Backup Documents 09/13-14/2011 Item #16F3ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO &6 F 3
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 #I 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 #I through #4_ comnlete the checklist_ and forward to Sue Filson (line #51.
Route to Addressee(s)
List in routing order
Office
Initials
Date
1.
appropriate.
Initial
Applicable)
2.
9/13/11
Agenda Item Number
Me F.3
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Grant tion
Number of Ori final
5. Ian Mitchell, Supervisor
Board of County Commissioners
Documents Attached
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
Artie Bay
Phone Number
252 -3740
Contact
appropriate.
Initial
Applicable)
Agenda Date Item was
9/13/11
Agenda Item Number
Me F.3
Approved b the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Grant tion
Number of Ori final
Attached
o
Wft
Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
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
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
should be provided to Sue Filson 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_9 /13/11 (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.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16F3
MEMORANDUM
Date: September 20, 2011
To: Artie Bay, Accounting Supervisor
EMS Operations
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Resolution 2011 -146: Approving submittal of a Florida
Emergency Medical Services Grant Application for funding
medical/rescue equipment and supplies
Attached please find a certified copy of the resolution and original grant application
referenced above (Item #16F3) approved by the Board of County Commissioners on
Tuesday, September 13, 2011.
A copy of the grant application will be held on file in the Minutes and Records
Department as part of the Board's official record.
If you have any questions, please call me at 252 -8406.
Thank you.
Attachment
RESOLUTION N0.2011- 146
16F3
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 Paramedic/Firefighters 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 $38,919 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 day of jMLOC, 2011.
ATTEST:
DWIGHT E. BROCK, Clerk
y`
BY. AD r
bep
Aft9i" : r
Approved as to form and
legal sufficiency:
Assisffnt County Attorney
BOARD OF COUNTY COMMISSIONERS,
COLLIER COUNTY, FLORIDA
�C BY: " "IuL W. .
FRED W. COYLE, ChairniaA
16F3
EMS COUNTY GRANT APPLICATION
FLORIDA DEPARTMENT OF HEALTH
Bureau of Emergency Medical Services
Complete all items
ID.Code(The State Bureau of EMS will assign the ID Code-leave this blank) C
1. County Name: Collier
Business Address: 3299 Tamiami Trail East, Suite 303
Naples, FL 34112
Telephone: 239-352-3740
Federal Tax ID Number(Nine Digit Number). VF 59-6000558_
2. Certification: (The applicant signatory who has authority to sign contracts,grants,and other legal
documents for the county)I certify that all information and data in this EMS county grant application and its
attachments are true and correct. My signatur acknowledges and assures that the County shall comply
fully with the conditions outlined in the Flor MS upty Dra Appli ion.
Signature: W Date: 9 I Li r
Printed Name: Fred W.Coyle
Position Title: Chairman
3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has
responsibility for the implementation of the grant activities. This person is authorized to sign project
reports and may request project changes. The signer and the contact person may be the same.)
Name: Artie Bay
Position Title: Administrative Supervisor, EMS
Address: 8075 Lely Cultural Parkway, Suite 267
Naples,FL 34112
Telephone: 239-252-3740 J Fax Number.239-252-3298
E-mail Address: ArtieBay @colliergov.net
4. Resolution: Attach a current resolution from the Board of County Commissioners certifying the grant
funds will improve and expand the county pre-hospital EMS system and will not be used to supplant
current levels of county expenditures.
5. Budget: Complete a budget page(s)for each organization to which you shall provide funds. List
the organization(s)below. (Use additional pages if necessary)
Collier County Emergency Medical Services
OH Form 1684,Decel 2AQe, 64J-1.015,F.A.C.
t7.;+ 3 Apl+Oved its to form & legal Sufficiency
DWIGHT E:`,i � Cita
Vf
AL
..1.:1 AsslstanfCount Attorney
E
BUDGET PAGE 1 6 F 3
A. Salaries and Benefits:
For each position title, provide the amount of salary per hour, FICA per
hour, other fringe benefits, and the total number of hours. Amount
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
B. Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an
agency, such as, commodities and supplies of a consumable nature excluding expenditures classified as
operating capital outlay(see next category).
List the item and, if applicable,the quantity Amount
Medical Equipment/Supplies $28,919
TOTAL $28,919
C. Vehicles, equipment,and other operating capital outlay means equipment, fixtures, and other
tangible personal property of a non consumable and non expendable nature with a normal expected life
of one(1) year or more.
List the item and, if applicable,the quantity Amount
Medical/Rescue Equipment $10,000
•
TOTAL $10,000
Grand Total $38,919
DH Form 1684, December 2008
4
16F3
FLORIDA DEPARTMENT OF HEALTH
EMS GRANT PROGRAM
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with 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.
emit i ayment i o:
Name of Agency: Collier County Board of County Commissioners
Mailing Address: 3299 Tamiami Trail East, Suite 303 _
Naples, FL 34112
Federal Identification number
Authorized Official:
W
Signature
Fred W. Coyle, Chairman
Type Name and Title
Sign and return this page with your application to:
Florida Department of Health
BEMS Grant Program
4052 Bald Cypress Way, Bin C98
Tallahassee, Florida 32399 -9738
Do not write below this line. For use by Bureau of
Grant Amount For State To Pay: $
Approved By : _
State Fiscal Year:
Organization Code
64- 42 -10- 00-000
Federal Tax ID:
Signature of EMS Grant Officer
t= 4: OCA
VF
Grant Beginning Date:
a
Date
Medical Services personnel
Grant ID: Code:
Grant Ending Date:
DH 1767P, b@Ce 64J- 1.015, F.A.C. r�ptll�."_ '
ATTE9r
DWIGH E. 8F�OCK, CjA 5
gy
Date
APPCOM lei to form & legal Sufficiency
Asslshnt County Attornev