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Backup Documents 10/11/2016 Item #16E13 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP E TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO L;, 1. 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 be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday 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 JABS 10/19/16 kb`Z&\b 4. BCC Office Board of County '' Commissioners irtS- / oa`ZA� 5. Minutes and Records Clerk of Court's Office wry 10-(010 0-(01 ( i :34111- PRIMARY 3PRIMARY 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 add.tional or missing information. Name of Primary Staff Artie Bay,E Phone Number 252-3756 Contact/Department Agenda Date Item was 10/11/16 Agenda Item Number 16-E-13 Approved by the BCC Type of Document Resolution—EMS County Grant Number of Original Two Attached Application Documents Attached PO number or account n/a alt b .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 ori signature JAB 2. Does the document need to be sent to another agency for additional signatures? If yes, JAB See Note provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. Below 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB 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 JAB 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 JAB 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 JAB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip JAB 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 10/11/16 and all changes made during JAB the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. PLEASE CONTACT ARTIE BAY (252-3756)WHEN READY 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 1 6 E 7 MEMORANDUM Date: October 21, 2016 To: Artie Bay, Supervisor EMS Operations From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Resolution 2016-211 — EMS County Grant Application Attached for further processing is one (1) certified copy and one (1) original of the document referenced above, (Agenda Item #16E13) approved by the Board of County Commissioners on Tuesday, October 21, 2016. The Board's Minutes and Records Office has kept a copy of the agreement as part of the Board's Official Record. If you have any questions, please feel free to call me at 252-8411. Thank you. 16E13 RESOLUTION NO. 2016 - 211 RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, CERTIFYING THAT THE APPLICATION FOR AND USE OF EMS COUNTY GRANT FUNDS WILL IMPROVE AND EXPAND PRE-HOSPITAL EMS DEPARTMENT ACTIVITIES AND WILL NOT SUPPLANT EXISTING COUNTY EMS BUDGET ALLOCATIONS. WHEREAS, EMS Department Paramedics and Paramedic/Firefighters provide basic and advanced life support care and highly technical service to the citizens and visitors of Collier County; and WHEREAS, the purchase of equipment and provision of training shall greatly enhance the effectiveness of pre-hospital emergency medical care. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA,that: The $72,971.00 in the EMS County Grant will be used to provide training and purchase medical/rescue equipment and these funds will not be used to supplant existing EMS Department budget allocations. PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this i\ r-ti day of O c ob cv' , 2016. ATTEST: BOARD OF COUNTY COMMISSIONERS, DWIGHT E. ,� K, CLERK COLLIER COUNTY, FLORIDA 44.2.0 1€46:& Beguu.141c� BY: A). est as to Cb 'S Clerk DONNA FIALA, Chairman signature only. , Approved as to form and legality: Jenni er A. Belpedio Assistant County Attorney 16E13 EMS COUNTY GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Emergency Medical Services Program HEALTH LTH Complete all items ID.Code(The State EMS Program will assign the ID Code—leave this blank) C50 _ 1. County_Name: Collier Business Address: 3299 Tamiami Trail East, Suite 700 Naples, FL 34112-5747 Telephone: 239-252-3740 Federal Tax ID Number(Nine Digit Number). VF 59-6000558 2. Certification: (The applicant signatory who has authority to sign contracts, grants, and other legal documents for the county) I certify that all information and data in this EMS county grant application and its attachments are true and correct. My signature acknowledges and assures that the County shall comply fully with the conditions outlined in the Florida EMS County Grant Application. Signature: Date: Printed Name: Donna Fiala Position Title: Chairman 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has responsibility for the implementation of the grant activities. This person is authorized to sign project reports and may request project changes. The signer and the contact person may be the same.) Name: Artie Bay__�_________..._.__...__ Position Title: Supervisor— EMS Admin Address: 8075 Lely Cultural Pkwy,Suite 267 Naples, FL 34113 Telephone: 239-252-3756 Fax Number: 239-252-3298 E-mail Address: Artiebay@ 4. Resolution: Attach a resolution from the Board of County Commissioners certifying the grant funds will improve and expand the county pre-hospital EMS system and will not be used to supplant current levels of county expenditures. We cannot process for funds without a current resolution. 5. Budget: Complete a budget page(s)for each organization to which you shall provide funds. List the organization(s) below. (Use additional pages if necessary) Collier County Emergency Medical Services DH 1684, December 2008 64J-1.015, F.A.C. 1 0 1 6 E BUDGET PAGE A. Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, other fringe benefits, and the total number of hours. Amount TOTAL Salaries= $ 0.00 TOTAL FICA&Other Benefits= Total Salaries & Benefits= $ 0.00 B. Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an agency, such as, commodities and supplies of a consumable nature excluding expenditures classified as operating capital outlay (see next category). List the item and, if applicable,the quantity Amount Training 5,000.00 Total Expenses= $5,000.00 C. Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other tangible personal property of a non consumable and non expendable nature with a normal expected life of one(1)year or more. List the item and, if applicable,the quantity Amount Medical/Rescue Equipment 52,971.00 Video Cameras for training,testing and QA 15,000.00 Total Veh.& Equipment= $ 67,971.00 Grand Total= $72,971.00 DH 1684, December 2008 2 „ E ,,, . , 0 1 :). FLORIDA DEPARTMENT OF HEALTH EMERGENCY MEDICAL SERVICES(EMS)GRANT SECTION REQUEST FOR GRANT FUND DISTRIBUTION In accordance with the provisions of Section 401.113(2) (a), Florida Statutes, the undersigned hereby requests an EMS grant fund distribution for the improvement and expansion of pre-hospital EMS. DOH Remit Payment To: The agency name and mailing address must be in the state MyFloridaMarketPlace (MFMP) system. Name of Agency: Collier County Board of County Commissioners Mailing Address: 3299 Tamiami Trail East,Suite 700 Naples, FL 34112-5749 Federal Identification number: 000558 • Authorized County Official: 10A l l l t b Sijnature Date Donna Fiala, Chairman Type or Print Name and Title Sign and return this page with your application to: Florida Department of Health Emergency Medical Services Section, Grants 4052 Bald Cypress Way, Bin A-22 Tallahassee, Florida 32399-1722 Do not write below this line. For use by State Emergency Medical Services Program Grant Amount for State to Pay: $ Grant ID: Code: C50 Approved By . Signature of State EMS Grant Officer Date State Fiscal Year: 2016 - 2017 Organization Code E.O. OCA Object Code Category 64-61-70-30-000 05 SF005 750000 059998 Federal Tax ID:VF Grant Beginning Date: Grant Ending Date: DH 1767P, Dember2008 64J-1.015, F.A.C. 3 p,pproved as to form and tct:►lily ATTEST: DWI c HT E. 13-4• K, Clerk " r 7�` Ass nt County AIk n1 O Aftest a toChairman's �\Z� 0 ,; nnnti+ra nniv ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 1 • E 3 TO ACCOMPANY ALL ORIGINAL DOCUMENTS.SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE hint on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office . at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. 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 throw mutinglines#1 through#2,complete the dmeck1ist,and forward to the Coin Attorney Office. Route to Addressee(s)(List in routing order)' Office Initials Date 1 2. 3. County Attorney Office County Attorney Office JABS 10/19/16 4. BCC Office Board of County Commissioners 5. Minutes and Records Clerk of Court's Office [q, ZS 14 PRIMARY CONTACT INFORMATION Normally the primary contact is the person who /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 Artie Bay,EMS Phone Number 252-3756 Contact/Department Agenda Date Item was 10/11/16 Agenda Item Number 16-E-13 Approved by the BCC Type of Document Resolution—EMSC'o�,Grant Number of Original Two Attached Application ,2O -'0,21/ 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 on)00 signature JAB 2. Does the document need to be sent to another agency for additional signatures? If yes, JAB goo`;fie provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. Maw 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB 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 JAB Office and all other parties except the BCC Chairman and the Cleric to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the JAB 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 JAB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip JAB 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 10/11/16 and all changes made during JAB the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the ti Chairman's signature. PLEASE CONTACT ARM BAY C 3 T I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 224.05;Revised 11/30/12 16E13 Martha S. Vergara From: Martha S.Vergara Sent: Tuesday, October 25, 2016 3:37 PM To: Bay, Artie (ArtieBay@colliergov.net) Subject: Replacement page - Commissioner Fiala's Signature Attachments: Backup Documents 10_11_2016 Item #16E13.pdf Hi Artie, Per your request. Attached is the grant replacement page that wasn't signed by Commissioner Fiala for your records and the State. 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 ar collierclerk.com 1 16E13 EMS COUNTY GRANT APPLICATION y' FLORIDA DEPARTMENT OF HEALTH Emergency Medical Services Program HEALTH TH Complete all items ID.Code(The State EMS Program will assign the ID Code—leave this blank) C50 1. County Name: Collier Business Address: 3299 Tamiami Trail East, Suite 700 Naples, FL 34112-5747 Telephone: 239-252-3740 Federal Tax ID Number(Nine Digit Number). VF 59-6000558 2. Certification: (The applicant signatory who has authority to sign contracts, grants, and other legal documents for the county) ertify that all information and data in this EMS county grant application and its attachments are true a11• orrect My si•, atdre acknowledges and assures that the County shall comply fully with the con,Q • s outlin-d i . - Fit,'da EMS County Grant Application. Signature: `` , /Pr: . Date: io1l 1 ‘1.c__ Printed Name: Donna Fiala Position Title: Chairman 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has responsibility for the implementation of the grant activities. This person is authorized to sign project reports and may request project changes. The signer and the contact person may be the same.) Name: Artie Bay Position Title: Supervisor—EMS Admin Address: 8075 Lely Cultural Pkwy,Suite 267 Naples, FL 34113 Telephone: 239-252-3756 Fax Number.239-252-3298 E-mail Address:Artiebay@ 4. Resolution: Attach a resolution from the Board of County Commissioners certifying the grant funds will improve and expand the county pre-hospital EMS system and will not be used to supplant current levels of county expenditures. We cannot process for funds without a current resolution. 5. Budget: Complete a budget page(s)for each organization to which you shall provide funds. List the organization(s) below. (Use additional pages if necessary) Collier County Emergency Medical Services DH 1684,December 2008 64J-1.015,F.A.C. 1 i' . CO4 ' . . Approved as to form and legality .� ATTEST: . . \ —D DWIGHT E.BRG. tc,,Ct,ERK Assi ant County Attorney i& -Thi L A -.p • Cie*,' IIIIoepury Attest as to Chairman . Sitinature only.