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Backup Documents 05/09/2017 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP _ TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 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 JAB 05/18/17 4. BCC Office Board of County Y "\› Commissioners y f'- rte\ Z \ \ �p� 5. Minutes and Records Clerk of Court's Office ; ����� �,� 1 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 Dan Summers/EMS Contact Information 239-252-3600 Contact/ Department Agenda Date Item was May 9,2017 Agenda Item Number 16E5 / Approved by the BCC Type of Document Certificate of Public Convenience and Necessity Number of Original 1 Attached for a Class 1 and Class 2 Advanced Life Service Documents Attached (ALS)Rescue and intra-facility ambulance transport for the Seminole Tribe of Florida Fire Rescue within the boundary of the Seminole Tribe in Immokalee. PO number or account 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 signa , e STAMP 0 JAB 2. Does the document need to be sent to another agency for as•• •s. _ .tures? If yes, JAB 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 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 05/09/2017 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 1 Chairman's signature. 1 6 E5 MEMORANDUM Date: May 18, 2017 To: Dan Summers, Director of Emergency Services Bureau of Emergency Services & Emergency Management From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: COPCN w/Seminole Tribe of Florida Fire Rescue Attached for your records is the original of the document as referenced above, (Item #16E5) adopted by the Board of County Commissioners on May 9, 2017. If you have any questions, please feel free to call me at 252-8411. Thank you. Attachment tillio rill. 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COLLIER COUNTY FLORIDA Class "1" and Class "2"COPCN Name of Service: Seminole Tribe of Florida Name of Owner: Seminole Tribe of Florida Principle Address of Service: 6300 Stirling,Road Hollywood, FL 33024 Business Telephone: (954) 966-6300 Description of Service: Class"1" Emergency Medical Transport: Class"2"Intra-facility and out-of-county transport for tribal members. Number of Ambulances: (2) Twos(1)One Fire Engine 1250 OMP Pumper,and(1)One Fire/EM Su* i *4 V .. I See attachment"A"for description of vehicles. This permit, as provided by Ordinance No. 2004-12,as amended, shall allow the above named Ambulance Service to operate intra-facility and out of county transports for a fee or charge for the following area(s): Seminole Tribe of Florida Fire Rescue Department boundaries for one year from the date executed 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 1 application to the provisions of Emergency Medical Services. Issued and approved this9-\--\ day of\--\4. • 2017 ATTEST: BOA:do t iOUNTY COMMISSIONERS DWIGHT E. BRO • CLERK COL i.R 1 UNTY, FLORI 9 , LC:.44)7J-"ICL- i 1 / , . as to ChainitleAty Clerk Penny Tayloe : rman signature only. Approved as to form and legality: Jennifer A. Belpe,dio ' c'''\ Assistant County Attorne 03 \* P, (17-EMO-00390/1333747/11 ...... _ na u 4 Attachment"A" Seminole Tribe of Florida Fire Rescue Department Immokalee Reservation Station VIN List-2017 . Two(2)Medical Rescue Units(Ambulances) - Rescue 38 -Class 1&2 ALS Transport and Intra-Facility(FL-ALS Permit# 19849) - Rescue 238 Class 1&2 ALS Transport and Intra-Facility(FL-ALS Permit# 14456) . One (I) Fire Engine 1250 GPM Pumper - Engine 38: Class 3 ALS Non-Transport(FL-ALS Permit#15633) . One(1)Fire/EMS Supervisory Vehicle - Battalion 38: Supervisor,Exempt [Rescue Services(Non-ALS)w/ Paramedic)]