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Backup Documents 11/12/2013 Item #16E 6
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIT C 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 ( C)2 \\ O\�� 4. BCC Office Board of County Gk\b<-\ Commissioners /s/ \\\\c\\3 5. Minutes and Records Clerk of Court's Office L113 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 Artie Bay Phone Number 252-3740 Contact/ Department Agenda Date Item was 11/12/13 \ Agenda Item Number 16E6 Approved by the BCC Type of Document Permit and Certificate Number of Original 2 (j_ O� �ct.f� Attached Documents Attached ll 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? AB 2. Does the document need to be sent to another agency for additional signatures? If yes, n/a 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 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 n/a 1 / should be provided to the County Attorney Office at the time the item is input into SIRE. V 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 AB 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 \J Chairman's signature. 4 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 16E6 MEMORANDUM Date: November 20, 2013 To: Artie Bay, Accounting Supervisor EMS Operations From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Certificate of Public Convenience and Necessity (COPCN) for Advanced Life Support Transport and Permit for Renewal Attached for your official use are the original documents referenced above, (Item #16E6) 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 me at 252-8406. Thank you. 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' J © ,f ' 1 v " ,N , ' tom �er. � , 1 , ..1A9 re ,_ / 16E6 COLLIER COUNTY FLORIDA Renewal of Class 1 COPCN This Permit Expires December 31, 2014 Name of Service: Collier Coun Emer ency Medical Services Name of Owner or Manager: Collier County Board 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: 23 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: 9 Number of non-transport ALS vehicles 10 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 a pp roved this �a 41.-N day of PYA 6-v421.412.a, 2013. ATTEST: B•AR I OF 0 N Y COMMISSSIONERS Dwight E. Brock, CLERK C'1 LL r R 0iOU, ' , FLORIDA est as t0yeputy Clerk Ge`I!ia A. Hiller, Esq., Chairwoman nattire only: =; Item# 1U2ELP proved as to form A legality: @4- Agenda Date ! Jennifer A. Belpedio �'� Assistant County Attorney Z',' Recd t eputy AP 16E6 ...... .-.E. __ ... 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