Backup Documents 02/08/2011 Item #15AORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 154
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 original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 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 #I through #4 complete the checklist and forward to Ian Mitchell (line #5)
Route to Addressee(s)
List in routing order)
Office
Initials
Date
1.
Assistant County Attorney
(Initial)
Applicable)
2.
1/25/11, 2/8/11
Agenda Item Number
10G, 15
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Jennifer B. White, ACA
County Attorney's Office
2/8/11
5. Ian Mitchell, BCC Office
Supervisor
Board of County Commissioners
Documents Attached
Zl S
6. Minutes and Records
Clerk of Court's Office
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, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Jennifer B. White
Phone Number
252 -8400
Contact
Assistant County Attorney
(Initial)
Applicable)
Agenda Date Item was
1/25/11, 2/8/11
Agenda Item Number
10G, 15
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Application for Certificate of Public
Number of Original
1
Attached
Convenience and Necessity (COPCN)
Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
amvmriat e.
(Initial)
Applicable)
1.
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
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
N/A
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
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
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
N/A
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 t 15 q +.2 g venter date) and all changes
IV
made during the meeting have been incorporate to the attached document. The
Coun Attorne 's Office has reviewed the changes, if applicable.
7.
Please return two executed original documents to Jennifer B. White, ACA
n/a
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 15A
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 original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 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 routine lines #1 through #4_ complete the checklist and fnrward to Tan Mitchell (line ff51
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1.
Assistant County Attorney
(Initial)
Applicable)
2.
1/25/11, 2/8/11
Agenda Item Number
10G, 15
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Jennifer B. White, ACA
County Attorney's Office
�„�
2/8/11
5. Ian Mitchell, BCC Office
Supervisor
Board of County Commissioners
Documents Attached
l
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
jzfj D
copy
(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, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Jennifer B. White
Phone Number
252 -8400
Contact
Assistant County Attorney
(Initial)
Applicable)
Agenda Date Itern was
1/25/11, 2/8/11
Agenda Item Number
10G, 15
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Application for Certificate of Public
I
Number of Original
2
Attached
Convenience and Necessity (COPCN)
Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
aDDrODriat e.
(Initial)
Applicable)
1.
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
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
N/A
Office and all other parties except the BCC Chainnan and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
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
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
N/A
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 (enter date) and all changes
made during the meeting have been incorporated in the attached document. The
I
County Attorney's Office has reviewed the changes, if applicable.
lorn
7.
Please return two executed original documents to Jennifer B. White, ACA
n/a
15q
MEMORANDUM
Date: February 10, 2011
To: Jennifer Belpedio -White
Assistant County Attorney
From: Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re: Original Application for COPCN and Original Certificate
for COPCN
Enclosed please find an original of both documents referenced above
(Agenda Item #10G / #15) adopted by the Board of County Commissioners on
Tuesday, January 25, 2011 and February 8, 2011.
The original is being held in the Board's Official Records.
If you should have any questions, please contact me at 252 -8411.
Enclosures
15A
MEMORANDUM
Date: February 8, 2011
To: Ian Mitchell, BCC Manager
Board of County Commissioners
From: Teresa Polaski, Deputy Clerk
Board Minutes & Records Department
Re: Application for Certificate of Public Convenience and
Necessity
Attached for your records, is a copy of the document referenced above
(Item #15) adopted by the Board of County Commissioners February 8, 2011.
If you have any questions, please call me at 252 -8411.
Thank you.
Attachment
15A
MEMORANDUM
Date: February 8, 2011
To: North Naples Fire and Rescue District
From: Teresa Polaski, Deputy Clerk
Board Minutes & Records Department
Re: Application for Certificate of Public Convenience and
Necessity
Attached for your records, is a copy of the document referenced above
(Item #15) adopted by the Board of County Commissioners February 8, 2011.
If you have any questions, please call me at 252 -8411.
Thank you.
Attachment
NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
ADVANCED LIFE SUPPORT NON - TRANSPORT SERVICES
WHEREAS, the NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT will
provided quality ADVANCED LIFE SUPPORT ( "ALS ") NON - TRANSPORT
services to the citizens within the service area boundary of NORTH NAPLES
FIRE CONTROL AND RESCUE DISTRICT ( "DISTRICT ") in COLLIER
COUNTY; and
WHEREAS, Collier County Emergency Services will continue to transport citizens within the
service area boundary of the DISTRICT; and
WHEREAS, the DISTRICT will provide essential ALS Non - Transport services to the citizens
within the service area boundary of the DISTRICT and follow the protocols of
the Collier County Medical Director; and
WHEREAS, the DISTRICT will comply with all requirements of Chapter 401, Florida
Statutes and all other applicable laws governing ALS Non - Transport Services.
NOW THEREFORE, the Board of County Commissioners of COLLIER COUNTY hereby issues a
Certificate of Public Convenience and Necessity for ALS Non - Transport
services one year from the date the North Naples Fire Control and Rescue
District receives its license from the State of Florida pursuant to Chapter 401,
Florida Statutes. In issuing this Certificate, it is understood that the DISTRICT
will meet the requirements of all applicable laws and regulations and will
provide ALS Non - Transport Services on a twenty -four hour (24) basis for the
following area(s):
THE 70 SQUARE MILES ENCOMPASSING NORTH NAPLES,
COLLIER COUNTY, FLORIDA, AS DELINATED IN THE BOUNDARY
MAP ATTACHED HERETO AS EXHIBIT "A" AND SPECIFICALLY
DESCRIBED IN THE LAWS OF FLORIDA CHAPTER 99 -450.
CLERK OF CO TES
d` ,Deputy Clerk
yFlatur
A j roved as io f r YA legal sufficiency:
Jennifer $. . eVh e, Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIE. C, UNTY, FLORIDA
r
FRED W. COYLE, CHAIRMAN
15A
EXHIBIT "A"
COLLIER COUNTY PROPERTY APPRAISER
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❑ GEOGRAPHIC INFORMATION SYSTEM
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COLLIER COUNTY FLORIDA
ADVANCE LIFE SUPPORT NON - TRANSPORT
NORTH NAPLES FIRE CONTROL AND RESCUE DISTRICT
PERMIT #1
This Permit Expires one year from the date the North Naples Fire Control and Rescue District
receives its license from the State of Florida pursuant to Chapter 401, Florida Statutes.
Name of Service: ALS Non - Transport
Name of Owner or Manager: North Naples Fire and Rescue District
Principal Address of Service: 1885 Veterans Park Drive, Naples, Florida 34109
Business Telephone: (239 ) 597 -3222
Emergency Telephone: 9 -1 -1
Number of Ambulances on 24 hour duty:
Number of Ambulances on 12 hour duty:
Number of reserve Ambulances:
Number of non - transport ALS engines,
ladders, squads and other vehicles:
Number of Medivac helicopter:
0
0
W
14 with 10 of the 14 needing permitting from the State
of Florida
W
See Attachment "A" for description of vehicles. The County recognizes that in addition to
Attachment "A ", other vehicles may be permitted by the State of Florida pursuant to Section
401.26, Florida Statutes, to provide non - transport ALS services within its boundaries. The
District shall provide within (10) ten days advanced written notification to the County of any
additional vehicles permitted by the State. The District shall also provide the County notification
when a vehicle listed on Attachment "A" is no longer permitted by the State.
This permit, as provided in Collier County, Florida, Ordinance 04 -12, as amended, shall allow North
Naples Fire Control and Rescue District to provide emergency response but not provide
emergency transportation within Collier County North Naples Fire Control and Rescue District,
as delineated in the Boundary Map attached hereto as Attachment `B" and described in the Laws
of Florida Chapter 99 -450, excluding the property known as Moorings Park and the property
known as Hole -in -Wall Golf Course, 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 follow the protocols of the Collier County Medical Director, or comply
with any applicable local, state or federal laws or regulations.
15 �1
Issued and approved this
ATTEST;;
,Dwigh'`E: Brock; CLERK
q ,bE.. day of , 2011
BOARD OF COUNTY CON IISSSIONERS
COLLIER COUNTY, FLORIDA
St r Z't��e &ty Clerk FRED. W. COYLE, Chairman�1rtasurei
Approvedas tQ`orin & legal'sufficiency:
Jennifer B. White
Assistant County Attorney
15A
ATTACHMENT "A"
Vehicle Year & Model
Vehicle Identification Number
2004 Pierce Quantum (E 40)
4P1CT02S93A003679
2000 Pierce Quantum (E 42)
4P1CT02S6YA000780
2006 Pierce Quantum (LA 43)
4P1CUO1S36A006032
1998 Pierce Quantum (E 44)
4P1CT02S9WA000592
2006 Pierce Quantum (TO 44)
4PCUO1HX6A006078
2010 Pierce Quantum (RES 45)
4P1CUOIE3AA010553
2002 Pierce Quantum (E 46)
4P1CT02S02A002256
1998 Pierce Quantum (LA 47)
4P1CT02S5WA000816
2005 Ford Expedition (SQ 40)
1FMPU16545LA78469
2005 Ford Expedition (SQ 45)
1FTSW221P05EC07402
* 2005 Ford 250 4X4 (CH 42)
1FTSW21P25EC07403
* 2006 Ford Expedition (CH 45)
1FNTU16506LA97618
* 2006 Ford Expedition (CA 410)
1FNDU16516LA64031
* 2007 Ford F250 (CA 41)
1FTSW21P67EA47402
* DO NOT NEED LICENSING
Legend
Q North Naples Flre District
Major Roads
r ] County Boundary
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ATTACHMENT `B ".
North Naples Fire District
Boundary Map
COLLIER COUNTY PROPERTY APPRAISER
GEOGRAPHIC INFORMATION SYSTEM
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Legend
North Naples Fire Distnct
- Major Roads
County Boundary
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EXHIBIT "A"
North Naples Fire District
Boundary Map
COLLIER COUNTY PROPERTY APPRAISER
GEOGRAPHIC INFORMATION SYSTEM
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1 in = 1 miles