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Resolution 2020-31131 RESOLUTION NO. 2020-31131 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AMENDING RESOLUTION NO. 2016-29465, WHICH APPROVED A PERPETUAL EASEMENT IN FAVOR OF THE STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION ("FDOT"), FOR CONSTRUCTING, MAINTAINING AND REPAIRING A PORTION OF ALTON ROAD ON CITY PROPERTY KNOWN AS THE "MIAMI BEACH GOLF COURSE," LOCATED AT 2301 ALTON ROAD, ALONG THE EAST SIDE OF ALTON ROAD, FROM MICHIGAN AVENUE, FOR 581 FEET TOWARDS THE NORTH; SAID AMENDMENT AMENDING THE SCOPE OF THE EASEMENT TO INCLUDE THE INSTALLATION AND MAINTENANCE OF A SIGNALIZATION MAST ARM; AND FURTHER APPROVING AND AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE THE AMENDED EASEMENT AND THE DONATION OF PROPERTY TO THE FLORIDA DEPARTMENT OF TRANSPORTATION, IN THE FORM ATTACHED TO THIS RESOLUTION AS COMPOSITE EXHIBIT "1". WHEREAS, in 2016, the State of Florida Department of Transportation ("FDOT") proposed to improve the intersection of Michigan Avenue at Alton Road; and WHEREAS, the construction work, which began in April of 2017 and has now been completed, included roadway reconstruction, drainage improvements, intersection improvements, milling and resurfacing, adjustment of numerous valves and manholes, sidewalk and curb ramps, signage, pavement markings, and signalization; and WHEREAS, at the time, FDOT requested that the City grant it a perpetual easement ("Easement") to accommodate this project on land the City owns, known as the "Miami Beach Golf Course," located at 2301 Alton Road ("Golf Course"); and WHEREAS, the proposed Easement was approximately 14 feet wide by 581 feet long, and the entire easement contained about 8,392 square feet; and WHEREAS, the golf course has over 149 acres of land, consisting of 18 holes, water features, mature landscaping, and an extensive perimeter buffer; and WHEREAS, FDOT needed the Easement area, in an effort to assist the City with pending traffic concerns, by providing a necessary turning lane from Michigan Avenue to Alton Road, which would be within the outer perimeter landscape buffer to the Golf Course, and would not interfere with the quiet enjoyment of the Golf Course; and WHEREAS, in order to accommodate the intersection modification, FDOT proposed adding a second southbound left turn lane to Alton Road, in the area east of the east FDOT right- of-way line, which area fell within the City' s Golf Course; and WHEREAS, the widened roadway required FDOT to obtain from the City a perpetual, easement to use, maintain, repair, and construct the roadway along the west side of the City owned property, which request was granted on July 13, 2016 pursuant to Resolution No. 2016- 29465; and WHEREAS, FDOT would like to amend the scope of the Easement to include the installation and maintenance of a signalization mast arm, which was part of the project and was omitted in error; and WHEREAS, in connection with this Easement donation, FDOT is requesting that the City execute a Donation of Property, pursuant to Section 337.25, Florida Statutes; and WHEREAS, the Administration recommends executing the amended Easement and the Donation of Property to the Florida Department of Transportation, incorporated herein by reference and attached to this Resolution as composite Exhibit "1". NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby amend Resolution No. 2016-29465, which approved a perpetual easement in favor of the State of Florida Department of Transportation ("FDOT"),for constructing, maintaining and repairing a portion of Alton Road on City property known as the "Miami Beach Golf Course," located at 2301 Alton Road, along the east side of Alton Road, from Michigan Avenue, for 581 feet towards the north; said amendment amending the scope of the Easement to include the installation and maintenance of a signalization mast arm; and further approve and authorize the Mayor and City Clerk to execute the amended Easement and the Donation of Property to the Florida Department of Transportation, in the form attached to this Resolution as composite Exhibit "1". PASSED and ADOPTED this /C day of 9-441/Orley , 2020. ' 1 Dan Gelber, Mayor ATTEST: Vi Z7 "Lc co Rafael E. Granado, ity Jerk 15,0,1& 1 I • IA/Copp 1 •• " ` \i; APPROVED AS TO 4126 m FORM & LANGUAGE & FOR EIKECUTION City Attorney Date ,a' !� 07-PE.t 3 This instrument prepared by, or under the direction of, Alicia Trujillo,Esq. District Six Chief Counsel State of Florida Department of Transportation 1000 N.W. Avenue Parcel No.:804.IR(5/28/2019)EQ Miami,Florida 33172 Item/Segment No.:429193-2 June 21,2016—DD Managing District:6 PERPETUAL EASEMENT THIS EASEMENT Made the day of ,2019,by THE CITY OF MIAMI BEACH,a municipality of the State of Florida, Grantor, to the STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION,its successors and assigns,Grantee. WITNESSETH; That the Grantor for and in consideration of the sum of One Dollar and other valuable considerations paid,the receipt and sufficiency of which is hereby acknowledged,hereby grants unto the Grantee, its successors and assigns,a perpetual easement for the purpose of constructing,installing and maintaining a signalization mast ann,asphalt pavement,curb and gutter,drainage improvements,signing,and lighting,and for other related transportation purposes in,over,under,upon and through the following described land in Miami- Dade County,Florida,viz: PARCEL 804 FIN. No.429193-2 A portion of NOT SUBDIVIDED land,lying in the NW 1/4 of Section 34 and the SW 1/4 of Section 27,Township 53 South,Range 42 East,in the City of Miami Beach, Florida,and being more particularly described as follows: COMMENCE at the intersection of the Baseline of Survey of State Road 907(Alton Road),as it is shown on the Florida Department of Transportation Project Network Control for said State Road 907,Project No.429193-1,dated 09/30/2011,and the Centerline of Michigan Avenue;thence N 39°19'22"E,along said Baseline of Survey of State Road 907 (Alton Road), for a distance of 72.60 feet; thence, departing said Baseline of Survey at right angle, S 50°40'38"E for a distance of 57.00 feet to a point on a line which is 7.00 feet Easterly of,as measured at right angle, and parallel with the existing Southeasterly right-of-way line of said State Road 907(Alton Road),as it is shown on the Florida Department of Transportation Right of Way Map for said State Road 907,Section 87037-2507,last revised on 12/15/1989,said point being the POINT OF BEGINNING of the following described parcel: Thence N 39°19'22' E,along said parallel line,for a distance of 373.69 feet;thence N 50°40'38"W for a distance of 3.00 feet;thence N 39°19'22"E,along a line being 4.00 feet Easterly of,as measured at right angles,and parallel with said existing Southeasterly right-of-way line of State Road 907(Alton Road),for a distance of 166.92 feet to a point on a tangent curve concave to the Northwest and having a radius of 801.39 feet,a chord bearing of N 38°20'31"E, and a chord distance of 27.44 feet; thence Northeasterly along the arc of said curve,through a central angle of 01°57'42", for a distance of 27,44 feet;thence S 52°38'20"E,along a radial line to lastly described curve, for a distance of 14.00 feet to a point on a non-tangent curve concave to the Northwest and having a radius of 815.39 feet,a chord bearing of S 38°20'31"W,and a chord distance of 27.92 feet;thence Southwesterly along the arc of said curve, through a central angle of 01°57'42",for a distance of 27.92 feet to a point of tangency;thence S 39°19'22"W for a I EXHIBIT 1 4 Page 789 of 1618 distance of 152.92 feet; thence S 50040138" E for a distance of 3.00 feet;thence S 39°19'22"W for a distance of 429.02 feet to a point on a non-tangent curve concave to the Southeast and having a radius of 68.00 feet,a chord bearing of N 20°36'32"E,and a chord distance of 43.64 feet;thence Northeasterly along the arc of said curve,through a central angle of 37°25'41",for a distance of 44.42 feet to the POINT OF BEGINNING. Containing 8,392 square feet,more or less. John Liptak,PSM 45664 State of Florida Triangle Surveying&Mapping,Inc. Date:04/19/16 Rev.by D.Denis:05/05/16 AS SHOWN ON EXHIBIT"A",ATTACHED HERETO AND TO BE MADE A PART HEREOF TO HAVE AND TO HOLD the same unto said Grantee,its successors and assigns forever,and the Grantor will defend the title to said lands against all persons claiming by,through or under said Grantor. [N WITNESS WHEREOF,the said Grantor has caused these presents to be executed in its name by its Mayor, and its seal to be hereto affixed,attested by its City Clerk,the date first above written. ATTEST: THE CITY OF MIAMI BEACH Its City Clerk By. Its Mayor Address STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of 20 by - , Mayor, who is personally known to me or who has produced as identification. (Signature of person taking acknowledgment) (Type,print or stamp name under signature) Title or rank and serial number,if any: 2 of 5 Page 790 of 1618 • EXHIBIT "A" LEGAL DESCRIPTION - PARCEL 804: A portion of NOT SUBDIVIDED land. lying in the NW 1/4 of Section 34 and the SW 1/4 of Section 27, Township 53 South, Range 42 East. In the City of Miami Beach, Florida. and being more particularly described as follows: COMMENCE at the intersection of the Baseline of Survey of State Road 407 (Alton Road). as it is shown on the Florida Department of Transportation Project Network Control for said State Road 907. Project No. 429193-1, dated 09/3012011, and the Centerline of Michigan Avenue; thence N 39'19'22' E, along said Baseline of Survey of State Road 907 (Alton Road), for a distance of 72.60 feet; thence. departing said Baseline of Survey at right angles. 5 50'40'38'E for a distance of 57.00 feet to a point on a line which is 7.00 feet Easterly of, as measured at right angles, and parallel with the existing Southeasterly right-of-way line of said State Road 907 (Alton Road), as it is shown on the Florida Department of Transportation Right of Way Map for said State Road 907• Section 87037.2S07. last revised on I2/15/1989. said point being the POINT OF BEGINNING of the following described parcel: Thence N 39.19'22" E. along said parallel line, for a distance of 373.69 feet; thence N S0.40'38" W for a distance of 3.00 feet: thence N 39'19'22' E, along a line being 4.00 feet Easterly of, as measured at right angles, and parallel with said existing Southeasterly right-of-way line of State Road 907 (Alton Road), for a distance of 166.92 feet to a point on a tangent curve concave to the Northwest and having a radius of 801.39 feet, a chord bearing of N 38'20'3I' E. and a chord distance of 27.44 feet; thence Northeasterly along the arc of said curve. through a central angle of 01°57'42'. for a distance of 27.44 feet: thence S 52'38'20" E. along a radial fine to lastly described curve, for a distance of 14.00 feet to a point on a non-tangent curve concave to the Northwest and having a radius of 815.39 feet, a chord bearing of 5 38°20'31" W, and a chord distance of 27.92 feet; thence Southwesterly along the arc of said curve, through a central angle of 01'57'42', for a distance of 27.92 feet to a point of tangency: thence S 39'19'22" W for a distance of 152.92 feet: thence 5 50°40'38" E for a distance of 3.00 feet: thence S 39'19'22' W for a distance of 429.02 feet to a point on a non-tangent curve concave to the Southeast and having a radius of 68.00 feet. a chord bearing of N 20'36'32' E. and a chord distance of 43.64 feet; thence Northeasterly along the arc of said curve. through a central angle of 37'25'41', for a distance of 44.42 feet to the POINT OF BEGINNING. R S Containing 8.392 square feet, more or .ess. • • •.ej�r'� .41 ! I r IT 4A t' na 3 This document consists of tntee131 sheets 1 HN LIPTAK MAP end shall not Oe corestee.ed full.r111id. ROFESSIONAL SURVEYOR AND PER : ane comaiete unless each cheer 711:trached LORIDA LICENSE NO. 5664 ' • ........• T0‘ a to the other. �- ',Ole{910..a•� THIS 15 NOT A SURVEY "' FLORIDA DEPARTMENT OF TRANSPORTATION SKETCH TO ACCOMPANY LEGAL DESCRIPTION e STATE ROAD NO. 901 MIAMI-OADE COUNTY iff 14,1k tar w ir:t'W v1r., sir ccrra.�w.S. uv cu(. so* awMtc cswc.ts wows • "6 16 w.v.t, I .erre+ ocw Crtu110 0401/11c.f..NO. 1129193.7 samba 87037 SHEET i of 3 Conan worm' 3 of 5 Page 791 of 1618 EXHIBIT .,lA, GENERAL NOTES: - Reproductions of this map are not valid without the signature and the original raised seal of the Florida Licensed Surveyor and MaDDer in responsible charge. • Lands shown hereon were not abstracted by this office for right of way. easement of record ownership, abandonments. deed restrictions. or Murphy Act Deeds. This information should be obtained through appropriate verification. - The Bearings shown hereon are referenced to the Baseline of Survey of State Road 907 (Alton Road). having a bearing of N 39'19'22• E, as shown on the Florida Department of Transportation Project Network Control for said State Road 907. completed on 09130/2011 by Manuel G. Vera and Associates, Inc., for Project No. 429193-1 • Right-of-Way lines shown are per the Florida Department of Transportation Right of Way Map for said State Road 907. Section 87037.2507. last revised on 12/15/1989. - Section line and Lot lines shown are approximated per information found in Plat Book B. Page 52, and are not supported by a survey. They are shown for graphical reference only. - Dimensions and areas are calculated based on existing plats. right of way maps. and digital files as provided by client. - Additions and/or deletions to survey maps. sketches or reports by any party other than the signing party are prohibited without the written consent of the signing party. - Triangle Surveying 61 Mapping. Inc. carries Professional Liability Insurance for Surveying & Mapping services. - This Sketch to Accompany Legal Description is in compliance with the Standards of Practice as set forth by the Florida Board of Professional Land Surveyors and Mappers. referenced in Rule 51.17 Florida Administrative code pursuant to Section 472.027, Florida Statues. LEGEND: • Baseline (P1 - Plat CCenter Line P.B. • Plat Book B • Chord Bearing PC -Point of Curvature CD- Chard Distance PG. - Page OParcel Identification R - Radius Number RGE. Range A - Curve Central Angle RT -Right EXIST. - Existing R/W • Right-of•Way FOOT- Florida Department SEC. - Section of Transportation STA. • Station $ . Financial Project TWP. -Township L -Length O . Block NO. - Number to Number This document consists of Wee 01 Sheets end shall not be considered lull.valid. o and complete unless each sheet Is attached to the other. THIS 15 NOT A SURVEY FLORIDA DEPARTMENT OF TRANSPORTATION SKETCH TO ACCOMPANY LEGAL DESCRIPTION tom._.. - -STATE ROAD NO. 907 MIAMI•OADE COUNTY y — _L .._.—r- • • I _ ,.,�... Sh uo1M,f sutvts • ^•• •.� —"r--•Y i-- '-—i f v NO 0 5153-2 SECTION 87037 SHEET 2 Or 3 cntcato a.. D4,).r14 ,‘,/t'ao{i Tr,sr i4rvr • r 4 of S Page 792 of 1618 1 PARCEL NO. OWNER'S NAME PARCEL AREAE REMAINDER f COMMENTS I 804 'CITY OF MIAMI BEACH 8.392 SQ.FT- UNDETERMINED] r e ol•srdsr 'an' EXHIBIT "A" 9-64..r... R®601.39' 11-68.00' L=27.44' L-44.42' Q�' CD-27.44' CD-43.64' 'C''' CB-N 36.20'31• E Ce-N 20'36'32' E AMENDED PLAT OF �) P.8. 8 SUNSET LAKE@DIViSION ims...—__ 111.7. . , 52 e=O 1's7'42• • a=61 s.39' L-27.92' I CD-27.92• 16 CB.S 36'20'31'W • I 2 5 6 7 89 10 C 11 .• i ._57.2 CP) 6u•IV, 211.0'L 601PI_ _ . '� C7u 1P1_— sF EXIST.NOR NWES�RLY RIW LINE a p. .F .MMEN E NT �O STATE ROAD 907 N U' t yam • (ALTON ROAD) 2 0 91 92 4• 95 96 Q OF SURVEY I 97 ii' 98 72.60' ' 9 . 1.1. N 50'40'38" W N 39'19'22"E 5 50'40'38"E S 4' ,`57.00 00' .,. 1/ .IN .F : I NI Ir ,. ••+1. ,, A 9 . I a.-. : + . 57-00.R 1 T),I TI •: 5..1,. 1 4 £e.. '. • �'� ' S7.O0'IRTI EXIST. • TN AST RL W LINE N 3999'22'8 , 166.92_ �� - / S 9.19 ' 9.02 S 39'19'22'W 152.92' 44)7 I '�+ 4,,,Cd .. •.+114.., .7+..-. AP 19�1e Ai00'ti4. S 50'60'38"53. 7+' I S 52'36'20' E _ 3S +,4'•, 6:41 t� .$O a,,, 66.00'111 (RADIAL) s NOT SUBDIVIDED CITY OF MIAMI BEACH MIAMI-DADE COUNTY, FLORIDA _0 0 1limilliro TM aocaa,lnf can1.•LS al,Nee 111•nr•1•i„a i •71N1 NI D!C..." a1.0',11 V.Itl.Nla Ca*P1atf LR ,ale1..K,•nR1,..n�•�fa la:�.a,1Y. THIS IS NOT A SURVEY Sole: e• .60• FLORIDA DEPARTMENT OF -_�-_-___ STATE ROAD NO. 907 MIAMI-DADE COUNTY 8 TRANSPORTATION - - - T r -T ----- -- .._..., ;SKETCH TO ACCOMPANY - - '� '.:�:• s .•. .:.K .. .:$1: ' 0444444 311.0,5 o..Iv16 - LEGAL DESCRIPTION '��� ; (*7c 7O wglna P.R.NO.429193.2 1 SECTION 67037 SHEET 3 OF 3 U14a16 Ca.Da 171 -1,ynP Page 793 of 1618 575-070.12 FD a.Nr OF WAY OGC-I119 Florida Department of Transportation RO!'D£SANTIS Office or Right of\\as KEVIN J.THIBAUL'r.P.E. GOVERNOR 11100'All I I tth.k%cnuc.Room 6105-11 SECRETARY \lirmi,11. 1l1?2 Donation of Property to the Florida Department of Transportation May 29,2019 ITEM/SEGMENT NO.: 429193-2 The City of Miami Beach MANAGING DISTRICT: 6 1700 Convention Center Drive Miami Beach,FL 33139 F.A.P.NO.: N/A STATE ROAD NO.: Alton RD COUNTY: Miami-Dade PARCEL NO.: 804 INTEREST CONVEYED: Perpetual Easement This is to advise that the undersigned,as owner of the property or property interest referenced above and as shown on Right of Way maps for referenced project,desires to make a voluntary donation of said property or property interest to the State of Florida for the use and benefit of the Florida Department of Transportation. The undersigned hereby acknowledges that he/she has been fully advised by a Department representative of his/her right to have the referenced property or property interest appraised,to accompany the appraiser during the appraisal inspection of the property,to receive full compensation for the above referenced property,and to receive reimbursement for reasonable fees and costs incurred,if any.Having been fully informed of the above rights,I hereby waive those rights unless otherwise noted below. Owner's Signature Type or Print Property Owner's Name Street Address City,State.Zip Code Date Page 794 of 1618 Resolutions-C7 P MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Jimmy L. Morales, City Manager DATE: January 15, 2020 SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AMENDING RESOLUTION NO. 2016-29465, WHICH APPROVED A PERPETUAL EASEMENT IN FAVOR OF THE STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION ("FDOT"), FOR CONSTRUCTING, MAINTAINING AND REPAIRING A PORTION OF ALTON ROAD ON CITY PROPERTY KNOWN AS THE "MIAMI BEACH GOLF COURSE," LOCATED AT 2301 ALTON ROAD, ALONG THE EAST SIDE OF ALTON ROAD, FROM MICHIGAN AVENUE, FOR 581 FEET TOWARDS THE NORTH; SAID AMENDMENT AMENDING THE SCOPE OF THE EASEMENT TO INCLUDE THE INSTALLATION AND MAINTENANCE OF A SIGNALIZATION MAST ARM; AND FURTHER APPROVING AND AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE THE AMENDED EASEMENT AND THE DONATION OF PROPERTY TO THE FLORIDA DEPARTMENT OF TRANSPORTATION, IN THE FORM ATTACHED TO THIS RESOLUTION AS COMPOSITE EXHIBIT"1." RECOMMENDATION The Administration recommends approving the Resolution. BACKGROUND/HISTORY In 2016, the State of Florida Department of Transportation ("FDOT") proposed to improve the intersection of Michigan Avenue at Alton Road. Construction work began in April of 2017 and included roadway reconstruction, drainage improvements, intersection improvements, milling and resurfacing, adjustment of numerous valves and manholes, sidewalk and curb ramps, signage, pavement markings, and signalization. At the time, FDOT requested that the City grant it a perpetual easement to accommodate this project on land the City owns, knowns as the"Miami Beach Golf Course," located at 2301 Alton Road. The FDOT proposed easement would still allow the City to have full access to the City s Golf Course. The golf course has over 149 acres of land, consisting of 18 holes, water features, mature landscaping, and an extensive perimeter buffer. FDOT sought the area in an effort to assist the City with pending traffic concerns, while having no impact on the 18 hole course, or any of the Page 783 of 1618 landscaping of 149 acre golf course. This allowed a necessary turning lane from Michigan Avenue to Alton Road,that would be within the outer perimeter landscape buffer to the course. The proposed FDOT easement was approximately 14 feet wide by 581 feet long, and the entire easement contained about 8,392 square feet (0.193 acres). In order to accommodate the intersection modification FDOT proposed to add a second southbound left turn lane to Alton Road, which area fell within the City s Golf Course. The widened roadway required FDOT to obtain from the City a perpetual easement to use, maintain, repair, and construct the roadway along the west side of City owned property. The City granted this request via Resolution No. 2016-29465. ANALYSIS FDOT and the City are looking to amend the scope of the easement to include the installation and maintenance of a signalization mast arm; and further authorize the Mayor and City Clerk to execute the amended easement and confirmation of easement donation, as described in Exhibit"1". Results from the 2019 Resident Survey show that 33% of residents rated crossing an intersection in the city as being very safe or safe; 74% of residents were concerned or dissatisfied with pedestrian safety; and 14% of residents ranked there being Insufficient signage/poor signage, when crossing the street at an intersection. In order to improve this area, the City intends to enhance pedestrian safety by including the installation and maintenance of a signalization mast arm. CONCLUSION The Administration recommends approving the Resolution. Applicable Area Citywide is this a Resident Right to Does this item utilize O.O. Know item? Bond Funds? Yes No Strategic Connection Prosperity-Revitalize targeted areas and increase investment. Legislative Tracking Public Works ATTACHMENTS: Description ❑ (Alton RD) P.804(CMB) Donation Form o Reso and Agreement • Page 784 of 1618 575-030-12 F D OT RIGHT OF WAY OGC-1119 Florida Department of Transportation RON DESANTIS Office of Right of Way KEVIN J.THIBAULT,P.E. GOVERNOR 1000 NW 111th Avenue,Room 6105-B SECRETARY Miami,FL 33172 Donation of Property to the Florida Department of Transportation May 29, 2019 ITEM/SEGMENT NO.: 429193-2 The City of Miami Beach MANAGING DISTRICT: 6 1700 Convention Center Drive Miami Beach, FL 33139 F.A.P. NO.: N/A STATE ROAD NO.: Alton RD COUNTY: Miami-Dade PARCEL NO.: 804 INTEREST CONVEYED: Perpetual Easement This is to advise that the undersigned, as owner of the property or property interest referenced above and as shown on Right of Way maps for referenced project, desires to make a.voluntary donation of said property or property interest to the State of Florida for the use and benefit of the Florida Department of Transportation. The undersigned hereby acknowledges that he/she has been fully advised by a Department representative of his/her right to have the referenced property or property interest appraised, to accompany the appraiser during the appraisal inspection of the property, to receive full compensation for the above referenced property, and to receive reimbursement for reasonable fees and costs incurred, if any. Having been fully informed of the above rights, I hereby waive those rights unless otherwise noted below. Owner's Signature Type or Print Property Owner's Name Street Address City, State, Zip Code Date Page 785 of 1618 575-030-12 F D OT RIGHT OF WAY occ-ups Florida Department of Transportation INSTRUCTIONS FOR COMPLETION OF THE DONATION OF PROPERTY TO THE FLORIDA DEPARTMENT OF TRANSPORTATION (FORM 575-030-12) This form should be printed on official DOT letterhead. DATE AND INSIDE ADDRESS: Space is provided for a date and inside address of the property owner. PROJECT/PARCEL The following information can be located in the legal documents and Right of INFORMATION: Way map for each project and is required on official Department forms: Item/Segment No. Managing District F.A.P. No. State Road No. County Parcel No. OWNER'S SIGNATURE BLOCK: The owner must sign and provide an address and date before the Department can accept the donation. ORIGINAL: Parcel File COPIES: Owner(s) Page 786 of 1618