Backup Documents 01/26/2010 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 dtlcumcnts should he !umd delivered to the Board 01lke. The completed routing slip and original
documents arc to be lorwarded to the Board Office onlv !:I_fttl:: the Iloard has tak('n action on the ilem_l
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 si2llature, draw a line throu2l1 routino lines #1 throu~ #4, complete the checklist, and forward to Sue Filson (line#S)'
Route to Addressee(s) Office Initials Date
(List in routing order'
1.
2.
3.
4.
5. Ian Mitchell, Supervisor Board of County Commissioners e 1/1&?/to
-j--
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(fhe primary contact is the holder of the original 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 stafffor additional or missing
information. All original documents needing the BCe Chairman's signature are to be delivered to the BCe office only after the Bee has acted to approve the
item.
Name of Primary Staff Artie Bay
Contact
Agenda Date Item was 1/26/10
A roved b the BCC
Type of Document Certificate =t ~"r<'\ ,+
Attached
Phone Number
252-3740
16Ft
- Minutes & Records
Please return ori .
Yes
(Initial)
Agenda Item Number
Number of Original
Documents Attached
I.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a 0 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 ssibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties ex 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 ature 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 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 our deadlines!
Tbe document was approved by the BeC on_I/26/10_(enter date) and all
chauges made during the meeting have been incorporated in tbe attached document.
Tbe Coun Attorne's Office bas reviewed the cban es, if a Iicable.
iR
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cP
I: Forms! eounty Forms! Bee Forms! Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
2.
3.
4.
5.
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16f lr.
MEMORANDUM
Date:
January 27, 2010
To:
Artie Bay
EMS, Operations Analyst
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Certificate & Permit
Attached please find one (1) original of each document referenced above, (Agenda
Item #16Fl) approved by the Collier County Board of County Commissioners on
Tuesday, January 26, 2010.
A copy of the original is being kept by Minutes and Records as a part of the
Boards official records.
If you have any questions, please call me at 252-7240.
Thank you.
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16F 1
COLLIER COllNTY FLORIDA
EMERGENCY SERVICES PERMIT #1
This Permit Expires December 31, 20 I 0
Name of Service:
Collier Countv Emergencv Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lelv Cultural Parkwav. Naoles. Florida 34113
Business Telephone:
(239) 252-3740
Emergency Telephone:
9-1-1
Description of Services Area: The 2,032 square miles encomoassing Collier County
Number of Ambulances on 24 hour duty: 24 ground units (ambulances)
Number of Ambulances on 12 hour duty: Il!found unit (as needed during season taken from reserve fleet).
Number of reserve Ambulances: 9
Number of non-transport ALS engines 6
N umber of Medivac helicopter:
See attachment "A" for description of vehicles.
This permit, as provided in Ordinance 04-12 shall allow the above named Ambulance Service to operate
Emergency Medical Services for a fee or charge for the following area(s): Collier Countv 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 approved this
, I
,I In I.
c/. ( : day of' Jo) I \i ,\
:), '\ /2010.
ATTEST:
I2r; wight E. Br Ck'('L~,
A~~\l~t. '1 to i. lerk.,"
, I ')(;#Jr'6~ed lIfto'form&legal sufficiency:
BOARD OF COUNTY COMMISSSIONERS
CQL_~lfR COUNTY, FLORIDA~, '
lu! 0.) (".,,9<;;
.i
Fred Coyle, Chairman '
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