Backup Documents 11/13/2018 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 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 routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office II/13115
4. BCC Office Board of County c\C.
Commissioners Z kAV1\ ?z,
5. Minutes and Records Clerk of Court's Office
1110-11/5 :91,0.,vh
PRIMARY CONTACT INFORMATION
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,may need to contact staff for additional or missing information.
Name of Primary Staff Artie Bay Phone Number 252-3756
Contact/ Department
Agenda Date Item was 11/13/18 ' Agenda Item Number 16.E.1 r/
Approved by the BCC
Type of Document Permit and Certificate Number of Original 2 — (1 (kiwi t
Attached Documents Attached I C-OPc:-t J )
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. ---''Initial) Applicable)
1. Does the document require the chairman's original signature?, ,S- .n., S� 0 '1 -‘70c13--
2. Does the document need to be sent to another agency for addictnal signatures? If yes,
provide the Contact Information(Name;Agency;Address;Phone)olran-attached"sheet. (L
3. 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 AB
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. 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.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required. �
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. n ��
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!
8. The document was approved by the BCC on 11/13/18 (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.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made,and the document is ready for the '"""
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 6 E 1
MEMORANDUM
Date: November 14, 2018
To: Artie Bay, Supervisor
EMS Operations
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: COPCN Permit and Certificate
Attached is the document referenced above, (Agenda Item #16E1) approved by
the Board of County Commissioners on Tuesday, November 13, 2018.
The Minutes and Records Department has kept the original as part of
the Boards Official Records.
If you have any questions, please feel free to call me at 252-8411.
Thank you.
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16E1
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2019
Name of Service: Collier County 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: 26 ground units (ambulances)
Number of Ambulances on 12 hour duty: 1 ground unit(as needed during season taken from reserve fleet).
Number of reserve Ambulances: 15
Number of non-transport ALS vehicles 1 1
Number of Medivac helicopter: 1
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 ` - day o r�� ;r- , 2018.
ATTEST: BO• ' P 0 I TY r w >/SSIONERS
Crystal K. Kinzel, CLERK r" CO LIE'/ •UNTY, O: DA
, 4 #$_
,,• ►i'`-__
to
1, Deputy Clerk Andy Solis, Chairman
rt�a�e only.
Approved as to form & legality:
Jennifer • . Belpedio
Assistant County Attorne z_4
[18-EMG-00419/1440015/1] \O\
EXHIBIT A
Page , of, a . 1 6 E 1
Permit# ALS Year Make Model VIN Assigned
1453 AT 1999 EUROCOPTER EC135 N911CK M H Q
17255 T 2012 FORD F550 1FDUF5GT8CEB23691 1
16166 T 2010 FORD F550 1FDAF5GR7AEB25355 2
20443 T 2016 FORD F550 1FDUF5GT8GED28644 3
19044 T 2015 Ford F550 1FDUF5GT8FEC82389 4 I
21405 T 2017 FORD F550 1FDUF5GT1HEF21218 5
18090 T 2013 FORD F550 1FDUF5GT9DEA35167 6
13312 T 2003 INTERNATIONAL 4400 1HTMRAAMX3H573348 7
18881 T 2008 STERLING ACETERA 2FZACFDJ58AZ51749 8
12441 T 2004 STERLING ACETERA 2FZACFCSX4AM52868 9
12442 T 2004 STERLING ACETERA 2FZACFCS84AM 52867 10
20444 T 2016 FORD F550 1FDUF5GT6GED28643 11
21709 T 2017 FORD F550 1FDUF5GTXHEF21220 12
18866 T 2015 FORD F550 1FDUF5GT7FEA64024 14
18089 T 2013 FORD F550 1FDUF5GT2DEA35169 15
21170 T 2017 FORD F550 1FDUF5GT9HDA02858 16
19305 T 2004 STERLING ACETERA 2FZACFCS44AM52865 17
14635 T 2008 STERLING ACETERA 2FZACFDJ78AZ51753 18
20445 T 2016 FORD F550 1FDUF5GTXGED28645 19
20548 T 2015 Ford F550 1FDUF5GT4FEC82390 20
21169 T 2017 FORD F550 1FDUF5GT5HDA02856 21
13313 T 2005 INTERNATIONAL 4300 1HTMNAAM85H689274 22
16168,T 2010 FORD F550 1FDAF5GR8AEB39233 23
18088 T 2013 FORD F550 1FDUF5GT7DEA35166 24
17256 T 2012 FORD F550 1FDUF5GTXCEB23692 25
16169 T 2010 FORD F550 1FDAF5GRXAEB39234 26
17257 T 2012 FORD F550 1FDUF5GT10EB23693 27
16170 T 2010 FORD F550 1FDAF5GR1AEB39235 28
21404 T 2017 FORD F550 lfduf5gt3hef21219 29
19046 T 2015 Ford F550 1FDUFSGT6FEC82391 30
18867 T 2015 FORD F550 1FDUF5GT9FEA64025 31
21403 T 2017 FORD F550 lfduf5gt1hef21221 32
20437 T 2015 FORD F650 3FRWF6GZ1FV675309 33
20550 T 2007 STERLING ACETERA 2FZACFCS17AY33965 34
20549 T 2008 STERLING ACETERA 2FZACFDJ18AZ51747 35
21171 T 2017 FORD F550 1FDUF5GT7HDA02857 36
17258 T 2012 FORD F550 1FDUF5GT3CEB23694 37
18087 T 2013 FORD F550 1FDUF5GTODEA35168 38
18868 T 2015 FORD F550 1FDUF5GTOFEA64026 39
18869 T 2015 FORD F550 1FDUF5GT2FEA64027 40
18870 T 2015 FORD F550 1FDUF5GT8FEA98764 41
19047 T 2015 Ford F550 1FDUF5GT8FEC82392 42
19048 T 2015 Ford F550 1FDUF5GTXFEC82393 43
19797 N 2016 Ford EXPLORER 1FM5K8ARXGGAO8079 AED
20439 N 2017 FORD EXPLORER 1FM5K8AR2HGB64926 BC80
21088 N 2016 FORD EXPLORER 1FM5K8AR5GGC07850 BC81
1 6E1
19304 N 2015 Ford EXPLORER 1FM5K8AR2FGC26953 QRP
21085 N 2016 FORD EXPLORER 1FM5K8AR2GGA46941 C
21087 N 2017 FORD EXPLORER 1FM5K8AR3HGA36372 BC82
20438 N 2017 FORD EXPLORER 1FM5K8AROHGB64925 DC
20440 N 2017 FORD EXPLORER 1FM5K8AR4HGB64927 TRAINING
21086 N 2017 FORD EXPLORER 1FM5K8AR7HGC57022 BC83
20441 N 2017 FORD EXPLORER 1FM5K8AR6HGB64928 DC
21084 N 2013 FORD EXPLORER 1FM5K8R8DGA18380 AS