Backup Documents 12/14/2010 Item #16F 1ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 b 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 taken action on the item.)
ROUTING SLIP
Complete routing lines #I through 44 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's Siflnature_ draw a line thmuah rnntino lin— k 1 thr...,.,h }IA
Route to Addressee(s)
List in routing order
..... .....n. -.. A11at, auu
Office
i"twau w Sue ruson
Initials
lme si .
Date
1.
a ro riate.
(Initial)
A licable)
2.
12/14/2010
Agenda Item Number
16F
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Certificate and Permit Application
Number of Original
2 — M & R — Please
5. Ian Mitchell, Supervisor
Board of County Commissioners
Documents Attached
�Z1,s1,z,
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
a ro riate.
(Initial)
A licable)
Agenda Date Item was
12/14/2010
Agenda Item Number
16F
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Certificate and Permit Application
Number of Original
2 — M & R — Please
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
Return Originals.
INSTRUCTIONS & CHF.CKi.I(CT
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS 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
a ro riate.
(Initial)
A licable)
I.
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,
�Q
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 (enter date) and all changes
made during the meeting have been incorporated ifi the attached document. The
County Attorne 's Office has reviewed the changes, if applicable.
1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16F1
MEMORANDUM
Date: December 16, 2010
To: Artie Bay
EMS, Operations Analyst
From: Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re: Certificate and Permit Application
Attached please find one (1) original document referenced above, (Agenda Item
#16F1) approved by the Collier County Board of County Commissioners on
Tuesday, December 14, 2010.
Please forward a fully executed original to the Minutes and Records
Department for the Board's Records.
If you have any questions, please call me at 252 -8411.
Thank you.
16F1
COLLIER COUNTY FLORIDA
EMERGENCY SERVICES PERMIT #1
This Permit Expires December 31, 2011
Name of Service: Collier Counjy Emergency Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway Naples Florida 34113
Business Telephone: 239 252 -3740
Emergency Telephone: 9 -1 -1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty:
Number of Ambulances on 12 hour duty:
Number of reserve Ambulances:
Number of non- transport ALS engines
Number of Medivac helicopter: 1
24 around units (ambulances)
1 around unit (as needed during season taken from reserve fleet)
12
9
See attachment "A" for description of vehicles.
This permit, as provided in Ordinance 04 -12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services 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
applicable to the provision of Emergency Medical Services.
Issued and approved this �. �i day of 10. t
ATTEST ` , �� BOARD OF COUNTY COMMISSSIONERS
Dwight E Srock� ;CL ERK' COLLIER COUNTY, FLORIDA
A Lest 6-vto W �� l4rk Fred W. Coyle, Chairman
4 4Ild WO OK0,
Approved as to form & legal sufficiency:
JennifeQB. White, Assistant County Attorney
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