Backup Documents 12/12/2017 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E 3 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
>ZI 0 1 n
4. BCC Office Board of County 1`'\
Commissioners 'j 4/ t-z-V-7 \\-
5. Minutes and Records Clerk of Court's Office 'a'o-)'} b; 9
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 addition or missing information.
Name of Primary Staff Artie Bay Phone Number 252-3756
Contact/ Department
Agenda Date Item was 12/017 Agenda Item Number 16.E. 3
Approved by the BCC n
Type of Document Permit and Certificate Number of Original I .- t��lA.w►i m-
Attached Documents Attached
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 signature? -4011!r":1„,,,„.0.. AB
2. Does the document need to be sent to another agency for addi '.nal signaturesAf yes, N/A
provide the Contact Information(Name;Agency;Address;Phone .• . attached sh• .
3. Original document has been signed/initialed for legal sufficiency. (All documen s to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed AB
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
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 AB
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 AB
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 1247 (enter date)and all
changes made during the meeting have been incorporated in the attached document. r t a
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 .e
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 ^
CC}7
16E3
MEMORANDUM
Date: December 13, 2017
To: Artie Bay, Supervisor
EMS Operations
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Permit Renewal & Certification
Attached is the document referenced above, (Agenda Item #16E3) approved by the
Board of County Commissioners on Tuesday, December 12, 2017.
If you have any questions, please feel free to call me at 252-8411.
Thank you.
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1 6 E3
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2018
Name of Service: Collier County Emergence Medical Services
Name of Owner or Manager: Collier County l3oard of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway, Naples, Florida 34113
Business Telephone: (239) 252-3740
Emergency Telephone: 9-1-1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty: 25 ground units(ambulances)
Number of Ambulances on 12 hour duty: 1 ground unit(as needed during season taken from reserve fleet).
Number of reserve Ambulances: 14
Number of non-transport ALS vehicles 12
Number of Medivac helicopter: 1
See attachment"A"for description of vehicles.
This permit, as provided in Ordinance 04-12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County 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 the provision of Emergency Medical Services.
Issued and approved this la day of \_j e C— ,2017.
ATTEST: . - : BOA'D:,OUNTY COMMISSSIONERS
Dwight E. Brock, LER COL/./
OL i •LINTY, FLORI
..
/�- ' _.,
Attie t9 Chairrtlan Deputy Clerk Penny Taylod'' airman Or
signature ably..Approved as to orm & legality:
111
Je er-A. p
Bel eaio
Assistant County Attor. c. \ \\I
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[17-EMS-00824/1374332/1]
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