grants an extension in writing.

3 Time The Grantee must comply with all the time requirements described In this grant agreement. In the performance of this grant agreement, time is of ~~~ .

4 Consldet•ntlou and Pnyment 4.1 Consldemtiou. The Slate wlll pay for all services performed by the Grantee under thls grant agreement as follows:

(a) Compensation. The Grantee will be reimbursed only for the specific items listed in Exhibit A up to Eight thousand seven hundt•ed fifty dollars ($8,750.00).

(b) Total Obligation, The total obligation of the State to the Gmntee under this grant agreement will not exceed Eight thousand seven hundred fifty dollars ($8,750.00).

4.2. Payment (a) Invoices, The State will promptly pay the Grantee aftet· the Grantee presents an itemized invoice for the services actually pet'formed and

the State's Authorized Representative accepts the invoiced services, Invoices shall be submitted In a form prescl'ibed by the State within the dates previously noted in "Term of Grant Agreement" In this contract. Invoice procedures are specified in Exhibit "A".

(b) Federalftmds. Payments under this grant agreement wlll be made from federal funds obtained by the State through the U.S. Coast Guard, Depattment of Homeland Security" through the Recreational Boating Safety Financial Assistance program to states, commonwealth and territories (CFDA numbet' 97.012) in 46 U.S. C. 13101-13110. The Grantee Is responsible for compliance with all federal requirements Imposed on these funds and accepts full financial responsibility for any requirements imposed by the Grantee's failure to comply with federolrequlrements,

2015 MN DNR Federal Boating Equipment Grant. Page 2

4.3 Contracting and Bidding Requirements per Mum. Stat. §471.345, grantees that are municipalities as defined in Subd. 1 must do the following if contracting funds from this grant contract agreement for any supplies, materials, equipment or the rental thereof, or the constLUction, alteration, repair or maintenance of real or personal property: (a) Ifthe amount of the contract is estimated to exceed $100,000, a formal notice and bidding process must be conducted In which

sealed bids shall be solicited by public notice. Municipalities may, as a best value alternative, award a contract for construction, alteration, repair, or maintenance WO!'k to the vendor or contractor offering the best value under a request for proposals as described inMiim. Stat.§l6C.28, Subd. 1, paragraph (a), clause (2).

(b) If the amount of the contract is estimated to exceed $25,000 but not $100,000, the contract may be made either upon sealed bids or by direct negotiation, by obtaining two or more quotations for the purchase or sale when possible, and without advertising for bids or otherwise complying with the requirements of competitive bidding. All quotations obtained shall be kept on file for a period of at least one year after receipt thereof. Municipalities may, as a best value alternative, award a contract for constluction, alteration, repair, or maintenance work to the vendor or contractor offering the best value under a request for proposals as described in Minn. Stat.§l6C.28, Subd. 1, paragraph (a), clause (2) ana paragraph (c).

(c) · If the amount of the contract is estimated to be $25,000 or less, the contract may be made either upon quotation or in the open market, in the discretion of the governing body. If the contract is made upon quotation it shall be based, so far as practicable, on at least two quotations which shall be kept on file for a period of at least one year after their receipt. Alternatively, municipalities may award a contract for construction, alteration, repair, or maintenance work to tlte vendor or contractor offering the best value under a request for proposals as described in Minn. Stat.§ 16C.28, Subd. 1, paragraph (a), clause (2).

(d) Support documentation of the bidding process utilized to contract services must be included in the grantee's financial records, including support documentation justifying a single/sole source bid, lf applicable.

(e) For projects that include construction work of $25,000 or more, prevailing wage rules apply per; Minn. Stat. §§ 177.41 through 177.44 consequently, tbe bid request must state the project is subject to prevailing wage. These rules require that the wages of laborers and wotkers should be comparable to wages paid for similar work in the community as a whole. A prevailing wage form should accompany these bid submittals.

5 Conditions ofPayrnent All services provided by the Grantee under this grant contract must be performed to the State's satisfaction, as determined at the sole discretion of the State's Authorized Representative and in accordance with all applicable federal, state, and local laws, ordinances, rules, and regulations. The Grantee wlll not receive payment for work found by the State to be unsatisfactory ot· petformed in violation of federal, state, or local law.

6 Authorized Rept•esentative The State's Authorized Representative is Rodmen Smith, Assistant Director. Enforcement Division- Central Office, Minnesota Department ofNatural Resources (DNR), 500 Lafayette Rd., St. Paul, MN 55155-4047. (651) 259-5054, [email protected] or his/her successor, and has the responsibllity to monitor the Grantee's performance and the authority to accept the services provided under this grant agreement. If the services are satisfactory, the State's Authorized Representative will certify acceptance on each invoice submitted for payment.

The Grantee's Authorized Representative is the County Sheriff or designee. If the Grantee's Authorized Representative changes at any time ~urlng this grant agreement, the Grantee must immediately notify the State.

7 Assignment, Amendments, Waivet•, nnd Grant Ag~eement Complete 7.1 Asslgumeut. The Grantee shall neither assign nor transfer any rlghts or obllgations under this grant agreement without the prior

written consent of the State, approved by the same parties who executed and approved this grant agreement, or their successors in office.

7.2 Amendments. Any amendments to this grant agreement must be In writing and will not be effective until it has been executed and approved by the same parties who executed and approved the original grant agreement, or their successors in office.

7.3 Waiver. If the State fails to enforce any provision of this grant agreement, that failure does not waive the provision or the State's right to enforce it.

7.4 Gra11f Agreemeut Complete. This grant agreement; including Exhibits ''A" and "B," contains all negotiations and agreements between the State and the Grantee. No other understanding regarding this grant agreement, whether written or oral, may be used to bind either party,

8 Liability The Grantee must indemnify, save, and hold the State, its agents, and employees hatmless from any claims or causes of action, including attorney's fees incurred by· the State, arising from the performance of this grant agreement by the Grantee or the Grantee's agents or employees. This clause will not be construed to bar any legal remedies the Grantee may have for the State's failure to fulfill its obligations under this grant agreement.

lviN DNR 2015 Federal Boating Equipment Grant Page3

9 State Audits Under Minnesota Statute § 16B.98, Subdivision 8, the Grantee's books, records, documents, and accounting procedures and practices of the Grantee 01' other party relevant to this grant agreement or transaction are subject to examination by the State and/or the State Auditor or Legislative Auditor, as appmprfate, for a minimum of six years from the end of this grant agreement, receipt and approval of all final reports, or the required period of time to satisfy all state and program retention requirements, whichever is later.

10 Government Data Practices and Intellectual Property 10.1 Government Data Practices. The Grantee and State must comply wlth the Minnesota Government Data Practices Act, Minnesota

Statute § 13, as it applies to all data provided by the State under this grant agreement, and as it applies to all data created, collected, received, stored, used, maintained, or disseminated by the Grantee under this grant agreement. The civil remedies of Minnesota Statute § 13.08 apply to the release ofthe data referred to in this clause by either the Grantee or the State.

If the Grantee receives a request to release the data referred to in this Clause, the Grantee must immediately notify the State. The State will give the Grantee instmctions concerning 1he release of the data to the requesting party befol'e the data is released. The Grantee's response to the request shaU comply with applicable law.

11 Workers' Compensntion The Grantee certifies that it is in compliance with Minnesota Statute§ 176.181, Subdivision 2, pe1taining to workers' compensation insurance coverage. The Grantee's employees and agents will not be considered State employees. Any claims that may arise tmder the Minnesota Workers' Compensation Act on behalf of these employees and any claims made by any third party as a consequence of any act or omission on the patt of these employees are in no way the State's obligation or responsibility.

12 Publicity and Endorsement 12.1 Publicity. Any publicity regarding the subject matter of this grant agreement must identify the State as the sponsm·ing agency and

must not be released without prior written approval from the State's Authorized Repi'esentative. For purposes of this provision, publicity includes notices, informational pamphlets, press releases, research, reports, signs, and similar public notices prepared by or for the Grantee individually or jointly with ofuers, or any subcontractors with respect to the program, publications, or services provided resulting from this grant agreement.

12.2 E11dorseme11t. The Grantee must not claim that the State endorses its products Ol' services.

13 Governing Lnw, Jurisdiction, and Venue Minnesota law, without regard to its choice-of-law provisions, governs this grant agreement. Venue for all legal proceedings out of this grant agreement, or its breach, must be in the appropriate state or federal court with competent jurisdiction in Ramsey County, Minnesota.

14 Termination 14.1 Tennlnatiou by tire State. The State may immediately terminate this grant agreement with or without cause, upon 30 days' written

notice to the Grantee. Upon termination, the Grantee will be entitled to payment, determined on a pro rata basis, for services satisfactorily performed.

14.2 Tenninafionfor Cause, The State may Immediately terminate this grant contract if the State fmds that there has been a failure to comply with the provisions of this grant contract, that reasonable progress has not been made or that the purposes for which the funds were granted have not been o1· will not be fulfilled. The State may take action to protect the interests of the State of Minnesota, including the refusal to disburse additional funds and requiring the return of all or part of the funds already disbursed.

14.3 Termluatiou for Insufjicleut Funding. The State may Immediately terminate this grant contract if: a) It does not obtain funding from the Jvlinnesota Legislature b) Or, if funding cannot be continued at a level sufficient to allow for the payment of the services covered here. Termination must be by written or fax notice to the Grantee. The State Is not obllgated to pay for any services that m·e provided after notice and effective date of termination. However, the Grantee will be entitled to payment, determined on a pro rata basis, for services satisfactorily pe1formed to the extent that funds are available. The State will not be assessed any penalty if the contract is terminated because of the decision of the Mirmesota Legislature, or other funding source, not to appropriate funds. The State must provide the Grantee notice of the lack of funding within a reasonable time of the State's receiving that notice.

15 Dnta Disclosure Under Minnesota Statute § 270C,65, Subdivision 3, and other applicable law, the Grantee consents to disclosure of its social security number, federal employer ta.x identification number, and/or Minnesota tax identification number, already provided to the State, to federal and state tax agencies and state personnel involved in the payment of state obligations. These identification numbers may be used in the enforcement of federal and state ta.x laws which could result In action requiring the Grantee to file state tax returns and pay delinquent state ta.'{ liabilities, if any.

.tviN DNR 2015 Federal Boating Equipment Grant Page 4

16 Invasive Species Prevention The DNR requires active steps to prevent or limit the introduction, establishment, and spread of :invasive species during contracted work. The contractor shall prevent invasive species from entering into or spreading within a pmject site by cleaning equipment prim· to arriving at the project site.

If the equipment, vehicles, gear, or clothing arrives at the project site with soil, aggregate material, mulch, vegetation (including seeds) or animals, it shall be cleaned by contractor furnished tool or equipment (brush/broom, compressed air or pressure waslter) at the staging area. The contractor shall dispose of material cleaned fi·om equipment and clothing at a location detennined by the DNR Contmct Administrator. If the material cannot be disposed of onsite, secure material prior to transport (sealed container, covered truck, Ot' wrap with tarp) and legally dispose of offslte.

The contractor shall ensure that all equipment and clothing used for work in inf~sted waters has been adequately decontaminated for Invasive species (ex. zebra mussels) prior to being used in non-infested waters. All equipment and clothing including but not limited to waders, tracked vehfcles, barges, boats, turbidity curtain, sheet pile, and pumps that comes in contact with any Infested waters must be thoroughly decontaminated.

IN WITNESS WHEREOF, the parties have caused this Grant Agreement to be duly executed intending to be bound thereby.

1, STATE ENCUlVlBRANCE VERIFICATION Individual certifiesthatjimds have been encumbered as required by illinnesota Statutes§' 16A.l5 and 16C.05.

Signed: -~_2__\___h~~"'---"'/II:CL...C>Y.~/ A-'-r-t~-'=--L --'-r)--'-'J1_---=-___e~-&-'-=i~<:.+-C/(_ Date: ___ Cj'----'---'J_LL-:J U-=----=--7-'--J ---=-5 __ _

SWIFT Contract# _ ___,_)_a=-·_,_/-'=_j"""':> (""'~"'-----L+/ ____ _

Purchase Order# _ ____._, 3__J_J,L.d_,.-d.....,·(J'----=--0-~=-/-' 5_.;;}----"'re'----'--} _

Title: County Sheriff

Date: --F-J/tJ"""--~-'L...t[_----=-~--=-"'-J---"J:: __ _

By: ___________________________ __

Title: Chairperson of County Board

Date:------------------

Title: County Auditor or Admi~

Date: \ (}-l·J - Is

!YIN DNR 2015 Federal Boating Equipment Grant

3. STATEAGENCY: NATURALRESOURCES

By: ;-;--,------:----7---::-----::--c-----------(With delegated authority)

Title: Assistant Dh·ector, Enforcement Division- Central Office

Date: _________________ _

Attachments: Exhibits "A" & "B"

Distribution: I. DNR • OlYIBS 2. Grantee • 2 (Sheriff's Office & Co. Board) 3. State's Authorized Representative

PageS

EXIDBITA Lake County

2015 STATE OFMINNESOTAFEDERALBOATING SAFETY SUPPLEMENTAL EQUIPMENT GRANT AGREEMENT

(CFDA #97.012)

1, The purpose of this grant is to provide supplementary funding to the Grantee, not exceeding the amount specified in Clause 4 of the Grant Agreement, to purchase the following specific equipment or other items that wlll be used for recreational boating safety activities:

a. (10) navigational buoys b, (10) inflatable life jackets c, (8) ARM-LOC rescue devices

2. The program shall begin on September 1, 2015, The purchase and request for reimbursement (county invoice) must be submitted to the State's representative by December 31, 2015, An extension beyond that date for purchase. delivet:y and reimbursement deadlines may be granted. if requested by the Grantee, and approved In writing by the State's representative. Requests submitted after December 31, 2015, that have not been granted a purchase or reimbursement extension from the State, are not eligible for reimbut'sement and will become the Gt'antee's sole responsibility,

3, The Grantee must fu·st purchase the item as specified in this grant, follow any specific county purchasing procedures and pay for it from the Grantee's funds. The Grantee must then submit the following for reimbursement by the deadline noted in #2 above:

a. An invoice from the Grantee, dated no earlier than September 1, 2015 and not later than December 31, 2015, with a description of all the item(s) being requested for reimbursement. The purchase/invoice deadline may be modified If an extension, as noted in clause #2 above, is granted in writing from the State's representative.

b, A copy of the invoice(s) from the vendor(s) showing the amount the Grantee actually paid, including shipping, sales tax and any setup costs,

c. If the item is valued over $5,000, the Grantee's asset number(s) & equipment serial number(s) must also be included on the invoice,

d. All reimbursement requests must be sent or delivered to:

Minnesota Dept. ofNatural Resources Boat & Water Safety 500 Lafayette Ro~td St. Paul, MN 55155-4047

4. Aids to navigation purchased through this grant must comply with the requirements in Minnesota Rule 6110,1500, Watercraft purchased through this grant must be registered with the State and display registration numbers and validation decals as noted in MitmesotaRule 6110.0100 -.0900,

. . 5, Invasive Species Prevention, Grantees and subcontractors must follow Minnesota DNR' s Operational

Order 113, which requires preventing or limiting the introduction, establishment and spread of invasive species during activitles on public waters and DNR administered lands, This applies to all activities performed on all lands under this grant agreement and is not limited to lands under DNR control or public waters, Duties are listed under Sections II and III (pp, 5-8) of Operational Order 113 which may be found at http://files.dnr.state.mn. us/assistance/grants/habitat/heritage/opol'del' 1 I 3 .pdf.

2015 Bl<hlbit A Page 1

6, The Grantee agrees that, when requested by the State, they will promptly complete an inventory on items purchased at a cost of more than $5,000 and forward it to the State's representative.

7. The State will supply a special label that will need to be applied to each :item of equipment that exceeds $5,000. This label indicates that federal boating safety funds were used for all or a portion of the purchase.

8. Items purchased under this gt'antmay not be sold, traded 0.1' disposed of without prior wdtten permission and instructions from the State as to the disposition of the item(s), and any funds derived from their sale or trade. The Grantee must promptly notify the State's representative if any item over $5,000 purchased · through this grant is lost or stolen,

9. By accepting this grant, the Grantee agrees, when requested, to accurately & promptly complete and return to the state any reports required by the State 01' the cognizant federal agency regarding activities, expenditures ·or accomplishments for the recreational boating safety program.

10. In any refel'ence to this grant, it should be referred to as: "A federal boating safety sub gmnt thl'Ough the Minnesota Department ofNatural Resources."

2015 Exhibit A Pnge2

2015 FEDERAL ASSURANCES NON~CONSTRUCTION PROGRAMS

ExhibitB

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant, I cetiify that the applicant:

1. Has the legal authority to apply for Federal ·assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper plmming, management and completion of the project described in this application.

2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award: and will establish a proper accm.)nting system in accordance with generally accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees :fi·om using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable time :fi·ame after receipt of approval of the awarding agency.

5. Will comply with the Intergovernmental Personn\}1 Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes l'elating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act ofl975, as amended (42 U.S;C, §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of dmg abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S. C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and dmg abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S. C. §§3601 et sq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and G) the requirements of any other nondiscrimination statute(s) which may apply to the application.

7. Will comply, or has already complied, with the requirements of Titles IT and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide fot' fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federallyassisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation purchases.

2015 ExhibitB Page 1

8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508) and 7324-7328) which limit the political activities of employees whose principal employment activities are funded :in whole or in patt with Federal funds.

9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S. C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor standards for federally-assisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the following: (1) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection ofwetlands pursuant to EO 11990; (d) evaluation offload hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§ 1451 et. seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176( c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§ 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Ddnking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P .L. 93-205).

12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S. C. §§ 1271 et seq.) related to protecting components ot'potential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-let seq.).

14. Will comply with P.L. 93-248 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et seq.) pe1iaining to the care, handling, and treatment of warm blooded aniinals held for research, teaching, or other activities supported by this award of assistance.

16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint :in constmction or rehabilitation of residence structures.

17. Will cause to be pmformed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1995 and OMB Circular A-133, "Audits of State, Local Govemments and NonProfit Organizations." *(see below).

18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program.

*If the COUNTY (as defined on page 1 of this grant) expends more than $500,000 in federal assistance per year, it agrees to have a program-specific or single audit made in accordance with the Single Audit Act Amendments of 1996 and 01viB Circular A-133 - "Audits of States, Local Governments and Non-Profit Organizations." Copies of the audit report are required to be sent to the following: 1) Office of the State Auditor- Single Audit Division, Suite 400, 525 Park Sh·eet, St. Paul, 1VIN 55103, 2} Minnesota Department of Natural Resources, Internal Audit Section - Office of Management & Budget Services 500 Lafayette Road, St. Paul, MN 55155 and 3) The Federal Single Audit Clearinghouse located at: Bureau of the Census, Data Preparation Division, 1201 East 10111 Street, Jeffersonville, IN 47132.. ·

2015 Exhibit B Page2

Laurel Buchanan

From: Sent: To: Cc: Subject: Attachments:

Laurel,

Steve Vankekerix Tuesday, October 13, 2015 2:17PM Laurel Buchanan Sharon Lind HSEM OPSG Grant 2014 HSEM OPSG Grant Agreement. pdf

I am attaching the 2014 HSEM Operation Stonegarden Grant Agreement for board action.

3

"Authorize the Chair of the Board to sign the Homeland Security and Emergency Management (HSEM) Operation Stonegarden 2014 grant agreement."

Thanks for your help. I will drop off the original agreement. Carey has signed it.

Steve Van Kekerix Lake County Sheriff's Office 613 3rd Avenue Two Harbors, MN 55616 (218)834-8387 [email protected]

1

Grant Agreement Page 1 of2

Minnesota Department of Public Safety ("State") Grant Program: 2014 (OPSG) Operation Homeland Security and Emergency Management Division Stonegarden 445 Minnesota Street, Suite 223 Grant Agreement No.: A-OPSG-2014-LAKESO-St Paul, Minnesota 55101-6223 0005 Grantee: Grant Agreement Term: Lake County Sheriff's Office Effective Date: 09/01/2014 613 3rd Avenue Expiration Date: 08/31/2016 Two Harbors, MN 55616 Gl'antee's Authorized Representative: Grant Agreement Amount: Carey G. Johnson, Sheriff Original Agreement $36,253.00 Lake County Sheriff's Office 613 3rd Avenue Two Harbors, MN 55616 Matching Requirement $0 Phone: {218) 834-8385 Email: [email protected] State's Authorized Representative: Federal Funding: CFDA 97.067 Gary Lokken, Program Director State Funding: None Homeland Security and Emergency Management Division Special Conditions: None 445 Minnesota Street, Suite 223 StPaul, Minnesota 55101 Phone: (651) 201-7448 Email: [email protected]. us

Under Minn. Stat.§ 299A.Ol, Subd 2 (4) the State is empowered to enter into this grant agreement.

Term: Effective date is the date shown above or the date the State obtains all required signatures under Minn. Stat.§ 16B.98, subd. 7, whichever is later. Once this grant agreement is fully executed, the Grantee may claim reimbursement for expenditures incurred pursuant to the Payment clause of this grant agreement. Reimbursements will only be made for those expenditures made according to the terms of this grant agreement. Expiration date is the date shown above or until all obligations have been satisfactorily fulfilled, whichever occurs ftrst.

The Grantee, who is not a state employee will: Perform and accomplish such purposes and activities as specifted herein and in the Gmntee's 2014 (OPSG) Operation Stonegarden Application ("Application") which is incorporated by reference into this grant agreement and on file with the State at 445 Minnesota Street, Suite 223, St Paul, Minnesota 55101-6223. The Grantee shall also comply with all requirements referenced in the 2014 (OPSG) Operation Stonegarden Guidelines and Application which includes the Terms and Conditions and Grant Program Guidelines (https://app.dps.mn.gov/EGrants), which are incorporated by reference into this grant agreement.

Budget Revisions: The breakdown of costs of the Grantee's Budget is contained in Exhibit A, which is attached and incorporated into this grant agreement. As stated in the Grantee's Application and Grant Program Guidelines, the Grantee will submit a written change request for any substitution of budget items or any deviation and in accordance with the Grant Program Guidelines. Requests must be approved prior to any expenditure by the Grantee.

Matc/ziltg Requirements: (If applicable.) As stated in the Grantee's Application, the Grantee cettifies that the matching requirement will be met by the Grantee.

Payment: As stated in the Grantee's Application and Grant Program Guidance, the State will promptly pay the Grantee after the Grantee presents an invoice for the services actually pe1formed and the State's Authorized

DPS Grant Agreement non•state (04/14)

Grant Agreement Page2of2

Representative accepts the invoiced services and in accordance with the Grant Program Guidelines. Payment will not be made if the Grantee has not satisfied reporting requirements.

Certification Regarding Lobbying: (If applicable.) Grantees receiving federal funds over $100,000.00 must complete and return the Certification Regarding Lobbying foqn provided by the State to the Grantee.

1. ENCUMBRANCE VERIFICATION Individual cert!ftes that fimds have been encumbered as required by Mlnn Stat.§§ 16A.15 and 16C.05.

Signed: _________________ _

Date:==================~

3. STATE AGENCY

By:~~~~~~~~-----------------(wlth delegated authority)

Title: _________________ _

Date:==================

Grant Agreement No. A-OPSG-2014-LAKES0-0005 I PO# 3-36354

2. GRANTEE

Date: /0 -£·-,Jo /....)

By: ________________ _

Title:------------------

Date:==================

DPS Grant Agreement non-state (04/14)

Distribution: DPS/FAS Grantee State's Authorized Representative

Organization: Lake County Sheriff's Office

2014 Operation Stonegarden

Budget Category

Operational Overtime

Operational Overtime

Total

Fringe Benefits

Fringe Benefits

Total

New/Replacement Equipment

New/Replacement Equipment

Total

Reimbursement for Mileage

Reimbursement for Mileage

Total

Total

Allocation

Balance

10/06/2015

2014 (OPSG) Operation Stonegarden

Budget Summary

Awarded

$16,640.00

$16,640.00

$2,791.00

$2,791.00

$15,600.00

$15,600.00

$1,222.00

$1,222.00

$36,253.00

$36,253.00

$0.00

L

EXHIBIT A

A·OPSG-2014-LAKESO.QOOS

I I

Page 1 of 1

601 Third Avenue

Two Harbors, MN 55616

October 8, 2015

Re: Parcel23-7644-11120, 11130

Robert W. Carlson 1615- gth Ave Two Harbors, MN 55616

Dear County Board,

Lake County Assftor Gregg Swartwoudt, AMA

601 3rd Avenue Two Harbors, MN 55616

PH: 218.834.8310- FX: 218.834.8302 Website: www.co.lake.mn.us

Anthony J. Vigen, CMA, Chief Deputy Assessor

Mr. Carlson's wife passed away and the homestead clerk removed her from the homestead file, in doing so, the homestead classification on the property was inadvertently removed. I would recommend classifying this property as homestead for the 2014 assessment, taxes payable in 2015 to correct a clerical error.

Sincerely,

Anthony J. Vigen, CMA Chief Deputy Assessor

OCT 0 9 2015

COMMISSIONERS OFFICE LAKE COUNTy COURT HOUSE

~-~,------J

DATE:

TO:

FROM:

RE:

10/15/2015

Lake County Board of Commissioners

5 Planning & Zoning

601 3rd Avenue Two Harbors, MN 55616

PH: 218.834.8325- FX: 218.834.8365 Website: www.co.lake.mn.us

Christine M. McCarthy, Environmental Services Director/Planning & Zoning

Items requiring Board action on October 27, 2015

On October 19, 2015, the Lake County Planning Commission will review the following interim use renewal permits and forward recommendations for Board review and action:

• 1-15-006- Jane Shallow- Triangle Lake, Ely, MN.

• 1-15-007- Eric & Diane Lindberg- 5506 Little Marais Road, Finland, MN.

In addition to the above items, our office will also be tentatively submitting "Breezy Point on Lake Superior" for final plat approval on October 27, 2015.

Thank you.

Lake County Board of Commissioners Resolution Resolution #

October 27, 2015

WHEREAS, Jane Shallow submitted an interim use renewal application (1-15-006) for a Vacation Rental Home on property located on Triangle Lake, Ely, MN 55731 and described asS. 685.96 ft. of Gov. Lot 9, Section 13, Township 63, Range 10, 32.50 acres, zoned RR/Residential one acre minimum, Fall Lake Township.

WHEREAS, The Planning Commission held a public hearing on October 19, 2015 and recommends a five year renewal of the interim use permit based on following findings:

1. Shallow's proposed composting toilet and pit privy are the appropriate septic systems for the area and will meet Health department requirements.

2. All vacation home rental requirements have been met. 3. Although Shallow did not begin the cabin rental during her initial permit year, there have been no

letters of concern resulting from the renewal notification. 4. This is a remote site with another rental cabin in the area. 5. Costs and difficulties of setting up the cabin rental delayed Shallow's rental start-up date. 6. There have been no changes from Shallow's original application.

WHEREAS, the Planning Commission recommends the following condition:

1. Rental rules should be posted and include language about noise limitations.

NOW THEREFORE BE IT RESOLVED that the Lake County Board of Commissioners adopts the findings by the Planning Commission and a five-year renewal of Interim Use Permit, 1-15-006, for Jane Shallow.

(ADOPTED: October 27, 2015)

Commissioner ____ moved the approval of the foregoing resolution and the same was declared adopted upon vote of all members present. Absent:


October 27, 2015

WHEREAS, Eric and Diane Lindberg submitted an interim use renewal application (1-15-007) for a Vacation Rental Home located at 5506 Little Marais Road, Finland, MN 55603 and described as that part of NW '!!.! of SW '!!.! southwest of Co Hwy, Section 22, Township 57, Range 7, 5 acres, zoned R-2/Residential five acre minimum, Crystal Bay Township.

WHEREAS, The Planning Commission held a public hearing on October 19, 2015 and recommends a five year renewal of the interim use permit based on following findings:

1. No concerns from neighborhood. 2. Type II septic system water usage limitations discussed and understood by the applicant. 3. No impervious surface problems. 4. Has met all vacation home rental criteria. 5. Ample parking. 6. Rental home owners are adjoining neighbors. 7. Property has been surveyed and lot lines have been defined.

NOW THEREFORE BE IT RESOLVED that the Lake County Board of Commissioners adopts the findings by the Planning Commission and a five-year renewal of Interim Use Permit, 1-15-007, for Eric and Diane Lindberg.



Human Resources Department Cammie B. Young

Human Resources Administrator 601 Third Avenue

Two Harbors, MN 55616 Phone: (218) 834-8394 ~ Fax: (218) 834-8482

Website: www.co.lake.mn.us

Therese Lorntson, Administrative Assistant

DATE: October 22, 2015 TO: FROM:

Lake County Board of Commissioners Cammie Young

RE: Request for Board Action on October 27, 2015 Revised

The Department of Human Resources requests consideration for board action on the following:

1. Approve the change in employment status of Jessica Dugas, Accounting Technician, due to completion of trial period effective October 13, 2015.

2. Approve the change in employment status of Renee Fuller, Public Health Nurse, due to completion of probationary period effective November 4, 2015.

An equal opportunity employer.

ke County MINNESOTA

LAKE COUNTY HIGHWAY DEPARTMENT 1513 Hwy 2

Two Harbors Minnesota 55616 (218) 834-8380

FAX (218) 834-8384

Road and Bridge Agenda 10/27/1 5

1. Approve Highway Department payment to Sinnott Contracting, LLC for Scenic Highway 61 blacktop patches in the amount of $5,000.00.

2. Approve Highway Department payment to PetroChoice for bulk oil in the amount of $3,699.97. 3. Approve and authorize Highway Engineer to sign Northshore Mining Company utility permit for

work in right-of-way to be completed on or before October 1, 2017 at designated location of CSAH 3 culvert tributary to the Beaver River.

7

ke County MINNESOTA

LAKE COUNTY HIGHWAY DEPARTMENT 1513 Hwy 2

Two Harbors Minnesota 55616 (218) 834-8380

TO:

FROM:

SUBJECT:

DATE:

CC:

FAX (218) 834-8384

INTEROFFICE MEMORANDUM

LAKE COUNTY BOARD OF COMMISSIONERS

KRYSTEN FOSTER, HIGHWAY ENGINEER

10/27/15 ROAD & BRIDGE ACTION REQUESTS

OCTOBER 15, 2015

MATIHEW HUDDLESTON, COUNTY ADMINISTRATOR

Dear Mr. Chair and Board Members:

Herein please find supporting details in regards to the Highway Department's current action requests.

Sinnott Blacktop: This work was authorized at the time this contractor mobilized to the area to pave a nearby driveway in order to restore culvert repair locations prior to the North Shore lnline Marathon. It is within budget for Bituminous Materials (Account 20-31 0-000-0000-6503).

PetroChoice: This bill is for periodic restocking of our truck oil supply. It is within budget for Shop Maintenance Supplies (Account 20-330-000-0000-6509).

Northshore Mining Company: This permit supports Cliffs' efforts to reduce environmental risks and operating costs associated with their basin by rerouting high-water stormwater overflows from Bear Lake through an engineered channel to the Beaver River. This permit allows Northshore Mining Company to perform work within Lake County's CSAH 3 right-of-way for channel reconstruction and the installation of riprap at our culvert outlet, which will control water velocity and reduce the potential for erosion as their channel meets the Beaver River. The Highway Department met with Northshore Mining Company to compare the current and proposed outlet design, and the Highway Engineer accepts Barr Engineering's channel and culvert sizing computations as they are in alignment with highway design standards. It is our understanding that this channel will remain an intermittent waterway, which generally flows only after rainstorm or snow melt events.

Thank you for your consideration. I'd be glad to answer any questions that may arise.

Respectfully,

Sinnott Contracting LLC PO Box 16205 Duluth MN 55816 (218) 626-1822

Billed To: Lake County Highway Dept. Accounts Payable 1513 Hwy 2 Two Harbors MN 55616

Description

Type SP 9.5 Wearing Course Mixture (B)

As per your signed proposal it is agreed that if payment as indicated herein is unpaid after 10DY of job completion, customer will agree to pay a finance charge.

Finance charge is computed by a periodic rate of 1 1/2% per month which is an Annual Percentage rate of 18%. Customer will pay for a// legal fees in the event of legal action taken to collect past due invoices.

Thank you for your business.

Unit

Ton

Contract Invoice Invoice#: 14151

Date: 10/01/2015

Project: Lake County Hwy 61 Bit Patch

Qty Price Amount

25.00 $200.00 $5,000.00

!Amount Due: $5,000.00

-51ilnott Contracting, lLC PO Box 16205 Duluth, MN 55816

To:

Address:

Project Name:

Project Location:

Lake County

1513 Hwy 2

Two Harbors, MN

Lake County Hwy 61, Bituminous Patching

Hwy 61, Two Harbors, MN

Thank you for the opportunity to quote on your proJect.

I Item # Item Description

1 Type SP 9.5 Wearing Course Mixture (B)

Notes:

'

Contact:

Phone:

Fax:

Phone: (218) 626-1822 Fax: (218) 740-3465

John Schlangen

Bid Number:

Bid Date: 8/19/2015

Estimated Quantity Unit Unit Price Total Prlcej

25.00 TON $200.00 $5,000.00

Total Bid Price: $5,000.00 =============~~

• Bituminous quote does not include traffic control, bond fee, saw-cutting, removals, back-fills, aggregate base; grading or compacting of aggregate base, or any prep or incidental work.

Payment Terms:

All overruns to be paid at the unit price above. Sinnott Contracting, LLC. proposal shall become an integral document to any subcontract agreement.

This quote is effective for 2015 Season only if signed and returned to our office within fifteen days after Quote Date.

. ACCEPTED: CONFIRMED:

Sinnott Contracting, LLC

Authorized Signature: -----------------------------Estimator: Dan Wyman

218·626·1822 [email protected]

6/19/2015 1:55:12 PM Page 1 of 1

0

0 0

etroChoice 0 0

0 Lubrication Solutions 0 ® <o

www.petrochoice.com

Bill To:

3301 JAMES DAY AVENUE SUPERIOR, WI 54880

1-800-333-8237

Sllip To:

INVOICE

INVOICE

7992431

Invoice Date Page

9/30/2015 20 1 of1

ORDER NUMBER

1937998

LAKE COUNTY HIGHWAY DEPARTMENT

1513 HIGHWAY 2 LAKE COUNTY HIGHWAY DEPARTMENT

1513 HIGHWAY2 TWO HARBORS, MN 55616 TWO HARBORS, MN 55616

Ordered By

---·· ·· ·-Gtlstomet·-ID:--1·71831 - ·

PO Number Terms Description Net Due Date Disc Due Date Disco1111t Amomzt

DM/TK Net30 10/30/2015 10/30/2015 0.00

Order Date Pick Ticket No Primary Salesrep Name Take•·

9/29/2015 11 2951071 DAVID MODEEN TKNOX

Quantities Prlclug Item ID UOM Uult Exteuded

Onleredl Shipped I Remaillillg I u'i!::lt Size .~ Item Descrlptio11 Price Price ~

U11itSize

Midwest Dlvisio11 - PetroCfwice- Thank you for your business

110.00 110.00

Total Lines: 1

O.OOGL EM110241 GL 33.3800 3,671.80 1.0 MOBIL DELVAC I ESP SAE 5W40 (BULK) 1.0000

CJ-4/SM

Contract Name: 171831-1 Li11e Number: 4

SUB-TOTAL: 3,671.80 -·--· ·---- ---TAx:·· ·--- o.oo --·

SERVICEANDHANDLINGFEE: 28.17

AMOUNT DUE: 3,699.97

U.S. Dollars

Remit to: Midwest Divisio11 - PetroChoice 3301 James Day Ave Supel'ior, WI 54880 /1DTr::!T11T AT Dlo~••n _ /}/l/L222 JJ')2"7 U~~ "'17~ ~UI'J """"

-. _. Shipping Ticket

" Pick Ticket Number

Q 0

etroChoice s a

Lubrication Solutions 0

www.petrochoice.com

Bill To:

3301 JAMES DAY AVENUE SUPERIOR1 WI 54880

1-800-333-8237

Ship To:

2951071 Pick Date I 9/29/2015 I

Order Number

1937998

LAKE COUNTY HIGHWAY DEPARTMENT 1513 IDGHWAY 2

LAKE COUNTY HIGHWAY DEPARTMENT 1513 IDGHWAY2

TWO HARBORS, MN 55616 2188348380

Ordered By: Mr. David

Customer ID: 171831

Order Date

9/29/2015

PO Number

DM/TK

Quautltles

Ordered! ToPickj

110.00 110.00

TWO HARBORS, MN 55616

Can·ier Taker

PETROCHOICE SUPERIOR TRUCI< TKNOX

/tem/D UOM

Sluppedlt Item Descriptlo11

Tha11k you for your busiuessl

EMI10241 GL MOBILDELVAC I ESP SAE5W40 (BULK) CJ-4/SM

Name: -------------------------------------Signature:

----~-------------------------------Date: q/;ti;s

:L 7

Page

1 ofl

UuftSi'~e

1.0

As it relates to 10/27/2015 Lake County CSAH 3 utility permit for Northshore Mining Company

Coogle earth m~s 1 ~ 2 A

Krysten Foster


Scamehorn, Daniel J [[email protected]] Wednesday, September 16, 20151:53 PM Krysten Foster Hayden, Andrea J Bear lake outlet ROW application ROW application.pdf; DNR Waters Bear Lal<e Outlet comments. pdf; Bear Lake Outlet Project Permit- December 2009.pdf; Hwy3 plans. pdf; hydro study. pdf

l<rysten, please find the attached documents for approval of work within the hwy 3 ROW. Please let me know if any additional information is needed or follow up required. Thank you for your help.

I Dan Scamehorn

P 218.226.6038 M 218.830.9328 [email protected]

CLIFFS NATURAL RESOURCES Northshore Mining 10 Outer Drive, MN 55616

This electronic message and any attachments included with this message are for the exclusive use of the individual or entity to which it is intended to be addressed. This message may contain infmmation that is privileged or confidential and thereby exempt and protected from unauthorized disclosure under applicable law. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, be aware that any disclosure, dissemination, distribution or copying of this communication, or the use of its contents, is not authorized and is strictly prohibited. If you have received this communication and are not the intended recipient, please notify the sender immediately and permanently delete the original message from your e-mail system.

1

Form No. 2962 Busrntss Records Corp

COUNTYOF LAIL£ DEPARTMENT OF HIGHWAYS

APPLICATION FOR UTILITY PERMIT on COUNTY HIGHWAY RIGHT OF WAY

Page 1

Board of County Commissioners

---------• Minnesota Attn: County Highway Engineer

C.S.A.H. ~-..3-------C.R.~----~----

Ap:rication is hereby made for permission to place, construct and thereafter mai~tain a----J)Jtt t1" Cij..,tJ ,V ~'L along or across County Highway No. ,J. from __ _

to ~~-----------------~~n.-~-------------------------------------S"G feet from center line on the..)'\}qfiL(east, west, north or south) side of the county highway in ;;c01·dance with the sketch shown on the inside hereof, or -attached thereto.

I. AERIAL CONSTRUCTION 0 Single pole 0 H-Fi·ame

VOLTAGE

0 Single pole and H-Frame 0 Steel tower 0 Other _______ _

NUMBER OF CONDUCTORS

0 Open wire 0 Cable 0 Vertical 0 Cross-arm 0 Vertical and cross-arm

SIZE OF CONDUCTORS

Minimum height of conductor: t. along highway t. at crossing over highway EXTENT AND LOCATION OF TREE TRIMMING AND/OR CLEARING:

IJ. UNDERGROUND CONSTRUCTION CONDUIT

SIZE

VOLTAGE

0 Multiple tile 0 Transite 0 Clay tile

CASING 0 Steel pipe 0 Sectional concrete

NUMBER OF CONDUCTORS

0 Other

0 Sectional concrete .(] Steel pipe .1XI Other C.~A-tVVt."L

SIZE OF CONDUCTORS

METHOD OF INSTALLING UNDER ROADBEDS (if open trench, explain why necessary) 0 Open trench--------------------------0 Jacking 0 Boring 0 Pneuma Gopher

IV. The applicant in carrying on any and all of the work herein above mentioned or referred to in its application and in the Permit issued herefore, shall strictly conform to the terms of such Pel•mit, and the regulations of the Boal'd of County Commissioners, as set forth herein together with the Special Provisions, all of which are made a part hereof. The applicant specifically agrees to be bound hereby. 'fhe applicant shall also comply with the regulations of all other governmental agencies for the p1·otection of the public. The work shall be accomplished in a manner that will not be detrimental to the highway and that will safeguard the public. ·

Dated thi•s-' (, d~i'~l Yooc d01:5" Signature _ ) aJ ~~ ~ Address J 0 Ou 1\..lll 0 It l utf S I l lklt 6'!)' M./\J

Rules and Regulations of Board of County Commissioners for Utilities on County Highways.

DEFINITIONS

Utility. Under ~hie order "utility" shall mean and include all privately, publicly or co·operatively owned communication Jines and facilities, any systems, lines and facilities fot• the distribution and transmission of electlcnl energy, oil, gao, water, sewer, steam and other pipe lines, railways, ditcheo, flumes or other struc~ureswhich underthc laws ofthls State or the ordinance of any town or city may be constructed, placed or maintained acroos, along or on county highway right of way. Dependent upon themeaningintended in the context, "Utility" shall also mean the utility company, inclusive of anY wholly owned subsidary.

GENERAL

I. Except as othenvioe permitted, utility construction and relocation on county highway tigM of way shall not be commenced until an application for a Permit hnll been made and ouch Permit granted. The Permit oketch shall show the location of the proposed utility with reference to county highway center line. A copy of the okctoh shall be provided fot• each copy of such Permit.

II. Bumingordialdngoporations and/or ~he uocofchemicals to control or kill trees, brush and other vegetation is prohibited without prior approval from the County Highway Engineer.

Ill. All waterways and lines of drainage shall remain operative. · '

IV. Wherever topsoil and sod are disturbed they shall be replaced and maintained oatlsfactorlly until the turf is' cotablished.

V. The utility facility and inotallation shall not interfere with any eJ<isting utility facilities on the county highway right of way.

VI. When necoaaary, barricades, weening deviceo and flagmen shall be provided by the Utility during all phaoea of their construction and maintenance operations on county highway right of way.

VII. At the tim a of construction of the utility and at the times of subsequent maintenance, prior approval shall be obtained from the County Highway Engineer for the cutting and trimming of trees within the county highway right of way. Wherever trees are cut the resulting atumpa shall be removed unless otherwise provided in the Spccio.l P1·ovioiona of the Permit. Any holes cauoed by stump removal shall be backfilled, the area leveled and all materials associated thm·e1vith disposed of outside the county highway right ofway. The utility shall advioetheCounty Highway Engineeratleaot 46 hours in advance ofita intent to otartclearing and grubbing ope1•atlona so that proper supervision can be provided.

VIII. Tho Utility shall notify the County Highway Engineer of ita intent to perform service and maintenance operations which will interfere with the flow of traffic on county highways, and sl1all obtain hio approval pl'ior to performing such operations. However, the Company may perform service and maintenance operationo on county higl1ways including opening and disturbing the surface of the right of way without prior approval in those instances where an emergency exiote Uu•t ie dangerous to tho life or safety of the public and which requires immediate repair. The Utility ohall tako all necessary and rel.lsonable safety measures to protect the traveling public and shall notify the County Highway Engineer at the eadiest

' poasible moment.

X. The Utility shall assume all liability for, and onve the County, Its agents and employees, harmleso from, any and all claims for damages, actions Ol' causes of action arising out of the work to be'done herein and the continuing uses by the Utility, including but not limited to the placing, constructing, reconstructing, maintaining and using of said utility under this application and Permit.

XI. The Board of County Commissionsra may require the Utility, or its conb•actor, to furnish a deposit in the form of a certified oheck, a ouroty bond or corporate undertaking, in favor of the Board of County Commlsaionol'B o County, for any expense incut·red by the County in the l'epairing of damage to any portion of the county highway right of way caused by work performed under a Permit, including pny Ol\t of the ordinary engineering supervision and inap.ection expense provided by the county. In those instances wherein a deposit is required, the amountofthe deposit shall be specified in the Special Provisions of the Permit. If a check is furnished, any monies remaining over and above such expense shall be returned to tho applicant.

XII. The Permit ao issued does not in any way imply an easement on private property,

XIII. The Installations shall be made in conformity with all applicable laws, regulations and codes covering said lnotallationlt' All installations ohall be made i'n conformity with regulations of governmental agencies for the protection of the public.

XIV. Upon completion of an inotsllation, the Utility ahall restore the county highway l'lght of way to ita original condition, The Utility shell then notify the office of the County Highway Engineer of the completion of the work so that inopection can be made to detennine ita acceptability.

AERIAL

I. There shall be c:mly a oingle pole line on the county highway right of way on either side o£ the center line thereof.

II. Longitudinal inst(lllations on county highwayo shall normally be located in the outer five feet of the rightofwny, At crosoing of the county highway, poles shall be placed at a minimum of thirty feet from the ohoulder linea of the through roadbeds unless right 9f way widths are prohibitive to ouch location,

III. The location of all brace poles, anchors and anchor poles within the limits of the county highway right of way shall be approved by the County Highway Engineer.

IV. In those instances in which a Utility is issued a Permit or Pennite for construction on both aides of the county highway right of way in a given oren, such Permit is conditioned upon tho Utility subsequently providing joint use to other Utilities upon reaeonable terms mutually agreeable to the Utilities.

UNDERGROUND

I. All crossings of the roadbeds of the county highways ohall be made by boring inside a casing or carrier pipe, or by jacking, unless thlo procedure is modified in the Special Pt·ovisions of the Permit. Tho auger shall not lead tho casing or carrier pipe by more than one Inch. Open trenching shall be restricted to tho area from 5 feet beyottd the shoulder to the righ tofway line except as modified in the Special Provisions of the Permit.

IX. If at any time County, acting through its Board of County Commietrioners,ohnll deem it neceaeary to make any improvements or cbangeo on all or any part of tho right of way ofthe county blgb.way whlch affect n utility located on county highway right of way, then and in ouch event, the owner of tho utility shall within 16 dnyo after written notice from the Board of County Commloalonera, or ita authorized ogent, proceed to alter, change, vo.cata or remove 118id ut\Uty from the county highway light of way oo ae to conform to said county highway changes and ao dirsoted by the Board of County Commiaoionere. Such work shall be done without any coot whatsoevor County and shall be oompleted within thedata specified in said writton notice. The Utility oholl oosume all lillbility and snv County hll.l'lllleos from any and an claiiJlll of damage of any naturo whatooever ocoaolonod by reaoon of not ho.ving removed said utility within the timo apeclfied in said notice.

Page 3

II. When pipeo with bello or flanges are installed, the crossings of the roadbeds of the county highway shaH bemado by boring inside n conduit ao provided in pat·agraph I ofthia section or jacking a conduit of eufficient diameter to pennit threading the can·ier pipe through it.

Ill. All voi~a caused by jacking ol' boring shall be filled by pressure grouting. The grout material shall consist of n sand· cement slurry of at least two sacko of cement percubioyard and a minumurn of water to assure satlefactory placement.

IV. ·The underground utiliteo shall be so installed as virtually to preclude any necessity for distt·ubing tho roadbeds to perform mplntenancc operations.

V. Underground lnstallntlons shall be accomplished wi thout d!IIUaging or destroying the principal root otructure of specimen treoa.

LOCATION SKETCH

Show location of proposed facility in relation to the center line of the county highway and other pertinent features auch as right of way line, shoulder line, curb line and edge of outfacing. The facility should also be referenced to adjacent land lines.

'•

--------------~COUNTY DEPARTMENT OF HIGHWAYS

Page 4

Utility Permit Reference: Project __________ _

C.S.A.H. ----------C.R. ----------

In accordance with the application herein, a Utility Permit is granted to-------------------------to place, construct and thereafter maintai • ._ _______ _ ------------ on or across, or under the right of way of County Highway No,, __ _ in the location shown on the sketch which is a part of said application, or in such location as may be specified by the Department of Highways in the Special Provisions hereof.

SPECIAL PROVISIONS:

Approved----------~~-------(dnteJ

Board of County Commissioners --------------·Minnesota

By County Hl11hwny Englneor

COPIES:

Permit No. __ Certified Check No. ---------Surety Bond No.-----------Date of S. Bond or C. Check Bank or Bonding Co. ---------Deposit Made by

Dennis Wagner Sr. Staff Environmental Engineer Northshore Mining Company l 0 Outer Drive Silver Bay, MN 55614

Re: Nmthshore Mining Company Permanent Bear Lake Outlet Final Design Repmt

Dennis,

June 9, 2008

MN DNR Waters has reviewed the "Permanent Bear Lake Outlet Final Design Repmt", dated March 19, 2008, prepared by Barr Engineering, and is satisfied with the proposed diversion design consisting of a new outlet for Bear Lake and a constructed channel for conveying the dive1ted water to the West Branch of the Beaver River.

The primary goals ofDNR Waters relating to this project are to maintain the existing water level regime of Bear Lake, and to discharge the dive1ted water into the West Branch of the Beaver River in a sustainable manner, in terms of both quantity and quality. The design appears to accomplish both goals consistent with the terms and conditions contained in the DNR Waters master permit for the project issued July 27, 1977.

I look fmward to continuing working with you as this project proceeds.

Sincerely,

Cliff Bentley DNR Waters Area Hydrologist

December 2, 2009

Depmiment of the Army

CLIFfS loiAHIRAL RESOURCES l'lC>I lhshorP. Mining r.omp:m;• 10 Oul~r Orive, Silv~ r Bay, Ml~ 55614 P 2 1B.22GA12f. f 21f..226.6037 clill~;,aiL1131reuource s.com

St. Paul District, Corps ofEngineers ATTENTION: REGULATORY BRANCH Sibley Square at lvfears Park 190 Fifth Street East, Suite 401 St. Paul Ml\T 55101-1638

Re: Operations Regulatmy (2007-00841-TWP)

To V\Thom It May Concern:

Upon agreement of the tenns and conditions ofPennit No. 2007-00841-TWP, enclosed are two, signed copies.

Sincerely,

_)w~;J1l-' Scott A. Gischia Sr. Section Manager, Environmental Nmihshore l\1ining Company

SAG/slb Enclosure

Information Technology Department

Memorandum

To: Commissioners and County Administrator

Date: October 16, 2015

From: Glen T. Backman

Glen T. Backman, Interim Director 601 3rd Avenue

Two Harbors, MN 55616 218.834.8392- 218.834.8479

Re: Request for Spending Authorization: Hybridge Imaging lnfiniVault Maintenance

Board Action Request to:

Authorize the purchase of lnfiniVault Maintenance from Hybridge Imaging, LLC for a price not to exceed $4,226.55.

Reason for Technology Expenditure:

This is an annual expense for hardware and software maintenance for the county's lnfiniVault data storage system.

Budget Implications:

This annual expense was planned for in the IT Department's 2015 budget.

Quotes attached.

I

~ilbrldgE=~ "'~/IMAGINGLLc

831 Shoreview Heights Road Two Harbors, MN 55616

Bill To

Lake County- IT 601 Third Ave. Two Harbors, MN 55616

QIJantlty ·.

'

Model30 TS Support Serial1747563 Effective dates 12/0 l/15-ll/30/16

Hybridge Federal ID# Date Invoice#

87-0753313 9/8/2015 1983

218-727-8804

mikc.stift@hybridgeimagi ...

Ship Date S.O.No. P.O. No. Terms

12/1/2015 25565 Net30

: < .· ... ' ,~ .•.. ·•.···. ·.··.

4,226.55 4,226.55

Invoice Total $4,226.55

Payments/Credits $0.00

Due Date : •· ... > ;! •·•·.·.· ·•·· •. ··•.

toJsl2Q.t5 .· ;B'AlatJ~~·~.\J~ . ·... . •.: .... · .. ·. :./ .... · ...

Thanks for your buisness

attachment with the descriptions of TS, TS24, and CS. Let me know if you have any questions!

Thank you,

Patrick

*Please email all quote requests to [email protected]*

*Please email all order requests to [email protected] OR fax 732-564-8280*

------- -- --------- '''

... ~-~~--=--1-....

MN LAKE COUNTY

Glen Backman 601 3rd Avenue Two Harbors, MN 55616 UNITED STATES Phone: 218-834-8478 Fax: Email: [email protected]

Support- 1 Year Renewal Data Trust Solutions- rt#: 28623

2 lnfiniVault Model5 TS24 Suppa -1 Year Renewal DataTrust Solutions- Part#: M5 2 18

3 lnfiniVault Model5 CS Support- 1 Year R Data Trust Solutions- Part#: 28720

4 lnfiniVault Model 30 TS Support- 1 Year Renewal Data Trust Solutions- Part#: 28625

5 lnfiniVault Model30 TS24 Support- 1 Ye Data Trust Solutions- Part#: M30 287

6 lnfiniVault Model30 CS Su rt- 1 Year Renewal rt#:28724

7 lnfiniVault Mo 35 TS Support- 1 Year Renewal DataT Solutions- Part#: 28627

lnfiniVault Model35 TS24 Support- 1 Year Renewal Data Trust Solutions- Part#: M35 28726

9 lnfiniVault Model35 CS Support- 1 Year Renewal Data Trust Solutions- Part#: 28728

Inside Account Manager

Patrick Widdoss 290 Davidson Ave Somerset, NJ 08873 Phone: 800-477-6479 Fax: 800-477-6479 Email: [email protected]

Qty

$3,127.00

$4,638.00

1 $4,733.00

$6,202.00

$8,616.00

$7,265.00

$9,574.00

----------- -----

-------------------

Total

$2,340.00

$3,127.00

$4,638.00

$4,733.00

$6,202.00

$8,616.00

$5,425.00

$9,574.00

11 Total Support 24 for lnfiniVault Additional RDU -1 Year Data Trust Solutions- Part#: RDU28449

12 Critical Support for lnfiniVault Additional RDU- 1 Year Data Trust Solutions- Part#: 28451

Additional Comments

$1.452.00 $1.452.00

$1,898.00 $1,898.00

Total $56,386.00

Currently you are under TS support. I have included the Expansion RDU in this quote because you currently have that under support as well. Let me know if you have any questions.

*Please note that the above is valid for the qty quoted. If your PO will not match the above please reach out to your inside rep to be re-quoted*

*Please email all quote requests to [email protected]*

*Please email all order requests to [email protected] OR fax 732-564-8280*

Retrieve your quote:

https://www.shi.com/Quotes/Quoteinfo.aspx

The Products offered under this proposal are subject to the SHI Return Policv. unless there is an existing agreement between SHI and the Customer.

Laurel Buchanan


Hi Laurel,

Mardi Harder [[email protected]] Sunday, October 18, 2015 7:21AM Laurel Buchanan Mary Hedin; Bette J. Vichorek Request: 2016 Lake County Extension Memorandum of Agreement 2016-2018 MOA Lake.docx

On behalf of the Lake County Extension Committee, attached please find the proposed 2016-2018 Memorandum of Agreement between Lake County and University of Minnesota contract for services for a .75 FTE 4-H Program Coordinator position for review. Please note the following requests related to this agreement:

• Review the attached document containing the proposed four page agreement. • Currently, Linda Libal, County Auditor Treasurer, is listed as the county designee for the agreement.

Please confirm if County Administrator Matt Huddleston should instead be listed as the county representative. Let me know if any changes are needed for the county designee.

• Request that the MOA be placed on an upcoming County Board Agenda for discussion and approval. • Once county signatures are obtained, please forward the signed document to Mary Hedin at the County

Extension Office for obtaining University signatures to fully execute the agreement. You will be sent a copy of the final agreement for your records.

Feel free to contact me for questions.

Thanks,

Mardi

Mardi Harder Regional Director, NE 1 Extension Regional Office- Cloquet 179 University Road I Cloquet, MN 55720 University of Minnesota Extension I extension.umn.edu [email protected] 1218.244.7980

The University of Minnesota is an equal opportunity Educator and Employer.

1

Agreement Between the University of Minnesota

And Lake County

For providing Extension programs locally and Employing Extension Staff

This Agreement ("Agreement") between the County of Lake Minnesota ("County") and the Regents of the University of Minnesota on behalf of its Extension unit, 240 Coffey Hall, St. Paul, Minnesota, 55108 ("University") is effective January 1, 2016, and supersedes and replaces any and all cunent or existing agreements relating to Extension and its programs that may exist between the County and University.

The term of this Agreement shall be three (3) years, beginning on January 1, 2016 and ending on December 31, 2018, unless earlier terminated as provided in paragraphs 8 and 9.

WITNESSETH:

WHEREAS, Minn. Stat. §38.34 authorizes a Board of County Commissioners to incur expenses and spend money for County Extension work; and

WHEREAS, the money set aside and appropriated by the County Board in the County Extension Fund may be paid out by orders of the University's Director of Extension, or the Director's designee, as identified in Minn. Stat. §38.36, Subd. 3; and

WHEREAS, Minn. Stat. §38.37 provides that Extension educators must be employed according to University personnel procedures and must be University employees; and

WHEREAS, it is the intention of the County and University that the University shall provide Extension services on behalf of the County in exchange for considerations as detailed herein.

NOW THEREFORE, in consideration of the mutual undertaking and agreements contained within this Agreement, the County and University hereby agree as follows:

1. In accordance with Minn. Stat. §38.37 County desires to augment University's state-wide Extension programs. The programs that the County will augment are detailed in Table A below.

Table A

Program FI'E 2016 Price FI'E 2017 Price FI'E 2018 Price

$0 $0 $0

4-H Program Coordinator 0.75 $51,661 0.75 $52,823 0.75 $54,144

$0 $0 $0 I

!Total _I o. 751 $51,661 I (). 751 $52,823 I o. 751 _ $54,144

2. County recognizes that University costs for supporting these positions may increase from year to year. The costs payable for these positions are reviewed by the Association of Minnesota Counties' ("AMC") Extension Committee and University's Extension central administration, at which time the patiies will agree on an appropriate inflation factor for the coming year(s). Unless County and University otherwise agree, the inflation factor will be as agreed to by AMC and University.

3. Based on the County's funding commitment, University will be responsible for providing salary & fringe benefits for the positions, enhanced programming from regional extension educator staff, program supervision, travel (mileage, meals, and lodging), in-service training within program area, payroll, and accounting services.

The County agrees to provide local suppmi in the form of office space, telephone, computer, network connections for email and other communications, software, suppmi staff and other general office supplies. The University will recommend technology needs and other office standards. Nevetiheless, the level of availability and type of such suppmi will be determined by the County.

4. University will bill the County on a qumierly basis and the County will submit payment within 35 days of receipt ofthe bill. The total annual amount to be paid by the County shall be paid in four equal qumierly payments.

5. As vacancies occur, and if the County and University agree to continue to suppmi the desired program and position, University will hire new personnel with involvement and concunence of the County Extension Committee. The County will not be billed for a position during the time that position is vacant.

6. The University will complete an annual performance evaluation of each University Extension employee working in the County and supporting the programs identified in paragraph 1. The County Extension Committee will have the option to provide input to University on such evaluation. The University in accordance with University personnel guidelines will determine salary adjustment of each University Extension employee.

7. Annually, the County Extension Committee, in coordination with University, will be responsible for approving the County Extension educational programming and services, as provided for in Minn. Stat. §38.34. The parties acknowledge that County extension educational programming includes University's Nutrition Education Program educational programming.

8. Nothing in this Agreement precludes the County or University at any time during the te1m of this Agreement from requesting a modification of the County Extension program, including an adjustment of the number of University Extension personnel working in the County. The County or University will provide a minimum of 90 days' notice if either pmiy desires a change in programs that results in a decrease in the staffing or funding level, and both pmiies agree to enter into good faith discussions to address such request.

9. If University or the County in good faith determines that funding is no longer available to suppmi the programs or positions providing services locally, either party may terminate this Agreement. Termination of the Agreement in its entirety requires a minimum of 90 days prior notice. Notice shall be dated and provided in writing to the pmiies listed below as the contacts for this Agreement.

If to County:

If to University:

Lake County Extension Linda Libal, Auditor/Treasurer 601 Third A venue Two Harbors, MN 55616 Facsimile: 218-834-8358 E-mail: auditor@co .lake.mn. us

University of Minnesota Minnesota Extension Attn: Director of Field Operations 240 Coffey Hall 1420 Eckles A venue St. Paul, MN 55108 Facsimile No.: 612-625-6227 E-mail: [email protected]

10. Each party agrees that it will be responsible for its own actions and the results thereof to the extent authorized by law and shall not be responsible for the acts of the other pmiy or the results thereof. The County's liability is governed by the provisions of Minn. Stat. Chap. 466 and other applicable laws. The University's liability is governed by the provisions of the Minnesota Tmi Claims Act, Minn. Stat. §3.736 and other applicable law.

11. Pursuant to Minn. Stat. §16C.05, Subd. 5, the University agrees that County, the State Auditor, or any of their duly authorized representatives at any time during nmmal business hours and as often as they may reasonably deem necessary, shall have access to and the right to examine, audit, excerpt, and transcribe any books, documents, papers, records, etc., which are pertinent to the accounting practices and procedures of relating to this Agreement. University agrees to maintain these records in accordance with applicable law.

12. All data collected, created, received, maintained, or disseminated for any purposes by the activities of University because of this Agreement is governed by the Minnesota Government Data Practices Act, Minn. Stat. Chap. 13, as amended, the Minnesota Rules implementing such Act now in force or as adopted, as well as Federal Regulations on data privacy.

13. The University is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran status, sexual orientation or other classifications protected by state or federal law. In adhering to this policy, the University abides by the Minnesota Human Rights Act, Minnesota Statute Ch. 363A; by the Federal Civil Rights Act, 42 U.S.C. 2000e; by the requirements of Title IX of the Education Amendments of 1972; by Sections 503 and 504 of the Rehabilitation Act of 1973; by the Americans With Disabilities Act of 1990; by Executive Order 11246, as amended; by 38 U.S.C. 2012, the Vietnam Era Veterans Readjustment Assistance Act of 1972, as amended; and by other applicable statutes and regulations relating to equality of opportunity.

IN WITNESS WHEREOF, the parties by their respective authorized agents or officers have executed this Agreement.

COUNTYofLake Regents of the University of Minnesota

BY ____ ~----~~--~~-----Chair, County Board of Commissioners

BY ____________________ ___

DATE ____________ __ DATE ____________ _

Approved as to fmm:

BY-------,---------------------county Attorney

DATE ______________ _

BY ________________________ ___

DATE ______________ _

Laurel Buchanan

From: Sent: To: Subject: Attachments:

Laurel,

Scott Zahorik [[email protected]] Tuesday, October 20, 2015 1:42 PM Laurel Buchanan Finland SCDP Pre-Application Finland Preliminary Proposal.docx

We are again submitting a Small Cities pre-application to DEED for the community of Finland this year. It is basically the same application we had submitted last year except this year we added one commercial property to the proposal. I have attached the pre-application for your review.

I was hoping that you could have Commissioner Sve sign the pre-application and then retum the signature page to me as a pdf. This is only the preliminary proposal and if the Board needs to take action on it we can do that once it moves forward to the full application process.

Let me know if that works for you or ifthere are any questions.

Thanks, Scott

Scott Zahorik Director of Housing Services Arrowhead Economic Opportunity Agency 702 3rd Avenue South Virginia, MN 55792 218-748-7331 Direct 800-662-5711

"Community Action -Helping People - Changing Lives"

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/11~5ft/4 Department of Employment and Economic Development

Small Cities Development Program(SCDP) 2016Preliminary Proposal

Submission Deadline

Thursday, November 12, 20154:30 PM

Eligible Applicants must submit one original andone copyofthePreliminary Proposalto be considered for funding to the address listed below. SCDP staff will review and evaluate all Preliminaty Proposals submitted to detennine which projects are ineligible and how competitive eligible projects would be.Ifyour preliminaty proposal is deemed noncompetitive, technical assistance with DEED concerning your proposal will occur after awards are am10unced. Keep in mind that DEED staff is assisting those that are competitive and marginally competitive during the time between the preliminary proposal and the application deadline.Please take the time to become familiar with the program prior to submitting the Preliminaty Proposal.

Preliminary Proposals must be received by DEED on or before 4:30pm, Thursday November 12, 2015. Faxed ore-mailed Applications will not be accepted.

• Only communitieswho have submitted through the Preliminaty Proposal screening process will be pennitted to submit an Application. Following the Preliminaty Proposal review, communities choosing to submit an Application must submit one original and two copies of their Application, including necessaty attachments to:

Mi1111esota Depatiment of Employment and Economic Development 1st National Bank Building 332 Minnesota Street, Suite E200 St. Paul, MN 55101-1351 Attn. Business and Community Finance Division, SCDP

The submission deadline is finn. Applicants should take this into account and make the necessary arrangements to adhere to the deadline and avoid any risk or loss of eligibilitybrought about byunanticipated delays or other delivety related problems.

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_Af_i/tPte5tJ!at Dl!partment of Employment and Economic Development

Small Cities Development Program Preliminary Proposal

City/County Applicant: Lake County for the community of Finland Application Author: Scott Zahorik

SCDP Amount Requested Amount of Other Funds SCDP Program Income Estimated Total Project Cost

$384,475 $112,760 $Q $497,235

Applicant governing board (city council, county board, township board) has approved the submission of this proposal. All secondary communities' (if applicable) governing boards have approved participation in the proposed project.

Applicant's (i.e., city/county official) Signature Date

By signing above, the Applicant certifies to the best of their knowledge that the data and information provided in the Preliminary Proposal is true and correct.

Please provide a 1,000 character or less narrative of your (and other related parties) professional experience with the activity(s) you are proposing.Lake county will be the grant recipient as well as the fiscal agent for this proposed program on behalf of the community of Finland. AEOA will provide overall administration of this potential grant.

Lake County staff are familiar with the SCDP Program and its requirements. Lake County has provided fiscal administration for the successful applications in 2008, 2010,2011, 2013 and 2015 and are willing to support this application as needed.

Continued on Attachement A.

Include experience on federal projects and Davis Bacon if applicable.AEOA staff are very familiar with Davis Bacon requirements from past SCDP projecfs in Lake and Cook Counties and the Cities of Two Harbors and Grand Marais. AEOA staff also complied with Davis Bacon requirements throughout the ARRA funded Weatherization Program as well.

Please list the activities you plan to apply for. Please separate administration costs from the activity. Activity #of Units SCDPCost Total SCDP Total Source of Total Costs

per Unit Leveraged Leveraged Funds-Sources use "c" after

source if committed

Res. Owner Rehab 12 $24,750 $297,000 $81,780 MHFAc, $378,780 Weatherization

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c, HOME Funds c, Lake County HRAc

Res. Owner Admin 12 $3,600 $43,200 $11,280 $54,480 Commercial Rehab 1 $38,500 $38,500 $17,700 Lake County $56,200

HRAc, IRRRB c

Commercial Admin 1 $5,775 $5,775 $2,000 $7,775 $ $ $ $ $ $ $ $

Totals 13 $ $384,475 $112,760 $497,235

Please fill out the information for the activities you are proposing. Leave blank if you are not proposing that activity. For Public Facilities you must list the specific activity. Wastewater treatment facility is not acceptable as an activity. Main water line, ponds, sanitary sewer lines are some good examples. For rental rehab list each activity separately such as single family, multifamily, duplex and provide separate budgets for each.

Owner Occupied Housing Rehabilitation Need

%of total LMI/SS homes proposed for rehab in area

Cost Effectiveness Max SCDP Loan Amount

SCDP% of total rehab costs

% of SCDP funds-

$24,750

70%

%If tiered explain in narrative 100%

In 1,000 characters or less describe: • Unique needs/target area needs

Average SCDP Loan Amount SCDP Administration

SCDP Loan Term

SCDP Loan Term

• How target area is impacted by this and other activities. • How activity is cost effective.

$22,000

14.5%

mths

120mths

The community of Finland, population 195, which is 6 miles inland from Lake Superior and 39 miles northeast of the City of Two Harbors in Lake County. The community was settled mainly by Finnish immigrants in 1895 and today most of the residents are Finnish Americans.

The median value of a home in Finland is $170,800 and the median household income is $54,500. These facts show that LMI homeowners in Finland have a susbstantial need for assistance to rehabilitate their homes. There is no natural gas service to the community so homeowners have no choice but to heat their homes with electricity, propane or fuel oil which only adds to the burden and reduces the ability of LMI homeowners to make the necessary repairs to their homes.

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Continued on Attachment A.

Rental Housing Rehabilitation:(51% of the units must be occupied by low to moderate households(80°/o of the area median income) and rent requirements must be met.Ifyou are applying for Minnesota Housing funds in conjunction with DEED funds complete this section. For 8 or more units Federal Davis-Bacon wages will apply.

Type of units: DSingle Family Rental DDuplex(2 units) DMulti-Family(3 or more units)

For all rentals, if more than one type of building is being proposed please complete this section for each type of building. You may need to make copies of this page.

Need # of similar rental units in community # of substandard similar rental units in

community % of substandard similar rental units in Median household income of community community A vg. age of similar rental homes in Number of bedrooms in units to be 1 BR community rehabilitated

2BR

3 BR

% of rental homes of all homes in target Rental vacancy rate in the community % area

Cost Effectiveness SCDP Max Loan Amount per unit $ SCDP Average Loan $

Amount SCDP% ofrehab costs % SCDP Administration %

% of SCDP funds -installment loan % SCDP Loan Term

In 1,000 characters or less describe: • Unique needs/target area needs • How target area is impacted by this and other activities. • How activity is cost effective.

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DEED funds in conjunction with Minnesota Housing Funds( any type): If you are applying/leveraging Minnesota Housing Funds, you must complete the DEED preliminary proposal. A full application will also be required if you are invited back by DEED

A. Please attach Minnesota Housing's Application(RRDL or MF RFP) to your submittal. If no application has been submitted please explain your intent to apply or your plan to access funds.

B. Please attach MH award letter if available. State the cunent status of all funding sources.

C. Please explain the major items that need rehab? i.e. roof, siding

D. When rehab is complete, what is the plan to occupy and maintain occupancy of these units? For example: employment housing, retirees .

A . 'f fR h bTt f cqUISI lOll e a II a lOll-H ousmg # of units requested I Total Request I$ Total Cost per unit $ I SCDP Max per unit I$ What are the loan terms? What is ownership status of propetiies? In 1,000 characters or less describe:

• Unique needs/target area needs-Why is activity needed? • How target area is impacted by this and other activities. What is your target area, • How activity is cost effective.

Acquisition/Demolition-Housing (used in disaster situations) # of units requested I Voluntmy or involuntmy acquisition I Planned reuse of site(s) Current Ownership status Is relocation necessary? Is one for one replacement necessmy? Total cost per unit $ I SCDP max per Unit I$ In 1,000 characters or less describe:

• Unique needs/target area needs: Why is activity needed? • How target area is impacted by this and other activities. • How activity is cost effective.

Relocation: Permanent(used in disaster situations) # of units requested l SCDP per unit max I $ Total cost per unit Which activity will require replacement and why? Voluntmy or Involuntmy relocation?

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j Adequate replacement housing in area? In 1,000 characters or less describe:

• Unique needs/target area needs • How target area is impacted by this and other activities. • How activity is cost effective. Include all leveraged funds and their commitment level.

Commercial Rehabilitation(must be combined with other activities in a Comprehensive Application) # of commercial buildings in target area 6 # of dilapidated buildings not suitable for rehab

10 in target area % of substandard buildings in target area 100% # of units requested 1 # of interested property 2/6 owners/properties SCDP Max Per Unit: $38,500 F~~ i';,,;iJ.)~~:/ 1 ;: 'ii. tvff~~·~f~t/1;~;"~¥/./;:~~s~f~;~~}f . ;; ·i'i •i

%of SCDP funds- % SCDP Loan Term SCDP Loan Rate % installment loan (payments) % of SCDP total funds - 100% SCDP Loan Term 5 years SCDP % of rehab 80% forgivable (grant) costs In 1,000 characters or less describe:

• Unique needs/target area needs-Identify and describe the key buildings • How target area is impacted by this and other activities. • How activity is cost effective. The community of Finland is 40 miles from the City of Two Harbors which makes the Finland Cooperative

General Store the only retail shop in the area and a true key building. The other commercial properties in Finland are Don's Auto Repair, the Maple Grove motel and Sportshop, the Four Season's Supper Club, Our Place and the West Branch Bar and Grille. The need to keep these properties viable and in place for the local residents is a top priority for the community of Finland.

This application proposes to rehabilitate at a minimum the General Store which would mean 16.7% of the commercial buildings in Finland would be rehabilitated. With the addition of the owner occupied rehabilition of homes in this applcation this Comprehensive project will be the most exciting event to occur in the community of Finland in quite some time.

Continued on Attachement A.

A ''f ID cqmsi Ion l'f emo I wn ( non-h ) ousmg. Planned reuse of site(s)-must meet a federal objective Current Ownership status Total cost per building Total SCDP cost per building How were acquisition costs determined?

In 1,000 characters or less describe: • Unique needs/target area needs-Why is activity needed? • How target area is impacted by this and other activities. • How activity is cost effective.

Community Center/Facilities

Unique need to warrant construction/rehab of activity?

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Existing facility age, condition,( uses if applicable)

Who are/will be the users of facilities?

Are 51% of users Low to Moderate Income persons? How was this determined?

Will there be user fees? If so how much?

Once complete, what community activities will be held at the center/facility?

How will operating costs of the facility be covered?


Public Facilities SCDP can only fund the construction of Public Facilities where, at a minimum, 51.0% of benefiting persons are LMI, by either the U.S. Census, or a survey. (See the "Federal Objectives for Applicants" section of the SCDP A-Z Guide.) If the HUD census dataabove indicates at least 51.0% LMI and the project is benefitting the entire city the Federal Objective has been met. No survey is required and the activity is eligible for SCDP financing. If the LMI% is less than 51.0%, you must provide survey. For a sample survey and summary form, see the SCDP website. If project is not benefiting the entire city but rather a targeted area please contact your SCDP representative for fmiher direction. SCDP funds cal1llot be used for projects anticipating future population growth.

Does the project involve service com1ections to individual households and propetiies?

If yes, how are the col1llections being paid for?

Note: SCDP funds can only pay for service connections if a permanent easement is secured, or if the service col1llection is publicly-owned. Finally, service connections can only be paid for under aSCDP housing rehabilitation activity and Housing Quality Standards(HQS) must also be met on the propetiy.

General Project Information Provide the following information for all public infrastructure construction activities( exclusive of assessment abatement), in patiicular those utilizing Public Facilities Authority (PF A) or USDA Rural Development funding.

Pre-engineering repmi DYes DNo On the Project Priority List? DYes DNo completed? Will the system benefit primarily DYes DNo Have professional services been DYes DNo residential users? procured through a competitive

process? Engineering, grant administration.

Target Area (indicate city Number of homes wide benefit or targeted area) outside of city limits

using proposed system? If applicable.

Applicant Median Household $ (HH) h1Come (from census): LMI Federal Objective met? DYes DNo % LMI Households (must be %

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>51%) either census or survey Total Population LMI Population

Source ofLMI infonnation 0 HUD LMI Census Data 0 Survey Activi!y(s) being funded with SCDP

Describe the physical need for the proposed activity. Include age, condition of facility and/or lines to be replaced

Critical Health & Safety Issues? (sewer backups, high levels of contaminants in water, out-of-compliance septic systems,violations, etc.)

Discuss the past history of actions taken to

finance operation, maintenance, and repair

including rate increases?

Explain how the system operation,

maintenance, and repair will be financed

over the useful life of the system

Total Costs and Rates Total Estimated Project Cost: $ $ Existing and Estimated Future Costs Current Estimated upon project

completion A. Annual system debt service $ $ B. Annual op. and maint.cost (do not include deprec.) $ $ C. Total $ $

Residential households (billed individually): A. Connections (Generally number ofhouses) B. ERU's (equals residential HH connections) c. Percentage of system use: % %

Other residential (multi-family, other residential facilities) A. Connections (Total could exceed# of structures) B. ERU's(Equivalent Residential Units) C. Percentage of system use % %

N omesidential A. Connections B. ERU's C. Percentage of system use: % %

Total Users: A. Connections B. ERU's C. Percentage of system use: % %

Average System Cost Per Household A. Average user rates per household - annual $ $ B. Average user rates per household - monthly $ $

s ources an d U (PI ses I F d ID . B ease apply e era avts- aeon wage rates w h d t en e ermmmg your b d ) u lget. SCDP RD PFA Local Total

Engineering $ $ $ $ $ $ Sewer Lines $ $ $ $ $ $ Lift Station $ $ $ $ $ $ Treatment Ponds $ $ $ $ $ $

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Treatment Plant $ $ $ $ $ $ Water Distribution Lines $ $ $ $ $ $ Water Tower/Tank $ $ $ $ $ $ Service Connections $ $ $ $ $ $ Streets(related to project) $ $ $ $ $ $ Administration $ $ $ $ $ $ Other: $ $ $ $ $ $ Totals $ $ $ $ $ $ In 1,000 characters or less describe:

• Unique needs/target area needs • Target area impact • How activity is cost effective. State commitment level of all leveraged funds.

Assessment Abatement DEED is limiting assistance for this activity to applications targeting very low income households (50% or less of county median). Assessments plus projected user rates must be over affordability threshold.Affordability threshold equals: Projected monthly cost per Equivalent Dwelling Unit(EDU's) are at least 1.5% of the latest median household income or $35.00 dollars per month, whichever is higher

If PF A or RD funding is being requested for construction, have they indicated that abating assessments are needed tokeep rates affordable? D Yes D No/f "No," this activity is not eligible for SCDP funding.

Assuming that the amount assessed will be structured as rate increases. Does the projection show a grant need? D Yes D No/f "No," this activity is not eligible for SCDP funding.

• Provide an estimate of the number ofVLI Households served by the construction activity; • Identify and explain the funding sources for construction of the public facility (bond, PFA, RD etc.); • Has an assessment hearing been held? If so, when? If not, when will it take place? • If average assessment is projected to be over $15,000, please explain?

• Provide the Census County Code and Tract Code of the locality where the project will take place. The source for this information is: http://www.ffiec.gov/Geocode/default.aspx.

County code ___ (3 digits, example 005) Tract Code ____ (example 9501.00)

Is the project that is facilitating this request already complete? Yes or No


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Name of Applicant: Lake County for the community of Finland I. Applicant Information (city/county/township)

Authorized Official & Environmental Certifying Officer Information (Mayor or Board Chair whichever is applicable)

Name: Rich Sve Title: Chairperson, Lake County Board Address: 601 3rd Avenue South, Two Harbors, MN 55616

Phone#: (218)-834-8320 Fax#: (218)-834-8360 Email: [email protected]

Federal ID #:41-6005823 State ID #:8026851 State Vendor #:021 438000-00 Applicant DUNs #:0876154551

Administrator/Implementing Agency Information

Name: Scott Zahorik Title: Director of Housing Services Address: 702 Third Avenue South, Virginia, MN 55792

Phone#: (218)-748-7331 Fax#: (218)-749-2944 Email: [email protected] Administrators DUNs #082523713

Environmental Coordinator


Phone#: (218)-748-7331 Fax#: (218)-749-2944 Email: [email protected] Rehabilitation Coordinator

Name: Dave Johnson Title: Housing Rehab & Weatherization Manager II Address: 702 Third Avenue South, Virginia, MN 55792

Phone#: (218)-735-6818 Fax#: (218)-748-7333

Applicant Author Information



Applicant Financial Officer Information

Name: Linda Libal Title: Lake County Auditor Address: 601 3rd Ave, Two Harbors, MN 55616


Individual Signing SCDP Payment Request Form (Applicant or ProgramAdministrator)


Phone #:(218)-748-7331 Fax #:(218)-749-2944 Email:[email protected] Fair Housing/Equal Opportunity Coordinator

Name: Laurel Buchanan Title: Clerk of the Board, Lake County Address: 601 3rd Avenue South, Two Harbors, MN 55616

Phone#: (218)-834-8320 Fax#: (218)-834-8360 Email: [email protected] Labor Standards Coordinator (when applicable)

Name: Joe Stanaway Title: Housing & Energy Conservation Inspector Address: 702 Third Avenue South, Virginia, MN 55792

Phone#: (218)-735-6835 Fax#: (218)-748-7333

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Inspector's Info:

Name: Joe Stanaway Title: Housing & Energy Conservation Inspector

Grantee/ Administrator/Co-Funder/ Author/Legislative District Information Sheet

Small Cities Development Program - State of Minnesota

Income Verification Info:

Name: Mary Politano

Title: Rehab Loan Coordinator

Address:702 Third Avenue South, Virginia, MN 55792 Phone #: (218)-735-6835

Address: 702 Third Avenue South, Virginia, MN 55792 Phone#: (218)-735-6831

Fax #: (612)-486-9060

Fax #: (218)-748-7333 Email: joe.stanaway @aeoa.or

Email: mary .politano@ aeoa.org

II. Co-Funder Contact Information: If one of the proposed activities within your Application is also requesting funding from Agencies such as MN Housing /Greater MN Housing (rental new development); Public Facility Authority and/or Rural Development (public facility projects) to the make the project financially feasible, please provide the following information for each respective funding partner.

Agency: Agency:

Name: Name: Title: Title: Address: Address: Phone#: Phone#: Fax#: Fax#: Email: Email:

III. Author of Application (Complete only if different from information previously provided above)

Agency:

Name: Title: Address: Phone#: Fax#: Email:

IV.Legislative District Information (Provide the following information for the geographical district(s) the SCDP funded activities are taking place in.)

House District: 3A

Congressional District 8

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Professional Experience, continued from Page 2.

AEOA has been involved with SCDP projects since the 1990's. AEOA's most recent projects include the 2015 Single Purpose Housing Project for the community of Knife River, 2014 Comprehensive application for Cook County and the Single Purpose application for the City of Beaver Bay both of these projects are well under way. 2013 projects include a Comprehensive application for Lake County and the City of Two Harbors and the Single Purpose Housing application for the City of Silver Bay.

AEOA has been working with other similar funds to provide rehabilitation services to the residents of Saint Louis, Lake and Cook Counties for over 40 years. A number of these other funds will also be resources to potentially be used as matching funds for this application.

Scott Zahorik, the Director of Housing Services at AEOA, has worked with SCDP projects since 1997, authored numerous successful SCDP applications and has directed 26 successful SCDP projects for 23 different communities. Scott has worked in the past as an Assistant Director and also as a Rehabilitation and Weatherization Auditor.

David Johnson, the Housing and Weatherization Manager at AEOA, has worked for AEOA for 7 years in the Rehab and Weatherization Programs. Dave has worked with the SCDP Programs for 7 years and is very familiar with Davis Bacon requirements and reporting and is also a licensed Lead Risk Assessor. Dave is a licensed general contractor with over 23 years experience prior to joining AEOA and continues to maintain his contractor license annually. Dave is now supervising both the Rehabilitation and Weatherization Programs.

Barbara Ackerson, the Community Technical Assistance Manager, has been with AEOA since 1998. She has an extensive financial background including over 23 years in the banking business as a real estate lender and served as Assistant Vice-president. She is a certified Homeownership Counselor. She is certified by National Development Council (NDC) as a Housing Development Finance Professional. Her current position with AEOA is Community Housing Technical Assistant for the entire Taconite Assistance Area helping communities address their housing issues. Barbara also is a licensed real estate agent in the State of Minnesota.

Cary Johnson, a Housing and Energy Conservation Inspector at AEOA, is a Certified Housing Inspector, Certified Energy Auditor, Licensed Lead Risk Assessor, and MN State Certified Building Official - Limited. Cary has also earned an Occupational Certificate in Housing Inspection and a one-year certificate in Building Inspection Technology through North Hennepin Community College and is certified in Property Maintenance and Housing Inspection through BOCA International. He has over 27 years of experience in weatherization services, energy-related repairs, electrical energy audits, and rehabilitation of singlefamily dwellings. Cary monitors work progress on rehabilitation projects, develops job specifications, keeps project records, and maintains relationships with local contractors and officials. Cary has worked with the SCDP Programs for 6 years.

Joe Stanaway, a Housing and Energy Conservation Inspector at AEOA, has worked for AEOA for just over a year as a Rehabilitation and Weatherization Inspector. Joe monitors work progress on rehabilitation projects, develops job specifications, keeps project records, and maintains relationships with local contractors and officials.

Mary Politano, a Rehabilitation Loan Coordinator at AEOA, has 10 years of lending processing and originating experience and over 20 years of administrative and marketing experience. Mary started with AEOA in June of 2015.

Jeannine Carlson, the Housing Supervisor of Finance at AEOA, has worked for AEOA in the Fiscal Department for 17 years and then in the Housing Department for an additional18 years as the Supervisor of Finance. Jeannine has an AA Degree in Accounting from Mesabi Community College and a BS Degree in elementary education from Saint Cloud State University.

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Owner Occupied Housing Rehabilitation, continued from Page 3.

Add to that the fact that 22% of the population of Finland is over 60 years old and it presents a very clear picture that owning a home in Finland presents some very significant challenges for all homeowners, much less for the LMI population.

A survey of homes in Finland has also shown that the physical need is substantial. Of the 51 substandard homes 19 need to have roofs replaced, 16 need siding replaced, 24 need new doors, 25 need new windows and 23 need new steps or handrails.

The community of Finland has basically two segments to the population the first being the well to do for which living in the area does not present a problem and the second being the LMI population which are typically working two to three jobs in their attempt to meet the high cost of living in the area.

This proposed program would rehabilitate 12 (16%) of the 74 owner occupied homes within the community of Finland and would have a very substantial effect on the overall picture of housing within the community.

This proposed project will be further enhanced by the leveraged resources which will be brought to bear in this project. These resources will include programs administered by AEOA such as the Fix-up Fund and Deferred Loan Programs from Minnesota Housing which can provide additional rehabilitation funds for qualifying homeowners. Another resource will be the Weatherization Program from the Department of Energy Resources which can provide insulation upgrades and other energy efficient upgrades to the home and mechanical systems for qualifying homeowners. The Energy Related Repair Program also from the Department of Energy Resources which can upgrade mechanical systems for homeowners that meet the guidelines of the program will also be available to qualifying households.

Discussions with potential applicants to this program have shown that with the high housing costs in Finland that a deferred loan program is what it will take to meet their rehabilitation needs. Adding the other match funds to the SCDP funding will serve to meet those needs and will also likely extend the reach of this program beyond the 12 units in this proposed program.

Commercial Rehabilitation, continued from Page 6

The loan terms proposed in this application are to fund 80% of the rehabilitation costs, up to $38,500 with a deferred loan that has a five year term. This proposed loan has been determined through conversations with the building owner to be both cost effective and affordable to them.

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Laurel Buchanan


Laurel,

Sharon Lind Wednesday, October 21, 2015 9:30AM Laurel Buchanan Steve Vankekerix; Chrissy Libal LCAS invoice LCAS invoices.pdf

Can you put this on for approval at the next Board meeting? The language to use is:

"Authorize payment in the amount of $4,212.00 to Lake County Ambulance Service for emergency

transportation provided for Lake County Jail inmates to Lake View Memorial Hospital."

Thanks,

8h.a.tc.on J.i.nd. Office Assistant Lake County Sheriffs Office 613 3rd Avenue Two Harbors, MN 55616 (218) 834-8440

This e-mail message is intended only for the addressee(s) and contains information that may be confidential and/or legally protected. If you are not the intended recipient, please notify the sender by reply e-mail and immediately delete this e-mail. Use, disclosure or reproduction of this e-mail by anyone other than the intended recipient(s) is strictly prohibited. No representation is made that this e-mail or any attachments are free of viruses. Virus scanning is recommended and is the responsibility of the recipient. For persons with disabilities this information is available in other formats by contacting us at (218) 834-8385.

1

Venders Number Warrant Number ----------------------- -------------------Total$ Amount Date Paid

LAKE COUNTY, MINNESOTA

Courthouse, 601 Third Avenue, Two Harbors, MN 55616

Claimant's Name LAKE COUNTY AMBULANCE -------------------------------------------------------------------------Address P.O. BOX 2122

City RIVERVIEW, Ml48193-1122

Date of Delivery Itemize Fully $Amount 6/23/2015 patient acct number 15-135480 $1,266.50

7/1/2015 patient acct number 15-143956 $1,266.50 6/27/2015 patient acct number 15-139223 $1,679.00

I declare under penalties of perjury that I am

(insert title of office and name of firm, If claim is by a firm)

the claimant making the within claim; that I have examined said claim and the same is just and true; that the money therein charged

was actually paid for the purposes therein stated; that the property therein charged was actually delivered or used for the

purposes therein stated, the value therein charged; that the services therein charged were actually rendered and were of the

value therein charged; that the fees therein charged are offical and such as are allowed by law; that no part of said claim has

been paid; and said claim against LAKE COUNTY is for

$

Date Signature of claimant ----------------------------FUND DEPARTMENT PROGRAM SERVICE OBJECT $AMOUNT

01 202 6381 $4,212.00

APP'o"dby £,._(\,~/'~~ Dote ~jQ-2..)'-~ this claim has been examined and ttVe goods dr s6'iVices t~er~1 referred to, have been delivered or rend~. and the amount

claimed is correct. This claim has been found to be correct an~rdered paid by Resoluntion of the County Board

committee on claims and accounts Chairman, Lake County Board of Commissioners

HEALTH INSURANCE CLAIM FORM

LAKE COUNTY JAIL IN TWO HARBORS

613 3RPAVENUE

TWO HARBORS, MN 55616

t a:: w 0: r:c (3 APPROVED BY NATIONAL UNIFORM CLAIM COMMITIEE (NUCC) 02/12

ITIJPICA PICA ITT+ (For Program In Item 1) 1. MEDICARE MEDICAID TRICARE

=:J (Medicare#) D (Medicaid#) D (/D/1/DoD#)

CHAMPVA GROUP FECA OTHER 1a. INSURED'S J.D. NUMBER HEALTH PLAN D BLKLUNG D 0 (Member/D/1) [8] (ID/1) (ID#) · {ID#)

2. PATIENT'S NAME (Last Name, First Name, Middle lnl!lal) 3. PATIENT'S BIRTH DATE SEX MM I DD I yy rvl D

M~ F 5. PATIENT'S ADDRESS (No., Street) 6. PATIENT RELATIONSHIP TO INSURED

seu[B SpouseD ChlldD OtherD

4. INSURED'S NAME (Last Name, First Name, Middle lnlllal)

SAME

?.INSURED'S ADDRESS (No., Street)

'

STATE B. RESERVED FOR NUCC USE CITY !STATE z TWO HARBORS MN ° ~~~~~~------~~~~~~~~~~ ~~~-----------.~==~~~~--~~----4~

CITY

ZIP CODE IT(ELEPHONE (Include Area Code) ZIP CODE ITELE(PHONE ()Include Area Code) ~

L5~5~6~1~6~~~~~~~~~~~~'-'~~~_j~~~~~~~~==~~=---~~~==~~~~~~~~~~~----------_J~ 9. OTHER INSURED'S NAME (Last Name, First Name, Middle Initial) iO. IS PAT)ENT'S CONDITION RELATED TO: 11. INSURED'S POLICY GROUP OR FECA NUMBER ~

Cl ~a-.-IN_S_U_R_E_D'_S_D_A_T_E_O_F_B_IR_T_H _______________ S_EX------------1~

MM 1 DO 1 YY :::1

D YES [1jNo 1 l MD FD Cl)

~~~--~--~----~~~--~~-------=~----~~ b. AUTO ACCIDENT? PLACE (State) b. OT

1HER CLAIM ID (Designated by NUCC) 0

DYES [])NO L___j : ~

a. OTHER INSURED'S POLICY OR GROUP NUMBER a. EMPLOYMENT? (Current or Previous)

b. RESERVED FOR NUCC USE

c. RESERVED FOR NUCC USE c. OTHER ACCIDENT? c. INSURANCE PLAN NAME OR PROGRAM NAME ~ • · DYEs. [1jNo · ·: · · .. , LU

~~~~~~~~~~~~~=-----------~~~~~~~~==~~~---1~~~~~~~~~~==~~--------------1~ d. INSURANCE PLAN NAME OR PROGRAM NAME 1 Od. CLAIM CODES (Designated by NUCC) d. IS THERE ANOTHER HEALTH BENEFIT PLAN? n.

READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other Information necessary

to process this claim. I also request payment of government benefits etlher to myself or to the party who accepts assignment below.

SIGNED SIGNATURE ON FILE DATE 06/23/2015

DYES [8] NO If yes, complete items 9, 9a, and 9d.

13. INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize payment of medical beneflls to the undersigned physician or supplier for services described below.

SIGNED SIGNATURE ON FILE

14. DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP) 15. OTHER DATE 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION

QUAL.I1

11

MM 1 DO I YY MM 1 DO 1 YY MM 1 DD ! YY MM1 DD, YY I 06 J 23 : 2015 QUAL.! 431 I I FROM I I TO I I

I I l I

17. NAME OF REFERRING PROVIDER OR OTHER SOURCE I

; 19. ADDITIONAL CLAIM INFORMATION (Designated by NUCC)

17a.

17b.

21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY Relate A-Lto service line below (24E)

A. I 78650

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'B. I 78605

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20. OUTSIDE LAB? $CHARGES

DYEs DNo / I 22. RESUBMISSION

CODE I ORIGINAL REF. NO.

23. PRIOR AUTHORIZATION NUMBER

1

24. A. DATE(S) OF SERVICE B, C. ,D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. Z From To PlACE OF (Explain Unusual Circumstances) DIAGNOSIS 0fj~S 'j!'!,~ ID. REI~DERING 0

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25, FEDERAL TAX I.D. NUMBER

411893902

SSN EfN

D0 31. SIGNATURE OF PHYSICIAN OR SUPPLIER

INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse apply to this bill and are made a part thereof.)

LAKE COUNTY AMBULANCE 09/15/2015 SERVICE

SIGNED DATE

· lFor govt. claims. see back) . 26. PAl lENT'S ACCOUNT NO. ) 27. ACCEPT ASSIGNMENT? !28. TOTAL CHARGE 129. AMOUNT PAID 130. Rsvd for NUCC Use

15-135480 ! [8]vEs DNo 1

s 126~50 s qoo :

32. SERVICE FACILITY LOCATION INFORMATION 133. BILLING PROVIDER INFO & PH# ( 800 ) 926-<'985 From: 613 3RD AVE LAKE COUNTY AMBULANCE SERVICE

TWO HARBORS MN 55616

a.

To: LAKE VIEW HOSPITAL TWO HARBORS MN 55616

PO BOX2122 I

1 RIVERVIEW, Ml 48193·1122

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613 3RD AVENUE

TWO HARBORS, MN 55616 HEALTH INSURANCE ClAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITIEE (NUCC) 02/12

fTliPICA

1. MEDICARE MEDICAID TRICARE tJ (Medicare#) D (Med/ca/d/1) 0 (/D/1/DoD/1)

CHAMPVA GROUP FECA 01HER 1a. INSURED'S !.D. NUMBER (For Program In Item 1)

2. PATIENT'S NAME (Last Name, First Name, Middle Initial)

5. PATIENT'S ADDRESS (No., Street)

HEALTH PLAN BLKLUNG D (Member/D/1) [8] (/D/1) D(/D/1) D(/D/1)

3. PATIENT'S BIRTH DATE SEX MM I DO I YY lvl D

M~ F

6. PATIENT RELATIONSHIP TO INSURED

Self[8J SpouseD ChlldD OtherD

4. INSURED'S NAME (Last Name, First Name, Middle Initial)

SAME 7. INSURED'S ADDRESS (No., Street)

CITY ISTATE 8. RESERVED FOR NUCC USE CITY )STATE 5 TWO HARBORS MN r:

~~~-----------.==~~~~~~~~----~~ ZIP CODE ~T~LEPHONE (Include Area Code) ZIP CODE )TELE(PHONE ()Include Area Code) a:

~5~5~6~16~~~~~~JJ--~~~~~~~---l~~~~~~~~~~~---l~~~~~~~~~~~~~----------_j~ 9. OTHER INSURED'S NAME (Last Name, First Name, Middle Initial) 10. IS PATIENT'S CONDITION RELATED TO: 11. INSURED'S POLICY GROUP OR FECA NUMBER S

Cl ~a-.~~~~~S~U~R~E~D~'S~D-A~T_E_O_F_B~I-RT-H~-------------S~E~X~--------~~

MM : DD : yy MD m ~ I FD z

a. OTHER INSURED'S POLICY OR GROUP NUMBER a. EMPLOYMENT? (Current or Previous)

DYEs [K]No ~~~~~~~~--~~~~----------~==----~-

PLACE (State) b. OT,HER CLAIM ID (Designated by NUCC) g DYES [8] NO '...__j I ~

b. AUTO ACCIDENT? b. RESERVED FOR NUCC USE

~~~--------------------------------~L c. OTHER ACCIDENT? c. INSURANCE PLAN NAME OR PROGRAM NAME z

·· DYEs. [K]No w c. RESERVED FOR NUCC USE

~~~~~~~~~~~~~~-----------r.~~~~~~~==~~~----~~~~~~~~~~==~~~------------~~ d. INSURANCE PLAN NAME OR PROGRAM NAME iOd. CLAIM CODES (Designated by NUCC) d. IS THERE ANOTHER HEALTH BENEFIT PLAN? 0.

READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other Information necessary

to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment below.

SIGNED SIGNATURE ON FILE DATE 06/23/2015

14. DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP) MM : DD I yy I

QUAL.: i 15. OTHER DATE

MM : DD , yy 07 ! 01 J 2015 QUAL: 431 I I l

17. NAME OF REFERRING PROVIDER OR OTHER SOURCE

19. ADDITIONAL CLAIM INFORMATION (Designated by NUCC)

21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY Relate A-Lto service line below (24E)

A. 178650

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24. A.

25. FEDERAL TAX 1.0. NUMBER

411893902

B.IL._... ___ _ c . .__ I __ _ F.L--1 _____ _ G. 1'--------

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00

I

I

I

I 26. PATIENT'S ACCOUNT NO.

15-143956

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D.IL._... ____ _

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31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse appl)• to this bill and are made a part thereof.)

32. SERVICE FACILITY LOCATION INFORMATION From: 613 3RDAVE . TWO HARBORS MN 55616

LAKE COUNTY AMBULANCE 1 0/06/2015 SERVICE

SIGNED DATE . a.

To: LAKE VIEW HOSPITAL TWO HARBORS MN 55616

DYES 0 NO If yes, complete Items 9, 9a, and 9d.

13. INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize payment of medical benefits to the undersigned physician or supplier for services described below.

SIGNED SIGNATURE ON FILE

16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION MM 1 DO , YY MM . DD • YY

FROM : I TO : i

20. OUTSIDE LAB? S CHARGES

DYES ONo I I 22. RESUBMISSION

CODE I ORIGINAL REF. NO.


I a. 1457346223 ,b. G2 411893902

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1

2

3

4

5

3

HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITIEE (NUCC) 02/12

LAKE COUNTY JAIL IN TWO HARBORS

613 3RD AVENUE TWO HARBORS, MN 55616

!TTl PICA -- --

PICA ITT 1. MEDICARE MEDICAID TRICARE CHAMPVA GROUP FEClu OTHER 1a.INSURED'S I.D. NUMBER (For Program In Hem 1)

~ (Medlcarell) D (Med{ca/dll) D (IDII/DoD#) HEALTH PLAN D BLKL NG

D (Member/D/1) 18] (JD#) (ID#) D(ID#)

2. PATIENT'S NAME (Last Name, First Name, Middle lnl!fal) 3. PATIENT'S BIRTH DATE SEX 4. INSURED'S NAME (Last Name, First Nama, Middle Initial) ~~ MM 1 DO 1 YY M~

FD SAME 5. PATIENT'~ ADDRESS (No., Street) 6. PATIENT RELATIONSHIP TO INSURED 7. INSURED'S ADDRESS (No., Street)

self~ SpouseD ChildD OlherD

CITY flSTATE

B. RESERVED FOR NUCC USE CITY 'STATE z SILVER BAY "v1N 0

~ ZIP CODE I TELEPHONE(Includa Area Code) ZIP CODE I TELrHoNE )nclude Area code) ~

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9. OTHER INSURED'S NAME (Last Name, First Name, Middle Initial) 10. IS PATIENT'S CONDITION RELATED TO: 11. INSURED'S POLICY GROUP OR FECA NUMBER ~ 0 L!J

a. OTHER INSURED'S POLICY OR GROUP NUMBER a. EMPLOYMENT? (Current or Previous) a. INSURED'S DATE OF BIRTH SEX oc JZIXZ267178300 DYES []No

MM I DD 1 YY MD FD :J

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b. RESERVED FOR NUCC USE b. AUTO ACCIDENT? PLACE (State) b. OT1HER CLAIM ID (Designated by NUCC) 0

DYES ~NO I z t______i I ~

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d. INSURANCE PLAN NAME OR PROGRAM NAME 1 Od. CLAIM CODES (Designated by NUCC) d. IS THERE ANOTHER HEALTH BENEFIT PLAN? "( Q.

BLUE CROSS BLUE SHIELD OF MINNESOTA [!]YES DNo If yes, complete Items 9, 9a, and 9d.

1 READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 13. INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize

12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other lnlormallon necessary payment of medical benefits to !he undersigned physician or supplier lor to process this claim. I also request payment of government benefits either to mysell or to the party who accepts assignment services described below. below.

SIGNED DATE SIGNED --14. D~TE OF CURRE~T ILLNESS, INJURY, or PREGNANCY (LMP) 15. OTHER DATE 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION

M 1 DO· Y I QUAL.:

I MM I DD 1 yy MM 1 DD : YY MM , DD , YY 06 : 27 i 2015 QUAL.: 431 I I I FROM I TO I

I I I I . 17. NAME OF REFERRING PROVIDER OR OTHER SOURCE

17a. ~t- 18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES I --- -- -------------------------- MM I DD I yy MM : DD I yy

17b. NPI FROM : TO ' 1 I · ! I

19. ADDITIONAL CLAIM INFORMATION (Des~nated by NUCC) 20. OUTSIDE LAB? $CHARGES POSSIBLE PSYCHOLOGICAL BREAK NCOOPEMTIVE POSSIBLE THREAT TO SELF AND

DYES DNo I I OTHERS 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY Relate A-Lto service line below (24E) lCD Ind. J9 ' 22. RESUBMISSION

: CODE

I ORIGINAL REF. NO.

A. 13009 B. I c. I D. I E. I F. I G. I H. I


I. I J, I K. I L.l 24. A. DATE(S) OF SERVICE B. c. I D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. z

From To PlACE OF (Explain Unusual Circumstances) DIAGNOSIS DAYS EPSOT !D. RENDERING 0 OR Fam}J Mlv\ DO YY MM DD YY SERVICE EMG CPT/HCPCS I MODIFIER POINTER SCHARGES UNrrs Plan QUAL. PROVIDER ID. # ~

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' 25. FEDERAL TAX I.D. NUMBER SSN EIN • 26. PATIENT'S ACCOUNT NO. : 21 . .{}£~~f.It!f~~~.~~b'jr~m 28. TOTAL CHARGE 129. AMOUNT PAID 130. Rsvd for NUCC Usa

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31. SIGNATURE OF PHYSICIAN OR SUPPLIER · 32. SERVICE FACILITY LOCATION INFORMATION 33. BILLING PROVIDER INFO & PH # ( BOO ) 926-89Bb INCLUDING DEGREES OR CREDENTIALS From: 613 3RD AVE , LAKE COUNTY AMBULANCE SERVICE (I certify thatlhe statements on the reverse TWO HARBORS MN 55616 apply to this bill and are made a part thereoi.) ESSENTIA ST MARYS DULUTH

I POBOX2122

LAKE COUNTY AMBULANCE 09/28/2015 To: ' RIVERVIEW, Ml 48193·1122 DULUTH MN 55808 SERVICE i

a. ,b. j a. 1457346223 jo. G2 411893902 SIGNED DATE -

NUCC Instruction Manual available at: www.nucc.org PLEAS£ PRINT DR TYP£ CR06i653 APPROVED OMB-0938-1197 FORM 1500 (02-i 2)

-- ·(htiting L11kt.' Sllflt'l'ior'.\ North:.~·lr;ll'!' :1Ju·ough l.ocal Co_operarion

Nortlt Shore· Ma::~1agernenr.-Bo_ard

~,!_· A,.:.....,_.:.--. .... .,._ ...... h-~·fv~'-•~~--,...... ............ --~ .,._~---- ~· ... ~ ~-··· -~~~-=~!~-~~~~~~...;·'"'l'' ~-s.~~P~v·,~~ ......... """""'"------.. -""'."'"'-~~~-,.......,..~

-:

. Qct6ber zo, 2015 .,

)_:

Pear Nqrth Shore M~n~g~n)enf Mefnb'er~ .

· ·E~ch new fiscal yea.r, the. North ~horeMariagelment BqarcJ (N?MB) ~:sks its member entitle~ tq . · co~tinue their m~m.b.er$hip aQ~· tp. pr~vid~ f9f}<:fing ~owa(ds the; NSMB~s actiyiti~s. ·. Enclosed .is

-· an lnvoiQ9 for Fiscal Year 20te (July 1 I 201.9' to Julie' 30, ~Q)6) fundihg,. The. North Shore . -M~nag~ment i:loa.rd i~ ·respom;.iple f¢(definlng tile mlnimt:iffi zoning stan,~ards for Minnesota't?

· North Shore ofJ.ake ·supedot Jne B9arc;i'_s area Qf aqtn.ority ·is property lhat-lies·.~etv/een ~~k~ . $uperibr and a line ·that i~ 30.0 fel3t ihl~nd fi:9h1 HighWay 61- or a <tine that .is~ 1,009 feetfrorir flie La~e $~;~peniorr :Whio~ever is ·gre.ater, . The NSMB .also· reylews. variance; conditional use, and· other ?!oning _ appl[cations/lssues' td provide _lonaljqrisdlctlons with addi.tiohal feedb~ck rt§g~arding pertinent d~ve19pment isst~es ·along th~ shore. · · · ·

.. .: ;· i ,_ '

. This year Ui.e · NSM~ Will· be.' vYill be· undertaking. ah update to. the North-Shon:f M~nagement · -Plan during; a~ Jt ha$ bee.n nearly teh ye~r$ siri~ 'the last ypdate;. The update· process. wifl - . e.ntail meetings with key stakehb.lq~rs; locaf gov~mment officials, zgniilg board mem~er~i 'and the put)ligto. gather iriputfor. Cli'anges to th~ plah. ~The __ primarY foau·s of the Upd~te. will'. be

. . m~kihg. th:e plan's: .c_qntent$ more a·cces~i.bk~ ~nd yserwfrfendly through a ne'J.{ 9111irie· format. · Additioh~lly, the N$MB will l.{eJoo!<trig'_to ihiplement$or:ne oft~-~ Mxt step$ J1ighlight_eg in tre · ·. r~in _ gar<:!<?h as~.e~sment~ J9PI11P.Ieted last ')tear).; to help further efforts- ·of ·rain g5it'den · Qohsfn1cti_orl' and edocatiorT all ·~*mg the ~hore: · · ·

' -' '- ; I' - - \ ' ;__ ' '

.· .. If you h~ve'questionior_cq111merits reg~rding.the NSMB.o.ftt;]e pl~n·update, you· may ~ake· .. · your. request'to .any ·NsMB member or- cont~ct Justin dtse~, Plarml;)r, R~g.ional Planning D_lvJsi_on ofARDC"at 218~5294529'or by email to [email protected]. . ·

We. hope yqu will Join 'us- in. our effort~ by :contiflliiNfYoUr support. . . .

-. . . . /~-- . . , Thanka:.YO-U. , .... _._-.. _ . ;-/ . .

·ctt-=~·;f~~ ~/ -. . ~-. ':y_· _ ... · . ·_, -_· __ · -<-,;_/_ ~··' .. -~. ·. 6~·):.· ~. : . ..:.~:·

r' '·. ' .. /.' . . . · ' Mike Hoops ':' · · ·. · · -~ . · ·

Chair · · .· N'oiih·Shore ManagementHoard · .- .

· · Enc.

... -.·-.

· TO)_··.. ~· ~ l ~· .wr IE · .. -_® \n) . : OCT Z'l 2015 · l\d) · . COMMI$SION~RS-9FFJGE . , LAKECQUNTY,COURT H.OUSE -··

l'w800:.232'-0707 o. 221 W. lst Sti·eet '? Duluth, Minri~:{ota 55802 o 2J 8-722:-55'45.

' ·~ . _y

(11'1 ..

-~-~-

North Shore· '-~.>.,.,..

·~~2:;l~~~~~ , . Management BOard U~Jitfng r~tke Sui~~riot•.; North /lllore

· .. Through L1cai Coopefati(}n. ·.,· :,· J r·' .·· .·.1-·j .·. ·. ,·

. . '

· . OCtober 20, 2CH5 ·

··. ,, ..

- (ake County · . Attn: Matthew Huddlesto·n -

· Lak~ County Courthouse 601 Third Avenue . : . Two Harbors, MN · ~5616

Invoic_e # : . . . 2658.

Iuvoice_-

order#:- 170019-Lake

I') •

. 'r.!

Description: . An~ual Local Match pledged toward the NSMB 7/1/2015 to 6/30/2016 ·. ·

· T,ota,l Amount Due $2,500:90 . . . \-·

Make ~hecks payable'to the North Shore Mc:mag€m1ent Board. pleas~ reference our order# and· invoice # on your remittiance. · -.

Remit to: North Shore Mahager}Jent,Boafd-, cjo ARDC - .

221 West First st. . Duluth, MN _ 55802·.

"· ·.

't,-

' ~- '

.,·_

:0

DATE: 10/27/2015

LAKE COUNTY Planning and Zoning

Courthouse, 601 Third Avenue Two Harbors, MN 55616-1565

(218 )834-8325 FAX 834-8365

TO: Board of Commissioners I County Administrator

FROM: Christine McCarthy, Environmental Service Director/Planning & Zoning

SUBJECT: P-15-002- "Breezy Point on Lake Superior"

I am respectively submitting the above named plat for final County Board approval. The technical aspects of the plat have all been met.

Thank you.

AN EQUAL OPPORTUNITY EMPLOYER


October 27, 2015

WHEREAS, Odyssey Development submitted a final plat application (P-15-002) for "Breezy Point on Lake Superior, LLC" on property described as 12.34 acres out of Outlots 11 & 12 of Gov Lot 1 as desc in Doc No A000162619 Parcel Code #:25-5211-21352); and,

WHEREAS, The Planning Commission held a public hearing on May 18, 2015 and determined the preliminary plat application met the intent of the Comprehensive Plan and basic criteria of the Lake County Land Use and Subdivision Ordinances; and

WHEREAS, the Planning Commission gave preliminary plat approval and recommended final plat approval to the Lake County Board of Commissioners upon completion of all the requirements of the final plat application.

NOW THEREFORE BE IT RESOLVED that with the completion of the requirements of the Lake County Subdivision Ordinance the Lake County Board of Commissioners the final plat application, P-15-002, for "Breezy Point on Lake Superior, LLC."



AGENDA October 27, 2015 LAKE COUNTY BOARD OF …€¦ · LAKE COUNTY BOARD OF COMMISSIONERS...

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