Backup Documents 11/12/2013 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL j 6 E 1 f
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. 'fhe 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. .kit completed routing slips arid original documents must he 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
-4. BCC Office Board of County Gkk "-\Y‘\1
Commissioners 45/ \\\4k3
5. Minutes and Records Clerk of Court's Office PC LI. 61 �
l'" �
PRIMARY CONTACT INFORMATION 01 0114/
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 Christine Bo i Phone Number 252-3617
Contact/ Department
Agenda Date Item was 11/12/13 Agenda Item Number 16E1
Approved by the BCC
Type of Document Permit and Certificate Number of Original 1 each
Attached Documents Attached
-PO number or account Need originals to send
number if document is to North Naples Fire
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? CB V
2. Does the document need to be sent to another agency for additional signatures? If yes, -GB-- h)IA
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 /
signed by the Chairman,with the exception of most letters,must be reviewed and signed CB V
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's -GB-- N I p[
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 CB
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 CB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CB
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 11/12/13(enter date)and all changes
made during 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.
1: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
16E1
MEMORANDUM
Date: November 20, 2013
To: Christine Boni, Senior Admin. Assistant
Bureau of Emergency Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: North Naples Fire Control and Rescue District
Certificate of Public Convenience and Necessity (COPCN)
and Permit for Advanced Life Support Non-Transport Services
Attached for your official use are the original documents referenced above, (Item #16E1)
approved by the Board of County Commissioners on Tuesday, November 12, 2013.
The Minutes and Record's Department will hold a copy of both in the Board's Official
Records.
If you have any questions, please call 252-8406.
Thank you.
Attachment
4 € i? , '
.a. . � di = i ' , , ,—,,, F� it + : e
,
.:fir.
�i `� i ..AV'✓ le"�� V�i�� �2L�V"��7'U1��.''`L'l�"�� 1�\.i L���.'' , •*11, Sall�li
'.,,,.��/ /1 /1 % i1 l �1 �1 !�L y/ LYE /i�V'.�s� 10 y 4s lit• U/ ��y,„1?Ao-
f X
C� �u
I
Cr� ,I�� I- i s'. .�f)
Ca l� 1 �C ,, O cv O
k� t y n C O ayL+ C U C z LO
al `--'"
CI U� 3 `' c� c a� O `z -
Ri > N Y a) N u U V_] o NC i
O O Y O c-,-) ERl O U .0 n y
0 .L y a) U N O Q:�Q C CI
fs1 .,�/ g '.
; Jfl �/ �\�/- a . ^O co > ° II
r �
,.' W 8 1-1 •.� 4c,;,),
0 vii
T'1 #'4 z Q v 'd U .a ca ^D �
T 1 a C% 4O ° „t'r ate.+ N > -,.
t;7z., s r .a L7 C G i P
7 Qy/ 0. Y b yo U MA:ob
4:1 V) w Z c 0 a;
a E., o( *' b OW
0.i U% 1 a n a s au v) aL
i</ .L., c 1:, c ,c.) to U E. ,,L, cr, 1 ,3'1 Z E" W - „f
a 9 U a ¢ O aai v ,.. co :LS a) f Y^
0
° 4,
" " ! i c6 > U n Q 2
= '
c Z ' b y C3 E a) c
44- j a .O p y O i vv,
,
o
� `s a u, U z cc • U r4 iMM
,4, �, �� W fA .� if
on
lit A,�a) �"
,, ,�j V2 V1 VI W , CO a "'
s Q Q Q - ;° I¢ yet
a; W W W
CC fY 0: W C _ ti
W W W F, Q C .* S'
Z
'
\� , j_1 `� J , am�` J J aJ y ''' ''41/ .`,..‘'4--.4 „ dn\- �*•\�� J h L ” �� 1Vjr \ �L c s
z'''*"' 1'41-41....:„h.; 4:61;41:1/2:6..._441"7: ;1
16E1
COLLIER COUNTY FLORIDA
Renewal of Class 3 COPCN
This Permit is effective January 1, 2014 and
expires December 31, 2014
Name of Service: North Naples Fire Control and Rescue District
Name of Owner: North Naples 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 Vehicles: 16 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 Naples Fire Control
response boundary and pursuant to a mutual-aid agreement until the expiration date
hereon, except that 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 Naples Fire
Control and Rescue District.
Issued and approved this he'day of t\jovem ber , 2013
ATTEST: BO• ' I OF COUNT COMMISSIONERS
DWIGHT E. BROCK, CLERK C• LI re LI; OUNTY FLORIDA
1t
Al A . w . A �Sas�: •� • i
a
Clerk Geo A I1-r, Esq., Chairwoman
hest as to 0
signature oni ty-~ ,
s
Approved as to fob and legality:
' Item#
-e-c k.`7 Agenda I
Jennife . Belpedio, AsAstant County Attorney Date `J-iL- 1
Date '\___'t
Recd •
"AAA-_.--•
•epu ta,