Backup Documents 02/22/2011 Item #16F1
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 F 1
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 original
documents are to be forwarded to the Board Office only after the Board has takt'n 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
excention of the Chaimlan's sipnature, draw a line throuP'11 wulin!> lines # 1 throuph #4, comnlcte the checklist, and forward to Sue Filson line #5).
~oute to Ad~\ressee(s) Office Initials Date
List in mulin" order
1.
2.
3.
4.
5. Ian Mitchell, Supervisor Board of County Commissioners ~ "1-/7.-1111
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the origmal document pending Bee 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 Bee Chainnan's signature are 10 be delivered to the Bee office only after the BCe ha.'i acted to approve the
item.'
Name of Primary Staff Artie Bay Phone Number 252-3740
Contact
Agenda Date Item was Feb 22, 2011 Agenda Item Number 16F I
A';nroved bv the BCC
Type of Document Grant Application, Fund Dist~~~ution Form Number of Original 3 (M & R-Please
Attached and Resolution ", '; Documents Attached return all originals)
'f,J'
I.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate.
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 ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the final ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCe officc within 24 hours of BCe approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the Bee's actions are nullified. Be aware of our deadlines!
The document was approved by the BCC on_2/22111_(enter date) and all
changes made during the meeting have been incorporated in the attached document.
The Count Attorne 's Office has reviewed the chan es, if a licable.
Yes
(Initial
2.
3.
4.
5.
6.
ct)
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04. Revised 1.26.05, Revised 2.24.05
16F 1
MEMORANDUM
Date:
February 24, 2011
To:
Artie Bay
EMS, Operations Analyst
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
EMS Grant Application & Resolution 2011-33
Attached please find one (1) original document and one (1) certified copy of the
resolution referenced above, (Agenda Item #16Fl) approved by the Collier County
Board of County Commissioners on Tuesday, February 22, 2011.
Please forward the fully executed original to the Minutes and Records
Department where it will be kept as part of the Board's Records.
If you have any questions, please call me at 252-7240.
Thank you.
16F 1
RESOLUTION NO. 2011 - 33
RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,
CERTIFYING THAT THE APPLICATION FOR AND USE
OF EMS COUNTY GRANT FUNDS WILL IMPROVE AND
EXPAND PRE-HOSPITAL EMS DEPARTMENT
ACTIVITIES AND WILL NOT SUPPLANT EXISTING
COUNTY EMS BUDGET ALLOCATIONS.
WHEREAS, EMS Department Paramedics and ParamediclFirefighters provide
basic and advanced life support care and highly technical service to the citizens and
visitors of Collier County; and
WHEREAS, the purchase of equipment and provision of training classes shall
greatly enhance the effectiveness of pre-hospital emergency medical care.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
The $39,565 in the EMS County Grant will be used to purchase medical/rescue
supplies/equipment and training classes and these funds will not be used to supplant
existing EMS Department budget allocations.
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County, Florida, this<:9O\l'\d day of fubrt.J-ory ,201 I.
ATTEST:
",C"r
DWIGHT"E...BROCK" Clerk
BOARD OF COUNTY COMMISSIONERS,
COLLIER COUNTY, FLORIDA
Deputy Clerk
Attest ....a.t
.....twt .. ~
--1',r ~.
f/u..dL lA' . p-~
BY:" '-."
FRED W. COYLE, Chairman
BY: ~,
Approved as to form and
legal su lcie
Item#~
Agenda ~.-uJ"
Date ~
I
16F 1
EMS COUNTY GRANT ApPLICATION
FLORIDA DEPARTMENT OF HEALTH
Bureau of Emergency Medical S",,'ces
Comple" aI/items
D The Stlte Bureau of EMS wlll..., n the ID Code - leave thla blank
re ~ u
. VF 59-6000558
Date: Q)C>b:l
3. Contact Pereon: (The Individual with direct knowledge of the project on a day-to-day basis and has
responslbllily for the implementallon of the grant actJvlties. This person Is authorized to sign project
reports and may request project changes. The signer and the contact person may be the same.)
Name: AllIe Ba
01 un,
75 u Pa u
: 239-252-3740
ress: 001 ov.net
Fax Number: 239-252-3298
4. lIlIO ut on: a current reso u e Board nly Commissioners ng e grant
funds willmprove and expand the counly pre-hoepltal EMS system and will not be used to supplant
current levels of counly expendUures.
\ TTEST: .' O.tfFoan '!1&4. December 2008
)WIGHT ~. 8ROCI<'CL~RK .
r
'/.DeputyCle
lttItt Ii " .
II. Budget: Complete a budget page(s) for each organlzaUon to which you shall provtUe IUnas. LIst
the organlzatlon(s) below. (Use additional pages If necessllly)
Coller Counly Emergency Medical Services
o '
"' " .
!
,
,
I
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I
84J-f.Of6, F AC.
3
r\ppn. '10 form a,ud legal suflidenl:Y:
.........--...
16F 1
BUDGET PAGE
per
Amount
es
GI'and lotal Salaries and FICA
B. Expenees: These ani travel cosl8 and the usual, ordinary, and Incidental expenditures by an
agency, such as. commodities and supplies of a consumable nature exc/udllll.J expenditures classified as
operallng capllal ouUay (see next call1gory).
t e man, app a
C. Vehlc'.., equipment, and other operating capital oullay means equipment, IIxtures. and other
tangible personal property of a non conaumable and non expendable nature with a nonnaI expected life
of one (1) year or more.
t e mowrt
M8dlcauRescue EquIpment. $29,565
..~-~--- ~_..----- . --.._.~.....
Gl'llnd Total S39.565
DH Form 1884, December 200lI
"
16F 1
. " '-, ~':);
ITTEST:.' " " ,
lWIG"!J E. BROCK ClERK
FLORIDA DEPARTMENT OF HEALTH
EMS GRANT PROGRAM
,BggUEST FOR GRANT FUND DISTRIBUTION
In accordance wllh the provisions of Section 401.113(2)(a), F. S., the undersigned hereby
requests an EMS grant fund distribution for the improvement and expansion of pre-hospital
EMS.
DOH Remit PaYment To:
Name of Agency; Collier County Board of County CommlaslonEllll
Mailing Address: 3299 Tamiami Trail East. Suite 303
Naptes,FL 34112
Federalldentiflcal/on number _59-6000558
Aulhorlzed OfIlcial: ~,~ G~drt &J~J I L
1l8lur8 Date
Fred W. Coyle, Chalnnan
Type Nerne and TRIe
Sign and retum this page with your application to:
Florida Department of Health
BEMS Grenl Program
4052 Bald Cypress Way. Bin e18
Tallahassee, Florida 32399-1738
Do not write below thle line. For un by Bureau of Emergency Medical 8ervlcee peraonnal only
Grant Amounl For Slate To Pay: $ GranlIO: Code:
Approved By
Signature of EMS Granl Offlcer Dale
Slate Fiscal Year. -
OrwuanbAHrvt. Code .E.Q. QCA Oblecl Code
64-42-1 ()..()().()OO 750000
Federal Tax 10: VF ---------
Grant Beginning Date: Grant Ending Dale:
-gePlltvCle~
" -
Attest . .. _.... .
.....bn' ilI.. '
64J-1_015, FAC.
Appro
J sulllclencv
5