PINE RIDGE PLANTATION
Community Development District
September 8, 2022

AGENDA

Pine Ridge Plantation Community Development District
475 West Town Place
Suite 114 St. Augustine, Florida 32092
District Website: www.pineridgeplantationcdd.com

September 1, 2022

Board of Supervisors
Pine Ridge Plantation Community Development District Dear Board Members:
The special meeting of the Board of Supervisors of the Pine Ridge Plantation Community Development District will be held Thursday, September 8, 2022 at 6:00 p.m. at the Pine Ridge Plantation Amenity Center, 4200 Pine Ridge Parkway, Middleburg, Florida 32068. Following is the advance agenda for the meeting:

Roll Call

Public Comments (Regarding Agenda Items Listed Below)

Discussion of Landscape Maintenance Contract

Ratification of Change Order No. 11

Ratification of Requisitions for Series 2020 Project (33-37)

Other Business

Public Comments / Supervisor’s Requests

Next Scheduled Meeting – 09/20/22 @ 6:00 p.m. at the Pine Ridge Plantation Amenity Center

Adjournment

FOURTH ORDER OF BUSINESS

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FIFTH ORDER OF BUSINESS

FORM OF REQUISITION FOR SERIES 2020 PROJECT
The undersigned, an Authorized Officer of Pine Ridge Plantation Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture from the District to U.S. Bank National Association, as successor in trust to SunTrust Bank, Orlando, Florida, as trustee (the "Trustee"), dated as of September 1, 2006 (the "Master Indenture"), as supplemented by the Second Supplemental Trust Indenture from the District to the Trustee, dated as of September 1, 2020 (the "Supplemental Indenture" and together with the Master Indenture, the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Requisition Number:

Name of Payee:

Amount Payable:

33

England-Thims & Miller, Inc. 14775 Old Saint Augustine Road Jacksonville, FL 32258
$ 237.50

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments or state Costs of Issuance, if applicable): Professional Services related to Pine Ridge CDD Completion Report - Invoice 204380 (July 2022)
Fund or Account and subaccount, if any, from which disbursement to be
made:
The undersigned hereby certifies that:
CE	obligations in the stated amount set forth above have been incurred by
the District, that each disbursement set forth above is a proper charge against the Series 2020A Acquisition and Construction Account referenced above, that each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Series 2020 Project and each represents a Cost of the Series 2020 Project, and has not previously been paid out of such Account;
OR
D  this requisition is for costs of issuance payable from the Series 2020A Costs of Issuance Account that has not previously been paid out of such Account.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set

forth above, which has not been released or will not be released simultaneously with the payment hereof.

The undersigned hereby further certifies that such requisition contains no item repref!enting payment on account of any retained percentage which the District is at the date of such certificate entitled i:o retain.
Originals or copies of the invoice(R) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.

PINE RIDGE PLANTATION COMMUNITY DEVELOPMENT DISTRICT

BKt,ytJ

/Re

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

date hereof.	/	/

If this requisition iR for a disbursement from other than the Seri.es 2020A Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Series 2020 Project and i;, consistent with (i) the applicable acquisition or construction contract, (ii) the plans and specifications for the portion of the Series 2020 Project with respect to which such disbursement is being made, and (iii) the report of the Consulting Engineer attached as an exhibit to the Supplemental Indenture, as such report shall have been amendedyr1nydified on the
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Consulting, 1gineer

Pineridge Community Development District	August10,2022		
GMS-SF, LLC	Project No:	03136.08000	
5385 N Nob Hill Road	Invoice No:	0204380	
Sunrise, FL 33351			

Project	03136.08000	Pine Ridge Cdd - Completion Report Work Description: RFP meeting for Amenity Center
Professional Services rendered through July 30. 2022 Professional Personnel
Hours	Rate	Amount
Engineer

Keller, Lyndsay CEI Sr. Inspector
Brooks, Jeffrey
Totals
Total Labor

7/2/2022

7/9/2022

.50

1.00
1.50

165.00

155.00

82.50

155.00
237.50

237.50

Invoice Total this Period	$237.50

England·Thim)& miller.Inc.
Bi Effi.S• PI.ANl,{l\$•SOOVE'l'OOS• OlS•LN1D5CA!'E A!ICillTECf$
1m50ldSt/.U;-od><R(Od•Ja:l<.sa1. .Flrll.\32258•td9iJH.12,w)•h.,9J4-W94M
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FORM OF REQUISITION FOR SERIES 2020 PROJECT
The undersigned, an Authorized Officer of Pine Ridge Plantation Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture from the District to U.S. Bank National Association, as successor in trust to SunTrust Bank, Orlando, Florida, as trustee (the "Trustee"), dated as of September 1, 2006 (the "Master Indenture"), as supplemented by the Second Supplemental Trust Indenture from the District to the Trustee, dated as of September 1, 2020 (the "Supplemental Indenture" and together with the Master Indenture, the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Requisition Number:

Name of Payee:

Amount Payable:

34

Basham & Lucas Design Group, Inc. 7645 Gate Parkway, Suite 101
Jacksonville, FL 32256
$ 3,150.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments or state Costs of Issuance, if applicable): Professional Services related to Pine Ridge Plantation Amenity - Invoice 9032
Fund or Account and subaccount, if any, from which disbursement to be
made:
The undersigned hereby certifies that:
C3	obligations in the stated amount set forth above have been incurred by
the District, that each disbursement set forth above is a proper charge against the Series 2020A Acquisition and Construction Account referenced above, that each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Series 2020 Project and each represents a Cost of the Series 2020 Project, and has not previously been paid out of such Account;
OR
D  this requisition is for costs of issuance payable from the Series 2020A Costs of Issuance Account that has notpreviously been paid out of such Account.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set

forth above, which has not been released or will not bo released simultaneously with the payment hereof.

The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.
Originals or copies of the invoice(s) from the vendor of the proporty acquired or services rendered with respect; to which disbursement is hereby requested are on file with the District.

PINE RIDGE PLANTATION COMMUNITY DEVELOPM.ENT DISTRICT

By:.. 		_dl,L--::,'_ uthorized· Offic(;

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a diBhursement from ot.her than the Series 2020A CoBts of Issuance Account, the undersigne,d Consulting Engineer hereby certifies that this disbursement is for a Cost of the Series 2020 Project and is consistent. with (i) the applicable acquisition er construction contract, (ii) the plans and specificationsfor the portion of the Series 2020 Project with respect: to which such dishut·sement is being made, and (iii) the report of tho Consulting Engineer attached as a11 exhibit to the Supplemental Indenture, as such report shall have been amende5J1'ir ;Jodified on the elate hereof.	//
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ConsultinJ Engineer

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	Basham & Lucas Design	Group Inc.	
	7645 Gate Pkwy Ste 101		
	Jacksonville, FL 32256 US		
	{904) 731-2323		
BASHAM				
OESIGN GROUP, INC,
IV.	i· ·				

INVOICE				
BILL TO		INVOICE	9032	
Pine Ridge Plantation CDD		DATE	08/11/2022	
Ernesto Torres		TERMS	Due on receipt	
c/o Governmental Management Services, LLC		DUE DATE	08/31/2022	
475 W. Town Place, Suite 114				
St. Augustine, FL 32092				
PROJECT NAME
(21-21) Pine Ridge Plantation				

CONTRACT SERVICES	
CONTRACT	
DUE	AMOUNT DUE	
Part 4: Interior Design Construction Documents	0.00	o.oo of 0.00	0.00	
for the Fitness Expansion				
Part 10: Fine Grading Design of the Pool (area	3,200.00	0.00 of 3,200.00	0.00	
within the fence)				
Part 11: Shop Drawing Review for Lakefront	7,500.00	0.00 of 7,500.00	0.00	
Park Improvements (NTE $7,500)				
Part 12: Construction Administration (NTE	5,000.00	0.00 of 5,000.00	0.00	
$5,000)				
Part 13: Reimbursable Expenses (NTE $1,500)	1,500.00	0.00 of 1,500.00	0.00	
Additional Services - Revise drawings due to	3,150.00		3,150.00	
reconfiguration of tennis & basketball courts				
and elimination of family pool				

&LUCAS

BALANCE DUE		$3,150.00	
Estimate Summary			

Estimate 20-129		84,600.00	
Invoice 8698		3,900.00	
Invoice 8754		528.00	
Invoice 8728		781.14	
Invoice 8415		6,800.00	
Invoice 9031		3,000.00	

Invoice 8499	18,600.00	
Invoice 8600	900.00	
Invoice 8640	40,600.00	
This invoice 9032	$3,150.00	
Total invoiced	78,259.14	

FORM OF REQUISITION FOR SERIES 2020 PROJECT
The undersigned, an Authorized Officer of Pine Ridge Plantation Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture from the District to U.S. Bank National Association, as successor in trust to SunTrust Bank, Orlando, Florida, as trustee (the "Trustee"), dated as of September 1, 2006 (the "Master Indenture"), as supplemented by the Second Supplemental Trust Indenture from the District to the Trustee, dated as of September 1, 2020 (the "Supplemental Indenture" and together with the Master Indenture, the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Requisition Number:

Name of Payee:

Amount Payable:

35

Basham & Lucas Design Group, Inc. 7645 Gate Parkway, Suite 101
Jacksonville, FL 32256
$3,000.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments or state Costs of Issuance, if applicable): Professional Services related to Pine Ridge Plantation Amenity - Invoice 9031
Fund or Account and subaccount, if any, from which disbursement to be
made:
The undersigned hereby certifies that:
C3	obligations in the stated amount set forth above have been incurred by
the District, that each disbursement set forth above is a proper charge against the Series 2020A Acquisition and Construction Account referenced above, that each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Series 2020 Project and each represents a Cost of the Series 2020 Project, and has not previously been paid out of such Account;
OR
D  this requisition is for costs of issuance payable from the Series 2020A Costs of Issuance Account that has not previously been paid out of such Account.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the 1·ight to receive payment of, any of the moneys payable to the Payee set

forth above, which has not been released or will not be released simultaneously with the payment hereof.

The undersigned hereby further CBrtifies that such requisition contains no item representing payment on account of any retflined percentage which the District is at the date of such certificate entitled to retain.
Originals or copies of tho invoice(s) from the vendor of tho property acquired or services rendered with respect to which disbursement is hereby requested are on tile with the District.
PINE RIDGE PLANTATION COMMUNITY DEVELOPMENT DISTRICT

By:

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Series 2020A Costs of fasuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Series 2020 Project. and is consistent with (i) the applicable acquisition or construction contract, (ii) the plans and specifications for the po1tion of the Series 2020 Project with respect to which such disbursement is being made, and (iii) the report of the Consulting Engineer attached as an exhibit to the Supplemental Indenture, as such report shall have been amended,or modified on the

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date hereof.	/./,.)  .

...	---11·, l	.1  _1•. -'LL .
Consulting Engineer

BASHAM &LUCAS
DBSIGN GROUP, INC.
""'-·�•WCIKJX

Basham & Lucas Design Group Inc.
7645 Gate Pkwy Ste 101 Jacksonville, FL 32256 US (904) 731-2323

INVOICE
BILL TO
Pine Ridge Plantation CDD Ernesto Torres
do Governmental Management Services, LLC 475 W. Town Place, Suite 114
St. Augustine, FL 32092

PROJECT NAME
(21-21) Pine Ridge Plantation

CONTRACT SERVICES

Part 4: Interior Design Construction Documents for the Fitness Expansion
Part 10: Fine Grading Design of the Pool (area within the fence)
Part 11: Shop Drawing Review for Lakefront Pali< Improvements (NTE $7,500)
Part 12: Construction Administration (NTE
$5,000)
Part 13: Reimbursable Expenses (NTE $1,500)

INVOICE DATE TERMS DUE DATE

CONTRACT	DUE

0.00	0.00 of 0.00

3,200.00	0.00 of 3,200.00

7,500.00	26.67 % of 7,500.00

5,000.00	20.00 % of 5,000.00

1,500.00	0.00 of 1,500.00

9031
08/11/2022
Due on receipt 08/31/2022

AMOUNT DUE

0.00

0.00

2,000.00

1,000.00

0.00

BALANCE DUE	$3,000.00	

Estimate Summary		
Estimate 20-129	84,600.00	
Invoice 8698	3,900.00	
Invoice 8754	528.00	
Invoice 8728	781.14	
Invoice 8415	6,800.00	
Invoice 8499	18,600.00	
Invoice 8600	900.00	
Invoice 8640	40,600.00	

This invoice 9031 Total invoiced

$3,000.00 75,109.14

FORM OF REQUISITION FOR SERIES 2020 PROJECT
The undersigned, an Authorized Officer of Pine Ridge Plantation Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture from the District to U.S. Bank National Association, as successor in trust to SunTrust Bank, Orlando, Florida, as trustee (the "Trustee"), dated as of September 1, 2006 (the "Master Indenture"), as supplemented by the Second Supplemental Trust Indenture from the District to the Trustee, dated as of September 1, 2020 (the "Supplemental Indenture" and together with the Master Indenture, the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Requisition Number:

Name of Payee:

Amount Payable:

36

Hoffman Commercial Construction, LLC 6919 Distribution Avenue S., Suite 5
Jacksonville, FL 32256
$ 389,045.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments or state  Costs  of  Issuance,  if  applicable):   Prnfessional  Services  related Pine Ridge Plantation Amenity Improvements -Application No. 6

Fund or Account and subaccount, if any, from which disbursement to be made:	2020 Project
The undersigned hereby certifies that:
u3  obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2020A Acquisition and Construction Account referenced above, that each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Series 2020 Project and each represents a Cost of the Series 2020 Project, and has not previously been paid out of such Account;
OR
D  this requisition is for costs of issuance payable from the Series 2020A Costs of Issuance Account that has not previously been paid out of such Account.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim

affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.

The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.
Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.

PINE RIDGE PLANTATION COMMUNITY DEVELOPMENT DISTRICT

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Series 2020A Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Series 2020 Project and is consistent with (i) the applicable acquisition or construction contract, (ii) the plans and specifications for the portion of the Series 2020 Project with respect to which such disbursement is being made, and (iii) the report of the Consulting Engineer attached as an exhibit to the Supplemental Indenture, as such report shall have been amended or modified on the date hereof.

August 29, 2022

APPLICATION AND CERTIFICATION FOR PAYMEN·1	AIA l)ll{T.MI-S'I Gitl::	PAO!:: or-;::· Llf ·tHRl-:l:.	PAGl-.4:-

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Pinc Ridgt! Plantation Ameni · Improvements	2201 6
Sch dulc or V:ilues	R'.!S: 02:?

DLSCRIPTlON	SCHEDLLE PR.EVIOCS	WORK		STORED	fOl'AL	t_,;t,	BALANCE OF	PPI.		I\	;\1ATERl:\L ('(JMPLI:TED			ro
VALIJ[.$	PLACE	TO D,\TE	FIXISH

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:'.! GE:'IZERAL RFQt.:IRFMF\iTS	3''.'. !)I}	!o.S 4	4.53ft	(l	15.120	40 {  S	2.!•SO
3 sn-r:woRK	S,	,:;<) ,4\),l	5J.712	71.61(,	,;	115,328	42 '/)  s	173.01:!
4  P(IC)L DEC PAVER$	s	l'.;.S(lu	IU.751.t	(J	L)	J0.750	i)';i,  s	l.75()
.5 B.\SKETBAI.l. & fE:':-.:JS conrrs	-;	i95.90•1	I)	f)	! (Ji ,4/,	101,165	51f.l,;.	94,+35
6 FE;s;G\.G	s.	145.-4{.'()	(1	0	:)	0	rr., s	I 4:5.4(1()
CCINCRF.TE SIDEW,\I..KS A D FOl.lNDA TK,'.	6J.r-/}1)	(}	t)	t•	i}	{\!!;.  s	63.tiOn
M.·\.SO\RY POOL HiCLOSt:RE	s	22 u•1	1.liSti	-WO	I)	:?,:?SO	!lr•,1  S	20,510
\f!SC METALS	:;	2.-UH.i	(1	0	tl	0	o ! . s	1AOO
PAl:\T'.xiJ ESCLOSUlE	'>	3.90(1	0	0	(J	(l	(•"-  s.	.?-,900
SPLASI-I POOL	_:i4f,,l_;(lti	1 f · ,:!O(•	1,6,500	11	28 .700	- 3''.v S	8.lOO
l::!  BEXCIIF5 ,\).:[) TrU5H C,\l\:S	.:.;	<•.ClO,)	0	I)	(1	0	(1•i;. 5'	6.(101)
u  r.m RT sn.,DE srm;cnJRF.	s	15/JfJ:)	.::'ili	0	i)	3.i50	..,.:1.., ."..	11,'.!50
1-4 PLt:.\i.o!M:	.._	! . .'.'.01)	(J	15.470	il	i5.47il	,-5 ;. $	.7'.:lO
15 ELECTRICAL	s	219.900	t.-9::i	:1,990	r,	Z6.3 8	12''-,) s	19 512
16 UULDCR IUSK l 'S	$	I :!.,lfi'J	l:?,90f1	0	I)	l .tJ(JO	IM''t,  $
17 f'&P Ih)'D	s	3.\.50fl	35.500	I)	n	.33.500	1(1(1".  $
18 CO#I .-\DDlTIOl\,\l. PARF-:rNG I.OT r•Ol.E	::.	(,J !	(I	0	tj	{)	i)'\,  s	6.116
1o ('0=2 REIMBURSE PE7-ti\'ITT COS-:"	;;	2J1	.... _, 1	()	ti	2JI	!f.10 ,. S
'.!(I C0/1 ELECTRICAL ,\DJCST\-1EKT CREDfT	s	(43.!Jt?f'\}	ll	()	i}	0	()'\, s	(-BJJOO}
11 CO ,q EIGHT CONC UGHT POLE 13A56S	19.1136	0	(J	()	0	ll':i, S	19.S36
2	C(t ;.;5 '.F\V PF:RIMETER FENCE	s	52.96:<	ti	0	ll	0	!f\)  s	52,968
::!J C'O t,6 C CLOSUIU: GATE \'.E.	s	(5.10{)1	(I	0	ll	0	0% $	{5.HlOJ
2-i (.'() :N IU:.VISr.D ET\-1 f>R,\Wl:--:G	':i	11.iO	f)	!}	(!	(I	,.. ,. s	11.704
:!5 CO#f(1 TW0 .-\Or>ITO AL LJGHT POLF RASi -.	.J}l59	(1	0	1)	n	t)n,,J  s	4.<l59
6 HCC FEE	)(J\l.{,O(J	1 :..	17.400	I)	.ft.12S	.,13•;}. s	6 .472
TOTAL	S 1,723.355	304,402	3 0.808	101, 65	736.675	43%	s	986,680

"\ J :t,: lfr l - f	P;:y f-t' :i:6 Au;u ,

From: Pro sooted Aiphalt Inc
11:::·1 Eouthpt,int C.l·,1,1.. ,!(t('i;<,rmi;iUt\11. .t>.;.11,

llill To:Paul Hoffman
IOI MU rtl"l,i<;i,; l,"Je, uitt, -10.ct-:;(),1 1-'QII\H
V•.f.lr,,, 1-1. ,ll031
CiJrrp,,ny: tl•Jllff1,)li (;1;11')',ITWICIOI
1	on-)tr\lf..tit,;n. tu..::

Doto of l!l!IUO

C0/11/J0'l?

Ouo Dato
oe/w/2022
Bolanco Du11
S!Ol,46ii70 U tl

Item	Price	Quantity	To:,c	Totol

Bose Install-Deposit Payment
SO':!, D•po!.11 flu por C>:11'11«.l<"t r:lot• OG/'J7/2'

V
Asph<llt rovlng·Dttposit
b0'1. 0 •1;.o:;,1 p.,r C<lf\lumt <lt1Wd U6 /21/22

sports court s1Jrlocln9-ooposlt
•,<> o;.pu,.,1 fJ'-'' t;uonuct t)(1ll>d 00/21/n

$43,1)56.00 USO

$28,258.20 VSD

$29,551.50 USP

14J,v G.OO USO

$28,2'58.20 VSll

$29,5S1.SO USU

 	

Grand Total

:SIOl,465,70 U D

$101,465.70
USO

CONTRACTOH'S
CONnlTIONAI.. WAl\'l H AND ltELEAS.E (W Llf.N 1JPON PROGRESS PAYMENT
(PAYMENT UY CHl CK)

The undtr:,;igncd licnor. in consideration of the prog.rcs:,; payment in the amount of$	3R9.045	and c<mditionctl
upon paym nt of check number-·...·-·--··· is ucd to the umk-rsigm:<.I by:	Pine tutlge Pb111lation CDD
in said mnount. waives itnd releases its lien right to claim .t lien for Iahor, services, or mat rials fornishcd to
Pint:! Ridge Plantation CDll	011 the job of	Pinc IUdgt• Plantation Amenity Im1m,vcmc11ts
to th!! l<.lllowing. described properly:

Pinc lUd c Plantation Amenity Improvements
4200 Pine Ridgti Parkway

 Middlebur . FL 32068	

I IC{' Project #

	2201	

( )w11cr's Projc..::t !I		

This W,tivcr and release docs not cover any retention of labor, services. or materials furnished
allcr the dak spcdlii::d:

Dat<:tl On:  8/25/2022 

l ..iennr's Name:
Address:

 llofl'man (:onunc1·ial Couslructo11, LLC	 M 19 Didrihutiou Ave South - Unit #5		

By:
Printed Name:

 	

Paul Hoffman	

STATF OF FLORmA. COUNTY OF	J)uval	. .:.

Tl lF FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME ON 	8/24/2022	
BY:	Pt1ul Uoffmao
( X ) WlIO JS PERSON,\LLY KNOWN TO ME OR

Notary Publle State or Flortda

Michelle A Swagerty

IIJ

MY. Commlplon

Exp. e12u202s

HH 177401

'•
'

,

(	) WHO I IAS PRODUCED 	··-····•-•m•--··-·..······-·····················--···•··········-······ i\S IDEN'I IFICA l"ION AND WI10 (	) DID ( X ) DID NOT TAKE AN OATJ I.

AA \7:7L\t..a\
COMMISSION NO.

Non·: 11:i.,;i,; a J/,:;turmJ·form pre.\Crifietl f,_1 Se!l'iitm ?13. O. Ffc,ricl<1 S111111tc. ( /!l<}t,j. Ef{,!din- <h-111/>er 1. I 996. <1
,,,·n,,11111< 1· ilor N</rtire 11 /i(!11or to jimrish u w11h·t1r or rt'i,•,1sc ,ifli,!11 tl1<1t i., ,i(l.lerm11.fin,11 ,,,., .,·t:t11tff11;1•.f1•l'III.
/(F/rl<J96

FORM OF REQUISITION FOR SERIES 2020 PROJECT
The undersigned, an Authorized Officer of Pine Ridge Plantation Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture from the District to U.S. Bank National Association, as successor in trust to SunTrust Bank, Orlando, Florida, as trustee (the "Trustee"), dated as of September 1, 2006 (the "Master Indenture"), as supplemented by the Second Supplemental Trust Indenture from the District to the Trustee, dated as of September 1, 2020 (the "Supplemental Indenture" and together with the Master Indenture, the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Requisition Number:

Name of Payee:

Amount Payable:

37

Clay County Utility Authority

3176 Old Jennings Road Middleburg, FL 32068-3907

$ 20,550.28

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments or state Costs of Issuance, if applicable): Letter Agreement CU0S/09-1 for the Pine Ridge Amenity Center expansion and splash pad located at 4200 Pine Ridge Parkway
Fund or Account and subaccount, if any, from which disbursement to be
made:
The undersigned hereby certifies that:
l2l	obligations in the stated amount set forth above have been incurred by
the District, that each disbursement set forth above is a proper charge against the Series 2020A Acquisition and Construction Account referenced above, that each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Series 2020 Project and each represents a Cost of the Series 2020 Project, and has not previously been paid out of such Account;

OR
D	this requisition is for costs of issuance payable from the Series 2020A Costs of Issuance Account that has not previously been paid out of such Account.

The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released 01· will not be released simultaneously with the payment hereof.

The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.
Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.

PINE RIDGE PLANTATION COMMUNITY DEVELOPMENT
DISTRICT	I

By: J\L	
Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Series 2020A Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Series 2020 Project and is consistent with (i) the applicable acquisition or construction contract, (ii) the plans and specifications for the portion of the Series 2020 Project with respect to which such disbursement is being made, and (iii) the report of the Consulting Engineer attached as an exhibit to the Supplemental Indenture, as such report shall have been amended or modified on the date hereof.

;(	
Consulting Engineer

£r,.(i;'C;J:Wi ,·-;;-.i.,,

Clay County Utility Authority
:l176 Old Jennings Road Middleburg, Horida 32068-3907

Workin,,:tosL'lltt•r lo J'fU/m:I 11111'/h' /,ea/It,,,·011.u:n·I! 011r 11al11ral rt'\'111tr<·c,•.,·. w1d

lP

(
V';

<. ( )
•	•	.//,..",I

Telephone (904) 272-5999
Fncsimile (904) 213-2498

n'c'<llc! /,mg-lam l'afu · for
our ralepuye1J.

'\. J•·	-':.'1i),'-

www.clayutilily.org

July 27, 2022

Pine Ridge Plantation COD 475 W Town Place, Suite 114 St. Augustine, FL 32092
Re:	Letter Agreement for the Pine Ridge Amenity Center expansion and splash pad located at 4200 Pine Ridge Parkway
This is to advise you (Developer) that the Clay County Utility Authority (Utility) will provide the additional ERCs, to the above-referenced location, for a total charge of $20,550.28. This charge is derived as follows:

Water Capacity Charge: ($360.00 x 22.50 ERCs) Alternative Water Supply Charge: ($365.74 x 22.50 ERCs)
SJRWMD Black Creek Connection Charge: ($100.25 x 22.50 ERCs) Wastewater Capacity Charge: ($3,200.00 x 0.50 ERC) Environmental Impact Fee: ($410.00 x 0.50 ERC)
Debt Service Charge:($167.00 x 0.50 ERC)
Plan Review Charge: Inspection Charge: Total:

$	8,100.00*
$	8,229.15 *
$	2,255.63 *
$	1,600.00 *
$	205.00 *
$	83.50 *
$	38.50
$	38.50
- =1,Q_.5 _Q,f.1 

* -		Includes 22.50 ERCs for water and 0.50 ERC for wastewater for the splash pad and additional fixtures.
All of the provisions in the original Developer Agreement CU08/09-1, dated October 1, 2008, entitled Amenity Center at Pine Ridge Plantation, recorded in Official Records Book 305, pages 1206 through 1219, will remain in full force and effect.
Developer will utilize the existing 2-inch meter to serve this expansion and splash pad.

If the above is acceptable to you, acknowledge same by signing in the space provided below and return the executed Letter Agreement to us, along with payment for same.

Please feel free to contact me at (904) 213"2420, if you have any questions or require any additional information.

Sincerely,
CLAY COUNTY UTILITY AUTHORITY

Accepted by:
Pine Ridgleantation, COD

Melisa Blaney
Service Availability Manager MB/jmg

1t1e: .�10tta1

Date:	;;J.c) . J

Cn11servatin11• Commit111e111 • Co111m11nity