Backup Documents 03/11/2014 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SIP 6E
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO j
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. attach to original document. The completed routing slip and original documents are to he tornarded to the County attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must he receis ed in the(bun ■-kttornec Office no later
than Alonday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office JAK((V.„_.\ 4/16/14
\
4. BCC Office Board of County T \_
Commissioners s AV-A. A
5. Minutes and Records Clerk of Court's Office
` itelr\ (121I14 (2.rxpM
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Jeffrey A.Klatzkow,County Attorney Phone Number 252-8400
Contact/ Department
Agenda Date Item was 3/11/14 Agenda Item Number 16-E-5 j
Approved by the BCC
Type of Document Medical Examiner Recommendation for Number of Original One
Attached Reappointment Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? JAK
2. Does the document need to be sent to another agency for additional signatures? If yes, JAK See Form
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAK
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAK
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JAK
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 3/11/14 and all changes made during the JAK r o
meeting have been incorporated in the attached document. The County Attorney's fi i¢s:Satoh
Office has reviewed the changes,if applicable. ii is i
9. Initials of attorney verifying that the attached document is the version approved by the JAK �� "ti+±o;
BCC,all changes directed by the BCC have been made,and the document is ready for the v-,, `im 400
11 e0
Chairman's signature.
r V'C hNQ5K Orr--
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16E5
Martha S. Vergara
From: Martha S. Vergara
Sent: Monday, April 21, 2014 2:44 PM
To: Neet, Virginia
Subject: M. E. Recommendation for Reappointment - Dist. 20
Attachments: Medical Examiner - Reappointment (Dr. Marta U. Coburn).pdf
Dinny,
This is a copy for Jeff's records of what was sent this afternoon from the 3/11/14 BCC Meeting, Agenda Item
#16E5.
Thanks,
Martha Vergara, BMR Senior Clerk
Minutes and Records Dept.
Clerk of the Circuit Court
& Value Adjustment Board
Office: (239) 252-7240
Fax: (239) 252-8408
E-mail: martha.vergara a,collierclerk.com
1
1 6E 5
> linty of Collier
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY COURTHICOSE
Dwight E. Brock 3315 TAMIAMI TRAI EAST ST 102 Clerk of Courts
Clerk of Courts Accountant
P.O. BOX 411044 a Auditor
NAPLES, FLORIDA 3491-3044 Custodian of County Funds
April 21, 2014
Florida Department of Law Enforcement (FULL;)
Medical Examiners Commission
Attn: Doug Culbertson
P.O. Box 1489
Tallahassee, Florida 32302
Re: Recommendation for Reappointment— District 20 Medical Examiner -
1)r. Marta U. Coburn
Transmitted herewith is the original of the above referenced document for your
records per request, as adopted by the Collier County Board of County
Commissioners of Collier County, Florida on Tuesday, March 11, 2014, during
Regular Session.
Very truly yours,
DWIGLIT E. BROCK, CLERK
titatt-L/ 0'4
Martha Vergara, Depu y Clerk
Enclosure
Phone- (239) 252-2646 Fax - (239) 252-2755
Website- www.collierclerk.com Email - collierclerk@collierclerk.com
16,E 5
MEDICAL EXAMINERS COMMISSION
Recommendation for Reappointment
District 20 Medical Examiner
Dr. Marta U. Coburn
Favorable XX
Unfavorable
I do not wish to express an opinion on this matter.
If Favorable, please give suggestions for improvement.
No suggestions for improvement.
If Unfavorable, please give reasons for negative response.
N/A
Completed By: ,i
Signature: ` , Date: 3/11/14
Please Print Name: TOM HENNING, CHAIRMAN
Agency Name: Collier County Board of County Comr ,ssione.rs
Address: 3299 East Tamiami Trail
X
Naples, Florida 34112
Approve as rm a.. 1.lity `
I ATTEST'.., •• :
114&I E : •,s CLERK
lease Return Completed Form To:`ll) ttorney I
Email: douoculbertson(a.fdle.state.fl.us Deputy Clsrk _
Phone: (850)410-8609— Doug Culbertson ,
Attest as to Chal s
Or Mail To: signature only.
Address: Medical Examiners Commission
Florida Department of Law Enforcement (FDLE)
Post Office Box 1489
Tallahassee, FL 32302
Service • Integrity •Respect • Quality