Backup Documents 11/13/2012 Item #16E 5ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLID 6 E
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and on mal
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
excention of the Chairman's signature_ draw a line through routine lines #I through #4. comnlete the checklist_ and forward to Sue Filson (line #5).
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1.
-----------------------------------
a ro riate.
(Initial)
Applicable)
2.
-----------------------------------
11/13/12
Agenda Item Number
16E5
3.
-----------------------------------
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Jeff Klatzkow
County Attorney's Office
CB
11/13/12
5 BCC Office
Board of County Commissioners
Documents Attached
6. Minutes and Records
Clerk of Court's Office
k k k6h Z
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, need to contact staff for additional or missing information. All original
documents needing the RCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to annrove the item_)
Name of Primary Staff
Christine Boni
Phone Number
252 -3600
Contact
a ro riate.
(Initial)
Applicable)
Agenda Date Item was
11/13/12
Agenda Item Number
16E5
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
COPCN renewal and certificate
Number of Original
1
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
INSTRUCTIONS & CHECKLIST
1: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a ro riate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
CB
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
CB
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
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.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
CB
signature and initials are required.
—
5.
In most cases (some contracts are an exception), the original document and this routing slip
CB
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 11/13/12 (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.
1: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09
16E 51
MEMORANDUM
Date: November 13, 2012
To: Christine Boni, Senior Admin. Assistant
Bureau of Emergency Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: COPCN Renewal & Certificate
Attached for your records are one (1) copy of the document referenced above,
(Item #16E5) adopted by the Board of County Commissioners on Tuesday,
November 13, 2012.
The original was kept by the Minutes and Records Department as part of the
Board's Official Records.
If you have any questions, please call 252 -7240.
Thank you.
Attachment
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16E
COLLIER COUNTY FLORIDA
Renewal of Class "2" COPCN
Name of Service: Ambitrans Medical Transport, Inc.
Name of Owner: Michael and Lorraine Grant
Principle Address of Service: 4351 Pinnacle Street. Charlotte Harbor, FL 33980
Business Telephone: (941) 743 -3665
Description of Service: Intrafacility and out of count transport ransport for Collier County
Number of Ambulances: 17 Ground Units available.
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 intrafacility and out of county transports for a fee
or charge for the following area(s): Collier County for the period October 25, 2012
through October 24, 2013, 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 application to the provisions
of Emergency Medical Services.
Issued and approved this 13 ii, day of NpUpmi( , 2012
ATTEST -— ; .
DWIGH'i7 E. BRO�k -- C'.LERK
A . V i :: T.
and legal sufficiency:
BOARD OF COUNTY COMMIS
COLLIER COUNTY, FLORIDA
Fred W. Coyle, Chairman ttllAlla
5'
Ambitrans Medical Transport
Vehicle Listing
1FDSS34P09DA59420
1FDSS34P78DA64922
1FDSS3ES1BDB27801
1FDSS3ES3BDA26145
1FDSS3ES3CDA18371
1FDSS3ES4BDA26137
1FDSS3ES5ADA25626
1FDSS3ES5CDA18372
1FDSS3ES6ADA31208
1FDSS3ES6BDA26138
1FDSS3ES6BDB36820
1FDSS3ES7BDB27799
1FDSS3ES7BDB27804
1FDWE35F92HA44797
1FDXE45F23HB15317
1 FDXE45F2YHB54092
1FDXE45F73HB48975
Vehicle
Permits (BLS)
Vehicle
Permits (BLS)
Vehicle
Permit (ALS)
Vehicle
Permits (BLS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permits (BLS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permit (ALS)
Vehicle
Permits (BLS)
Vehicle Permit (ALS)
Vehicle Permits (BLS)
Vehicle Permits (BLS)
16E 5 3
ATTACHMENT "A"
4477
4476
17027
4355
17149
16462
17151
17150
15923
4475
17356
17025
17026
4133
15452
4228
4470