Backup Documents 03/23/2010 Item #16F 3
ORIGINAL DOCUMENTS CHECKLIST & RouTulAJip3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documenls should h.: hiUld delivered 10 the Board OfTi,," rhe completed routing slip and original
documents are to be ttm\'ardcd to the Board CHlice onlv !llt:~J 1h,' Board ha.... taken action on tilt' itl.:m )
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 Chairman's sifmature, draw a line throu2l routine: lines #1 through #4, comolete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s) Office Initials Date
(List in routine. order)
t.
2,
3,
4.
5, Ian Mitchell, Supervisor Board of County Commissioners ~ '?/1-S ) 10
6, Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder oflhe 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 staff for additional or missing
information. All original documents needing the Bce Chairman's signature are to be delivered to the Bee otlice only after the BeC has acted to approve the
item.
Name of Primary Staff Artie Bay Phone Number . 252-3740
Contact
Agenda Date Item was ~3)d31Io Agenda Item Number' I6F
A ved b the BCC
Type of Document Certificate of Public Convenience and Number of Original 2-M &R-PIease
Attached Necessi and Permit to Renew COPCN Documents Attached return both Ori inaIs
L
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, C~
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 ssibI 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 tore 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 BCe's actions are nullified, Be aware of our deadlines!
The document was approved by the Bee 011..'3 G: (enter date) and all changes
made during the meeting have been incorporated in the attached document. The (}{),
Coun Attorne's Office has reviewed the chaD es, if a licable. ~
2,
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4,
5,
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I: Forms/ County Forms/ Bee Forms! OriginaJ Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16F 3
MEMORANDUM
Date:
March 24,2010
To:
Artie Bay
EMS Operations Analyst
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Permit for renewal and the Certificate of Public
Convenience & Necessity (COPCN) for NCH Healthcare
System regarding non-emergency ambulance service
Attached, for further processing are the original documents referenced
above, (Agenda Item #16F3) approved by the Collier County Board of County
Commissioners on Tuesday, March 23, 2010.
If you have any questions, please call me at 252-8406,
Thank you,
Attachment (1 )
16F 3
COLLIER COUNTY FLORIDA
Renewal of Class "B" COPCN
Name of Service: NCH Ambulance Services
Name of Owner: NCH Healthcare Svstem
Principle Address of Service: 2157 Pine Ridge Road, Naples, Florida
Business Telephone: (239) 513-7080
Description of Service: Intrafacilitv and out of countv transport for the NCH Healthcare
S vstem
Number of Ambulances: 3 Ground Units: NCH will operate no less than one (]) and UP
to three (3) Ground Units on immediate call at all times,
See attachment for description of vehicles,
This permit, as provided by Ordinance No, 2004-12, as amended shall allow the above
named Ambulance Service to operation intrafacility and out of county transports for a fee
or charge for the following area(s): Collier County 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 application to the provisions of Emergency Medical Services,
Issued and approved this &3-d day of m 2\ \ c / h ' 20 I 0
ATTESA: ,"" .....
DWIGth E, 'BROCK, CLERK
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Approved a's"/c)"form and legal sufficiency:
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..~.~ )\,-')"'~tL
Assistant ounty Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
'-ll, t..l LA) C>-<.~
Fred W, Coyle, Chairman "
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16F3
NON EMERGENCY TRANSPOR Fax;2l9-513-7192
, Feb 25 2010 12;dOp. P006l9P.l , ,,-,
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ATTACHMENT B
Charge Number Description
2800100 Non Emergency Transport Mileage
2800704 Basic Life Support - Non Emergency
2800407 Advanced Life Support - Non Emergency
2800308 Advanced Life Support - Level II
nfa Non Emergency Wheel Chair Van
Price
$6,00 per number of miles driven
$656,00
$669,00
$764,00
no charge
ATTACHMENT C
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NOH EWERGENCY TRANSPOR Fax;239-513-1192
Feb 25 2010 12;dOPB P007/001
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ATTACHMENT E