Backup Documents 02/28/2017 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 E �.
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 JAB 2/28/17
4. BCC Office Board of County
Commissioners V6/5/
5. Minutes and Records Clerk of Court's Office l r, „r�l�� 3�'r
L{ l `1�m
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 Jennifer Belpedio County Attorney's 252-8400
Contact/ Department Office
Agenda Date Item was 2/28/17 V Agenda Item Number 16E1
Approved by the BCC
Type of Document Permit Number of Original One ' 4. 'A c
Attached Q P 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 signatu - STAMP OK JAB
2. Does the document need to be sent to another agency for a. 'onal s'•• res? If yes, NA
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 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 NA
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 fmal 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 NA
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 2/28/17 and all changes made during the JAB
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.
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
16E 1
MEMORANDUM
Date: March 2, 2017
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: COPCN & Permit
Attached is one (1) original of the document as referenced above, (Item #16E1)
approved by the Board of County Commissioners on Tuesday, February 28, 2017.
A copy has been kept as part of the Board's Official Records in the Board's Minutes
and Records Department.
If you have any questions, please contact me at 252-7240.
Thank you.
Attachments
1ÔE 1
COLLIER COUNTY FLORIDA
Renewal of Class "3" COCPN
This Permit is effective April 1, 2017 and
Expires March 31,2018
Name of Service: North Collier Fire Control and Rescue District
Name of Owner: North Collier Fire Control and Rescue District
Principle Address of Service: 1885 Veterans Park Drive,Naples, FL 34109
Business Telephone: 239-597-3222
Description of Service: Non-Transport Advanced Life Support
Number of Ambulances: 19 Ground Units available.
See Application for Description of Vehicles
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Non-transport ALS Service to operate within the North Collier Fire Control and
Rescue District response boundary and any mutual aid or auto aid agreement for fire and
rescue service within Collier County in which the District is a party until the expiration
date hereon, except that this permit may be revoked by the Board of County
Commissioners of Collier County at any time the service named herein shall fail to
comply with any local, state or federal laws or regulation applicable to North Collier Fire
Control and Rescue District.
Issued and approved this -2-14\--k. day of ovr-V , 2017.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK COLLI R . TY, FLORIDA
Attes to Chairman's ,Depit Cl: ' Penny Tayloo1 airman '
signature.only
Approved as to form and legality:
Jentr fer A. Bel io
Assistant County Attorney
[14-EMG-00333/1123457/1]
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