Agenda 02/26/2019 Item #16E102/26/2019
EXECUTIVE SUMMARY
Recommendation to renew the annual Certificate of Public Convenience and Necessity for a Class 1
and Class 2 Advanced Life Support (ALS) Rescue and intra-facility ambulance transport for the
Seminole Tribe of Florida Fire Rescue within the boundary of the Seminole Tribe in Immokalee.
OBJECTIVE: To renew the Certificate of Public Convenience and Necessity (COPCN) issued to the
Seminole Tribe of Florida Fire Rescue for Class 1 Advanced Life Support (ALS) Transport, and Class 2
Advanced Life Support (ALS) intra-facility ambulance transport services within the boundary of the
Seminole Tribe Immokalee for a period of one year.
CONSIDERATIONS: Seminole Tribe of Florida Fire Rescue is currently operating under a Class 1 and
Class 2 COPCN. The renewal of a COPCN may be approved routinely by the Board as provided by
Section 50-60 of the Collier County Code of Laws and Ordinances governing medical transportation
services. Seminole Tribe of Florida Fire Rescue intra-facility transport was originally granted a Certificate
of Public Convenience and Necessity on March 17, 2017 by the Board. The certificate requires annual
renewal and the current COPCN expires on April 29, 2019. Staff has deemed Seminole Tribe of Florida
Fire Rescue renewal application as complete and recommends that the COPCN be renewed for one year.
A Class 1 Advanced Life Support (ALS) Transport, and a Class 2 Advanced Life Support (ALS) intra-
facility ambulance transport provides post-hospital inter-facility medical transfer services, both within and
outside the County within the boundary of the Seminole Tribe in Immokalee. Seminole Tribe of Florida
Fire Rescue employees are dually certified fire rescue personnel licensed by the State of Florida. The
Department’s Medical Director has adopted the Greater Broward Emergency Medical Directors
Association (GBEMDA) Regional Medical Protocols, which are in compliance with the State of Florida’s
standard for medical oversight. The Tribe’s Medical Director is Wayne Lee, MD.
Section 50-60 of the Code of Laws and Ordinances provides:
Each certificate holder shall file within 90 days of expiration, an application for renewal of his
certificate. Renewals shall be based upon the same standards, as the granting of the original
certificate along with such other factors as may be relevant. The renewal application shall be
accompanied by a $250.00 renewal fee. The renewal certificate may be approved routinely by the
board, upon advice of the administrator, or the board may hold a hearing on same.
These requirements have been met and the administrator recommends renewal based on the finding that
there is a public necessity for Seminole Tribe of Florida Fire Rescue to provide the service and that all
other requirements under Chapter 50 have been met. If this item is approved by the Board, the renewal
COPCN and Permit will commence on April 29, 2019 and expire on April 28, 2020.
FISCAL IMPACT: This redistribution of emergency and non -emergency transports on the
Seminole Reservation in Immokalee by authorizing the Seminole Fire and Rescue Department to receive
a Class 1 and Class 2 certificate is expected to be minimal. There is no increase to the Collier County
EMS budget for granting this Class 1 and Class 2 COPCN if approved. The Board shall also recognize
and accept the $250 application fee within Fund 001.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from
16.E.1
Packet Pg. 984
02/26/2019
this action.
LEGAL CONSIDERATIONS: A hearing is not required for renewal. If a hearing is held, the Boar d
must find that the standards set forth in Section 50-57 of the Code of Laws and Ordinances have been
satisfied based on competent evidence as follows:
(1) That there is a public necessity for the service. In making such determination, the Board of
County Commissioners shall consider, as a minimum, the following factors:
a. The extent to which the proposed service is needed to improve the overall emergency
medical services (EMS) capabilities of the County.
b. The effect of the proposed service on existing services with respect to quality of service
and cost of service.
c. The effect of the proposed service on the overall cost of EMS service in the county.
d. The effect of the proposed service on existing hospitals and other health care facilities.
e. The effect of the proposed service on personnel of existing services and the availability of
sufficient qualified personnel in the local area to adequately staff all existing services.
(2) That the applicant has sufficient knowledge and experience to properly operate the proposed
service.
(3) That, if applicable, there is an adequate revenue base for the proposed service.
(4) That the proposed service will have sufficient personnel and equipment to adequately cover the
proposed service area.
This item is approved as to form and legality and requires a majority vote for approval. -JAB
RECOMMENDATION: To approve and authorize the Chairman to execute a Class 1 and Class 2
Permit and Certificate of Public Convenience and Necessity to Seminole Tribe of Florida Fire Rescue for
one year.
Prepared by: Dan E. Summers, Director, Bureau of Emergency Services
ATTACHMENT(S)
1. 2019 SemTribe CoPCN Renewal Application (PDF)
2. 2019 Seminole Tribe Permit (PDF)
3. 2019 Seminole Tribe Certificate (PDF)
4. 2019 Seminole Tribe VIN List (PDF)
16.E.1
Packet Pg. 985
02/26/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.1
Doc ID: 7901
Item Summary: Recommendation to renew the annual Certificate of Public Convenience and
Necessity for a Class 1 and Class 2 Advanced Life Support (ALS) Rescue and intra-facility ambulance
transport for the Seminole Tribe of Florida Fire Rescue within the boundary of the Seminole Tribe in
Immokalee.
Meeting Date: 02/26/2019
Prepared by:
Title: Executive Secretary – Emergency Management
Name: Kathy Heinrichsberg
01/29/2019 10:36 AM
Submitted by:
Title: Division Director - Bureau of Emer Svc – Emergency Management
Name: Daniel Summers
01/29/2019 10:36 AM
Approved By:
Review:
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 01/29/2019 12:11 PM
Emergency Management Daniel Summers Additional Reviewer Completed 01/30/2019 3:32 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 01/31/2019 10:23 AM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 02/11/2019 2:36 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 02/11/2019 4:53 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 02/13/2019 8:25 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 02/13/2019 10:02 AM
County Manager's Office Heather Yilmaz Level 4 County Manager Review Completed 02/19/2019 6:22 PM
Board of County Commissioners MaryJo Brock Meeting Pending 02/26/2019 9:00 AM
16.E.1
Packet Pg. 986
SEMINOLE TRIBE FIRE RESCUE DEPARTMENT
FIRE/EMS ADMINISTRATION
c/o OFFICE OF FIRE CHIEF
3101 North State Road 7
Hollywood, Florida 33021
(9s4) 967-s100
IMMOKATEE RESERVATION
FIRE STATION S38
1110 South First Street
lmmokalee, Florida 34142
(239) 6s7-35s9
BIG CYPRESS RESERVATION
FIRE STATION T2
30290 Josie Billie Haghway, PMB #280
Clewiston, Florida 33440
(863) 983-21s0
HOI.IYWOOD RESERVATION
FIRE STATION S1O8
3105 North State Road 7
Hollywood, Florida 33021
(9s4) 986-2080
BRIGHTON RESERVATION
FIRE STATION #7
600 E. Harney Pond Road
Okeechobee, Flotida 3497 4
(863) 763-1s81
TAMPA RESERVATION
c/o POLICE STATION
5217 Orient Road
Tampa, Florida 33610
(813) 623-s748
Donald DiPetrillo
Fire Chief/Director
December 19,2Ol8
Dan E. Summers, CEM, FPEM, Director
Collier County Bureau of Emergency Services
Emergency Services Center, Suite 445
8075 kly Cultural Parkway
Naples, Florida 34113
RECEIVED
DEC 2 I 2ol8
EMERGENCY MANAGEMENT
Re: Certificate of Public Convenience and Necessity (COPCN) Renewal Application - Seminole
Tribe of Florida Class I - ALS Transport & Class 2 - ALS Transfer
Dear Mr. Summers,
In accordance with Collier County Ordinance No. 04-12, Chapter 50, Article III, Sections 1-25,
please find attached the Certificate of Public Convenience and Necessity (COPCN) Application
Renewal. The Seminole Tribe of Florida Fire Rescue Department wishes to continue to provide
Basic/Advanced Life Support Emergency Medical Services, Class-I Transport and Class-2 Transfer
services to the Seminole Indian Immokalee Reservation located in Collier County, Florida.
During the past years, it has been a pleasure working along with the entire staff of the Collier County
Emergency Medical Services (EMS) Division providing lifesaving assistance when and where
warranted.
Your assistance with this matter is greatly appreciated. Should you have questions or require
additional information please do not hesitate to contact me at (954) 966-6300 x I l6 I I .
Respectfully,
4*.4/h<
Donald DiPetrillo, Fire Chief/Director
Attachment
Cc: file
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16.E.1.a
Packet Pg. 987 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
16.E.1.a
Packet Pg. 988 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
Fire Rescue
COPCN Application
Collier County
Ord. No. 04-12, $ 4; Ord. No.05-16, $ 4; Ord. No.20l l-36, $ 2
Sec. 50-55. - Procedure for obtaining certificate
( I ) The nunrc, age, and address of the owner rt the unthulcmce or ALS Operutor, or if' the
ov)ner is a c:orporation, then of the directors of the corporation und of all the stockholders
holding ntore than 257o oJ'the outstanding, shores. For goverttmental units, this inJornrution
shall be supplied for ntentbers of the governing body.
r SEE ATTACHMENT #I
Marcellus W. Osceola, Jr., Chairman Age/DOB: 46 ylo,06118l1972
Mitchell Cypress, Vice Chairrnan Age/DOB: 7l ylo,04l02l1947
Mondo Tiger, Councilman Age/DOB: 59 y/o, 0711511959
Andrew J. Bowers, Jr. Councilman Age/DOB: 72 ylo, llll0l1946
ChristopherOsceola,Councilman Age/DOB: 48ylo,0ll20l1970
c/o Seminole Tribe of Florida
6300 Stirling Road
Hollywood, FL 33024
Telephone: (954) 966-6300
(2) The boundctries of the territorl desired to be servecl.
o SEE ATTACHMENT #2
The geographical boundaries of the territory served will encompass the entire Seminole
Tribe of Florida lmmokalee Reservation as noted in Attachment #2. Occasionally mutual
aid requests by Collier County and/or other Public Safety Agencies have necessitated
responses outside the geographical boundaries of the reservation. In such cases, STFR
has/will promptly notify the appropriate licensed EMS provider via the Seminole
Police/Fire Rescue Communications Dispatch Center, or authorized interagency mutual aid
radio communications channels of all such incidents.
(3) The nurnber und brief descriptiort of the arnbulunc'es or other vehicles the applic'ant will
hove avuilable.
o Two (2) Medical Rescue Units (Ambulances)
Rescue 38: Class l&2 ALS Transport and Inter-Facility (FL-ALS Permit # 19849)
Rescue 238: Class l&2 ALS Transport and Inter-Facility (FL-ALS Permit # 14456)
o One (l) Fire Engine 1250 GPM Pumper
Engine 38: Class 3 ALS Non-Transport (FL-ALS Pennit #15633)
o One (1) Fire Brush Truck/Utility Vehicle
Utility 38: Non-ALS, Non-Transport, Suppression Unit
Page I of 5
16.E.1.a
Packet Pg. 989 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
Fire Rescue
(-1) Continuetl
COPCN Application
Collier County
One (1) Squad Truck Vehicle
Squad 38: Non-ALS, Non-Transport, Air Truck (SCBA Cascade Compressor wiAir
Tanks)
One (1) Fire/EMS Supervisory Vehicle
Battalion 38: Supervisor, Exempt [Rescue Services (Non-ALS)w/ Paramedic)]
Note: Only permanently assigned vehicles listed above. STFR has additional spare Fire/EMS vehicles used
lor temporary maintenance, hack-t'ill or special events permitted in accordance with Florida Statutes 401 and
FDOH Regulations 64-8.
(4) The address of the intended heudquarters cutd an), substotions.
Fire Rescue Headquarters:
Seminole Tribe of Florida
Fire Rescue Department
310-5 North State Road 7
Hollywood, FL 33021
Fire Rescue Substations:
Fire Station #38
I I l0 South I st Street
Immokalee, FL 34142
Fire Station #2
30280 Josie Billie Highway
Clewiston, FL 33440
Fire Station #7
660 East Harney Pond Road
Okeechobee,FL 34974
Fire Station #108
3105 State Road 7
Hollywood, FL 33021
(Executive Admin. Offices)
(5)The training and experience of the applic:ant.
Experience - The Seminole Tribe of Florida Fire Rescue (STFR) Department was established in
2003 and has provided single-tier, Advanced Life Support Emergency Medical Services
(ALS/EMS) since 2005 at all eight Tribal reservations and non-trust lands state wide directly or
indirectly via contractual relationships. STFR ernploys over 130 dual certified fire and rescue
personnel licensed through the State of Florida. The department directly serves 4,000 tribal
members and over 22 million visitors annually at its public venues and attractions. Annually STFR
and its contractual partners respond to over 12,000 requests for 9-l-l emergency and non-
ernergency tlre rescue services.
The Seminole Tribes Fire Rescue Department manages or provides Fire/EMS services in multiple
statewide locations including Broward, Dade, Hendry, Okeechobee, Saint Lucie, Polk and
Hillsborough Counties. The department is highly recognized by the State of Florida DOH/EMS
Bureau and receives outstanding ratings on all annual EMS in-service inspections. It is 1007o
complaint on annual data reports to DOFUEMS, NFIRS and FFIRS incident data collection systems
Page 2 of 5
16.E.1.a
Packet Pg. 990 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
Fire Rescue
(5) Continued
COPCN Application
Collier County
sent directly to federal, state and local agencies. As the primary base of operations for the Tribe is
in Hollywood, Florida; the Broward County Office of Medical Examiner/Trauma Services
continually reviews the departrnent's operations and receives excellent ratings among all local EMS
providers. STFR routinely participates in county. state and regional associations or activities fbr
fire rescue and emergency medical services in each community served.
STFR's Executive/Management team averages 35+ years' experience in fire and emergency
medical services: and field operations personnel average l0+ years of experience. Several staff
members have been recognized by the state or other EMS organizations and awarded such
distinctions as: "Firefighter/Paramedic of the Year", and "Paramedic Instructor of the Year".
Training- All Seminole Tribe of Florida Fire Rescue (STFR) employees are dual-certified fire and
rescue personnel licensed by the State of Florida. The department provides vigorous six (6) week
multi-disciplinary Fire/EMS orientation training program for all new employees. An additional (12)
month probationary "in-service" skills sign-off program is mandated for successfirl completion by
all new employees. Every two years all personnel must successfully complete a continuing
education medical training matrix including but not lirnited to the State of Florida EMS mandatory
thirty (30) contact hours to include ACLS, Protocols and "hands on" lab skills testing, etc.
The department's Medical Director has adopted the Greater Broward Emergency Medical Directors
Association (GBEMDA) Regional Medical Protocols, which are in compliance with the State of
Florida's standards for medical oversight. The Tribes Medical Director Wayne Lee. MD is a
certified Emergency Medical physician with more than 40 years' experience as a local and
statewide leader in the field of medicine.
Additionally, the department delivers life safety classes (CPR/AED/Fire Extinguisher training) and
Crowd Manager Classes to Tribal Gaming employees. They also provide Youth Safety, Senior
Safety, CPR/AED classes and Fire Drill presentations to Tribal children, seniors and employees. On
average, this pro-active life safety training has reached over I 1,000 people annually.
(6) The names und uddre,sses ofthree Collier Courtty- residents yvho vvill dct os re.fereru:es .for
the upplic:uttt.
Tina Marie Osceola, 5920 Westpoft Lane. Naples, FL 34116, Ph. (239\ 298-3279
O.B. Osceola, Sr., 5870 Westport Lane, Naples, FL 341 16, Ph. (239) 455-217 |
Michael D. Murphy, 1280 San Marco Rd., Marco Island, FL 34145, Ph. (239) 393-0099
a
a
a
Page 3 of 5
16.E.1.a
Packet Pg. 991 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
Fire Rescue
COPCN Application
Collier County
(7)A scltedule of rates which
o Classl-ALS/BLS
the service intends to clrur54e.
Emergency Transports Only
** The Seminole Tribe of Florida contracts with ADPl-Intermedix, 500 NW 165 St., Ste. 102,
Miami, FL 33169, (305) 945-2280 for all EMS patient transportation billing/collections services.
All non-emergency Class 2 - EMS Interfacility Transports are strictly for the private use of
Seminole Tribal members and billed directly to Medicare eligible patients only.
(8) Such other pertinent infonnation as the administrator nruy require.
ATTACHMENT #3
Florida Department of Health
Bureau of Emergency Medical Oversight
Advanced Life Support License #2603
ATTACHMENT #4
Certificate of General Liability Insurance (STOF)
ATTACHMENT #5
Harry W. Lee, M.D. - Medical Director License
ATTACHMENT #6
Harry W. Lee, M.D. - Medical Director Personal Services Agreement
ATTACHMENT #7
Certificate of General Liability Insurance (Medical Director)
(e)An upplicatiut or renewal fee of $250.00. (Exception Collier County EMS).
o ATTACHMENT #8
Payment to Collier County enclosed with application - Check # 726362
Financial dara including assets and liabilities of the operator. A schedule of oll debts
encurnbering any eEtipntent shall be included.
ATTACHMENT #9
Seminole Tribe of Florida Fire Rescue Departmenr FY'19 Annual Budget
ATTACHMENT #IO
20 19 -2020 Traini n g Matrix
( 10)
**Mileage Rate = $15.00/mile
Page 4 of 5
Call Level Rate
BLS $660.00
ALSl $800.00
ALS2 $1,000.00
16.E.1.a
Packet Pg. 992 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
SEMINOLE TRIBE OF FLORIDA
GOVERNMENT
Tribal Council
I,Iarcellus IlI. Osceola Jr.
Chairman
Seminole Trihe of Florida
I,[anuel Tiger
Big Cypress Representati're
Chric Osceola
Hollywood Councilman
Andrew J. Bower*, Jr.
Brighton Representative
I,Iitchell Cyprees
Vice Chairman
16.E.1.a
Packet Pg. 993 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
Fire Rescue
COPCN Application
Collier County
ATTACHMENT #2Fire Rescue Web App
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16.E.1.a
Packet Pg. 994 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
STATE OF FLORIDA
DEPARTMENT OF HEALTH
BUREAU OF EMERGENCY MEDICAL OVERSIGHT
ADVANCED LIFE SUPPORT SERVICE LTCENSE
ThiS iS tO CCrtifY thAt: SEMINOLE TRIBE OF FLORIDA. DEPARTMENT OF EMS Provider Number #2603
Name of Provider
3I05 STATE ROAD 7. HOLLYWOOD. FLORIDA 3302I
Address
has complied with Chapter 401, Florida Statutes, and Chapter 64J-1, Florida Administrative Code, and is authorized to operate as an
Advanced Life Support Service subject to any and all limitations specified in the applicable Certificate(s) of Public Convenience and
Necessity and/or Mutual Aid Agreements for the County(s) listed below:
f] INTER.FACILITY X TRANSPORT
BROWARD: GLADES: HENDRY: COLLIER
County (s)
E NON-TRANSPORT
Steve A. McCoy
Emergency Medical Services Administrator
Florida Department of Health
THIS CERTIFICATE EXPIRES ON: 08/2112019
This certificate shall be posted in the above mentioned establishment
16.E.1.a
Packet Pg. 995 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Page
ACo.r,if CERTIFICATE OF LIAB!LITY INSURANCE DATE (MM/DD/YYYY}
L2/07 /29te
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE ISSU|NG INSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
lMPoRTANT:lfthecertificateholderisanADDlTloNALlNSURED,thepolicy(ies)musthaveA
lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Wil1is of Texa8, Inc.
c/o 26 Century BIvd
P.O. Box 305191
Na3hville. TN 3?2305191 USA
IttSllRED
s@inole Tribe of Florida
Insurance & Risk Managerent Depts
5300 Stirling Road, Suite 220
Holl!ryood, FL 33024
INSURER A :
INSURER B:
INSURER C :
INSURER D:
INSURER E :
INSURER F :
INSURER(S}AFFOROINGCOVERAGE L NIIC*
Eudson Insurance Company 25054
L"*r.gaor r.*r"."" corffi {37
New York Marine And General Insurance Compl 15G08
COVERAGES CERTIF|CATE NUMBER: we101s78 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTMCT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHO\A/N MAY HAVE BEEN REDUCED BY PAID CLAIMS,
10/or/2017
GEN'L AGGREGATE LIIUIT APPLIES PER
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ASE - POLICY LIMIT
DESCRIPTIONOFOPERATIONS/LOCAflONS/VEHICLES (ACORDl0l,AdditiomlRemrksschedule,mybeattachedtf morespaceisrequlred)**Supplemental, Namer*
Seminole Tribe of Florida
Seminole Sport Managemen!, LLC
Native A[rerj.can Travel, LLC
Seminole Taft Street Properties, LLC
6365 Taft, LLc
HOLDER CANC
Ssinole Tribe of Elorida
5300 Stirling Rd.
Ilollywood, FL 33024
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
o 1988-2016 ACORD CORPORATTON.
The ACORD name and logo are registered marks of ACORDACORD 2s (2016/03)
sR ID:17171145 B tcHt 982276
All rights reserved.
tt'Willis Torers t{atson C€ltificato Cente!. _;. Exrl: 1-877-945-7378 ' [16. Not: 1-888-467-2378
i55; certif icatesoxillis . com
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. | ,uueneururs iX occun'X ExcEssLtAB I
iCLA|MS_MAoE I
16.E.1.a
Packet Pg. 996 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
AGENCY CUSTOIIER ID:
LOC #:
a,iQo"ADDITIONAL REMARKS SCHEDULE Page z of 2
AGENCY
wj-1J'is of Texas, Inc.
NAMED INSUREDS@inole fribe of Florida
fnsurance 6 Riak Manag@nt D€pt
5300 Stirling Road, Suite 220
Holllry@d, Fl 33024
POLICY NUMBER
See Page 1
CARRIER
See Page 1
NAIC CODE
See Page 1 EFFECTIVE OATE: See page 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certifi.cate of Lj.a.biLiry rnsurance
First Anerican Music & Entertainment, Lr.C
O 2008 ACORD CORPORATTON. Alt rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: L7I7LL46 BATCB: 982216 CERT: w9101578
ACORD 101 (2008/01)
16.E.1.a
Packet Pg. 997 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
DATE LICENSE NO.CONTROL NO.
12t13t2018 ME24378 641742
AC#
Are You Renewal Readf
The Department of Health will now review
your continuing education records at the
time of license renewal.
To leam more, please visit
www. FL H ea lth Sou rce.g ov/AYRR
r STATE OF FLORIDA
DEPARTMENT OF HEALTH
DIVISION OF MEDICAL QUALITY ASSURANCE
The MEDICAL DOCTOR
named below has met all requirements of
the laws and rules of the state of Florida.
Expiration Date: JANUARY 31,2021
HARRY W LEE
2856 NE 36TH ST
FORT LAUDERDALE, FL 33308.5818
GOVERNOR
DISPLAY IF REQUIRED BY LAW
EXPIRATION DATE: JANUARY 31, 2021
Your license number is ME 24378, Please use it in all correspondence with your board/council. Each licensee is solelyresponsible for
notiling the Department in writing of the licensee's current mailing address and practice location address. lf you hale not receiwd your
renewal notice 90 days prior to the epiration date shown on this license, please visit www.FLHealhSource.gov and click 'Renew A License"
to renew online.
fi4edical QualityAssurance has a new and improwd Online Services Portal. ln the new system, 1ou hare the abilityto renew your license,
update your mailing and practice location addresses, request a name change, request a duplicate license and update pur profile
information all from the con\enience of your online account.
1. Go to www.FLHealthSource.gov.
2. Click on "Provider Services' and select'Manage Your License.'
3. Select your profession and license type and click "Submit."
4. The question "Harne you Renewed or fuplied Online Since 2015?" will display.
a. Click on "No" if you hale not registered ficr an account in the new s),stem and follow lhe instructions provided for new user
registration.
b. Click on 'Yes' if pu are a retuming user. Enter the user lD and password 1,ou selected during the registration process, then
select "Sign ln" to access pur ttilQAOnline SeMces Portal account.
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Grounds for Discipline
You should be familiar with lhe Grounds for
Discipline found in Section 456.072(1),
Florida Statutes, and in the practice actfor
the profession in which ),ou are licensed.
Florida Statutes can be accessed at
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16.E.1.a
Packet Pg. 998 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
OEPARTMENT OF HEALTH
DIVISION OF MEDICAL QUALIW ASSURANCE
LICENSURE SUPPORT SERVICES UNIT
'1052 BALD CYPRESS WAY, BIN #C.10
TALLAHASSEE, FLORIDA 3239{'.3260
PRSRT. FIRST-CIASS
U.S. POSTAGE
PAID
TALLAHASSEE, FL-3J
P€RMIT NO. 552
AUTO **********
HARRY W LEE
2856 NE 36TH ST
FORT LAUDERDALE, FL 33308-5818
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16.E.1.a
Packet Pg. 999 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
SEMTNOLE TRIBE OF FLORIDA
PERSONAL SERVICES AGREEMENT
THIS PERSONAL SERVICES AGREEMENT made on this lTth day of April,20l8, is
between the Seminole Tribe of Florida, a federally recognized Indian Tribe under 25 U.S.C.
$ 476 (hereinafter "Tribe") and Harry Wayne Lee, MD, FACEP, (hereinafter "Contractor").
WHEREAS, the Tribe has determined that it is in the best interest of the Tribe and its
members to engage Contractor to perform personal services in connection with Advanced
Life Support and EMS Services under the terms of this Personal Services Agreement and,
WHEREAS, the Contractor is an independent contractor willing to perform and render
personal services for the Tribe under the term of this Personal Services Agreement;
NOW, therefore, for and in consideration of the promises and mutual covenants
hereinafter set forth and for other good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the parties do hereby understand, acknowledge
and agree as follows:
I. PERSONAL SERVICES
The Tribe hereby engages and contracts with the Contractor for the Contractor
to provide certain personal services for the Tribe upon the terms and
conditions hereinafter set forth.
The Contractor is not an employee of the Tribe and agrees to act at alltimes as
an independent contractor while performing personal service for or on behalf
of the Tribe. Accordingly, contractor specifically agrees to abide by Section
4.1 which makes the contractor solely responsible for paying all employment
taxes and other expenses related to employment and Section 4.2 which
disallows the Contractor from seeking or obtaining any benefits that are paid
to Tribal employees.
II. CONTRACTOR'S DUTIES
The Contractor agrees to devote his best efforts as well as such time and
attention as is necessary for Contractor to properly render and provide to the
Tribe the personal services which are more fully described in Section 2.3 of
this Personal Services Agreement.
The contractor agrees to fully comply with the Tribe's policies, procedures,
rules and regulations, which are subject to change from time to time without
notice, and as determined by the Tribe . The contractor may obtain, upon
request, a copy of pertinent policies, procedures, rules and regulations from
the Tribal Fire Rescue Director.
The Scope of Work for the Contractor is as follows:A) The scope of work is fully set forth in Attachment "A" which is
attached hereto and made a part hereof by reference.
Ll
1.2
2.1
2.2
2.3
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page I of 16
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Packet Pg. 1000 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
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The Contractor agrees to maintain such licensure and
credentialing as is required under the applicable laws of the
Tribe, the State of Florida and the United States of America.
The Contractor will comply with all applicable tribal, state and
federal laws, statutes, rules, regulations, policies and
procedures. Contractor will immediately notify the Tribal Fire
Rescue Director in writing if the Contractor has reason to
believe that the Contractor is not in compliance or cannot
comply with such laws, statutes, rules regulations, policies and
procedures.
III. TERM
The term of this Personal Services Agreement shall be for a period of three (3)
years, which will begin on June 1,2018 and terminate on May 31,2021. This
Personal Services Agreement may be extended for an additional period of
time by written agreement of the parties.
Immediate Termination for Cause. The Tribe may elect to terminate this
Personal Services Agreement for cause, in which case, the Tribe will be
relieved of all liability to the Contractor which accrues at or after the date of
termination. As used herein, the term "Cause" shall include, but shall not be
limited to, the following:
A) a good faith determination by the Tribe, in its sole discretion,
that insufficient funding exists to continue the performance of
this Personal Services Agreement; orB) the Contractor fails to abide by the terms of this Personal
Services Agreement or acts in a manner contrary to applicable
policies, rules and regulations of the Tribe , as determined by
the Tribe, in its sole discretion; or
C) the Contractor fails or is otherwise unable to report to work and
does not give the Tribal Fire Rescue Director sufficient
reasonable advanced notice; or
D) the Contractor fails to abide by applicable law in the
performance of this Personal Services Agreement; orE) the Contractor is or has been convicted of any felony crime or a
misdemeanor involving dishonesty or moral turpitude without
a full restoration of Contractor's civil rights and a written
waiver of this provision by the Tribe after contractor makes a
full disclosure thereof to the Tribe in writing; orF) the contractor dies or becomes injured or disabled to a point
where the contractor cannot fully perform the duties and
obligations required and prescribed under this personal
Services Agreement.
In the event the Tribe elects to terminate this Personal Services Agreement
pursuant to this Paragraph 3.2, the Tribe shall notify the Contractor in
B)
c)
3.1
3.2
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 2 of 16
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Packet Pg. 1001 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8_04_006
writing, specifying the basis for such termination, and set forth therein the
effective date of termination, which date shall not be less than three (3)
calendar days after the date of such notice; provided, however, during such
period, the Tribe may, in its sole discretion, exclude the contractor from the
Tribe 's premises except on previously approved occasions for the supervised
removal of the Contractor's personal belongings. Any expenses incurred
during this three (3) calendar day period shall be the sole responsibility of the
Contractor, unless specifically authorized in writing by the Tribe.
Termination Without Cause. In addition to the termination option set forth in
Paragraph 3.2, this Personal Services Agreement may be terminated by the
Tribe or the Contractor for any reason upon Thirt), (30) calendar days prior
written notice.
IV.COMPENSATION
The Tribe agrees that for all services rendered by the Contractor pursuant to
this Personal Services Agreement, the Tribe shall pay the Contractor, during
the term of this Personal Services Agreement, all sums required to be paid to
Contractor in accordance with Contractor's Proposed Services (Scope of
work) contained in Attachment "A" which is attached hereto and made a part
of this Personal Services Agreement by reference. Tribe shall pay Contractor
at the end of each month for the preceding month's services. If a period of
time during which services were rendered is less than a full month, the
corresponding percentage of that month's services will be paid. Contractor
agrees to be solely responsible for the payment of all state and federal and
local taxes, health insurance, worker's compensation insurance and all other
expenses borne by Contractor.
The Contractor acknowledges that Contractor shall not be entitled to and
hereby disclaims any claim or entitlement to any benefits offered to the Tribe
's employees, including vacation or sick leave, participation in any pension,
profit-sharing, salary continuation, disability insurance, hospitalization
insurance, major medical insurance, medical reimbursement, or life insurance
plan or any other benefit plan established by the Tribe.
Contractor agrees that as a condition precedent to payment under this Personal
Services Agreement, contractor shall send invoices to "seminole Tribe of
Florida" Attn: Accounts Payable. P.o. Box 840939. pembroke pines. FL
33084-2939 or inroicesrrr'semtribe.con," for services performed during the
preceding period. In the event that Contractor provides personal services to
the Tribe for a fixed price, contractor shall include on the invoice a
description of the services performed, the percentage of completion of
services represented by the invoice and the amount of the fixed price to which
the percentage of completion was applied. In the event that Contractor
contends that an ambiguity or conflict exists between or among the terms and
conditions of this Personal Services Agreement and any Attachments hereto;
J.J
4.1
4.2
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 3 of 16
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Packet Pg. 1002 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
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Contractor shall immediately request and obtain the Tribe 's written directions
as to how to proceed.
Contractor is responsible for completion and retention of the I-9 form,
required by the U.S. Citizenship and Immigration Services as part of the
Immigration Reform and Control Act of 1986, on any employees of
Contractor.
V. BUSINESS EXPENSES
Within guidelines determined by the Tribe, the Contractor may be authorized
to incur travel expenses, which may include transportation, food, lodging and
other incidental expenses, in connection with the personal services to be
provided to the Tribe hereunder; provided, that Contractor's travel expenses
are within the guidelines determined by the Tribe and provided further that the
Contractor first obtains the prior written approval of the TribalFire Rescue
Director. The Contractor may be entitled, within the sole discretion of the
Tribe, to reasonable reimbursement for expenses incurred in connection with
this Section in an amount within the Tribe's sole determination; provided that
such expenditures are documented by the Contractor in an itemized account
and provided further that such expenditures are incurred in a manner
consistent with the Tribe's purchasing and procurement policies and
procedures. Contractor may be required to use the Tribe's contractor-issued
travel card for all official travel expenses unless otherwise stated herein. To
apply for the travel card, each cardholder employed by the Contractor will be
asked to complete and sign an agreement. Be sure to review the attached
agreement because it contains cardholder responsibilities. Contractor is
required to book all travel through Native American Travel, LLC. Contact
information will be provided to the Contractor.
Unless expressly otherwise provided herein, it shall be the sole responsibility
of the Contractor to provide all equipment, tools, resources, support and
facilities necessary for the Contractor to fully perform the duties set forth and
described in Section 2.3 of this Personal Services Agreement.
vI.CONTRACTOR'S NEGLIGENCE/INDEMNITY
The parties acknowledge and agree that as a personal services provider under
the terms and conditions of this Personal Services Agreement, all personal
services provided by the Contractor to the Tribe or on its behalf for the Tribe
shall be provided under the direction, supervision and control of the Tribe.
Nothing contained in this Personal Services Agreement shall be construed so
as to prohibit the Contractor from controlling the details as to how the services
are to be performed hereunder.
contractor shall defend, indemnify and hold harmless the Tribe, its Tribal
Council members, and all officials, officers, employees and agents thereof
from and against all claims, suits, actions, losses, damages, liabilities, costs
4.3
5.1
5.2
6.1
6.2
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 4 of 16
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Packet Pg. 1003 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
7.1
PUR20l8_04_006
and expenses of any kind or nature whatsoever arising out of, or relating to,
the actions or inactions of the Contractor, including those actions or inactions
of Contractor relating to the personal services provided under this Personal
Services Agreement.
VII. DISPUTERESOLUTION
In the event that any dispute, controversy, claim, question or difference arising
out of or relating to this Personal Services Agreement or any alleged breach
hereof, upon written notice by any party to the other, the dispute, claim,
question, or difference shall be finally settled by a binding proceeding
administered by the Tribal council of the Seminole Tribe of Florida or as
otherwise specifically delegated under the provisions of the Amended
Constitution and Bylaws of the TRIBE.
This Personal Service Agreement is intended to be binding upon the
signatories hereto as well as their successors and assigns. Moreover, nothing
contained herein shall prohibit the Tribal Council from requiring the parties to
first engage in mediation or a non-binding arbitration so as to enhance the
possibility of a mutually acceptable resolution of such dispute or differences
and to give to the Tribal Council a full and fair opportunity to understand and
appreciate the nature of the dispute or differences between the parties so as to
better enable the parties and the Tribal Council to arrive at a just and fair
result of any such dispute.
VII CONTRACTUAL OBLIGATIONS
The Contractor acknowledges and agrees that Contractor will not, unless
authorized to do so by the Tribe, in writing, execute, make, draw, accept or
endorse any contract, lease, promissory note, or other instrument, document or
agreement requiring the payment of money by the Tribe , nor shall Contractor
pledge the credit of the Tribe unless express written authorization is provided
to the Contractor by the Tribal Council to do so in a resolution duly enacted
by the Tribal Council in legal session.
IX. NOTICE
8.1
9.1 All notices sent to the Tribe shall be addressed and sent by certified mail,
return receipt requested or by express delivery such as Federal Express, UpS,or any other like service, so long as a written receipt is provided to evidencedelivery, as follows:
Harry Wayne Lee, MD, FACEP personal Services Agreement Page 5 of 16
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Any such notice, to be valid, must be accompanied by a copy of the complete
Personal Services Agreement together with all attachments accompanied by a
copy of all Purchase Orders and a list of all Purchase Order Numbers and a
copy thereof must be sent to the Tribe's General Counsel and to the additional
address listed below
All notices to the Contractor shall be sent by certified mail, return receipt
requested or by express delivery such as Federal Express, UPS, or any other
like service so long as a written receipt is provided to evidence delivery, as
follows: Harry Wayne Lee. MD. FACEP 2856 NE 36 Street For Lauderdale.
Florida 33308 Phone: (954) 850-8041/ E-Mail: bozzersliigrnail.com.
X. INVALID PROVISION
l0.l In the event that any provision of this Personal Services Agreement shall be
rendered invalid or unenforceable for any reason, such invalidity, or
unenforceability shall not affect the other provisions hereof, and this Personal
Services Agreement shall be construed in all respects as though such invalid
or unenforceable provisions never existed in the first instance.
I l.l
XI. INTERPRETATION
The terms and condition of this Personal Services Agreement shall be
interpreted in accordance with the applicable laws of the Tribe, the State of
Florida and the United States of America.
XII. MODIFICATION
12.l This Personal Services Agreement constitutes the entire agreement between
the parties, and may not be varied, contradicted or modified in any respect
unless the same shall be in writing and signed in the same manner as this
Personal Services Agreement has been signed and executed.
XIII. ASSIGNMENT
l3.l The rights, duties and obligations of the Tribe under this Personal Services
Agreement shall inure to the benefit of and be binding upon the written
assigns and designees of the Tribe. The Contractor agrees that the obligations
of this Personal Services Agreement may not be assigned or delegated by him
and this Personal Services Agreement shall be binding upon his heirs,
personal representatives, successors and any permissible assigns approved by
the Tribe in writing.
XIV.INSURANCE
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 6 of 16
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Packet Pg. 1005 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
l4.l The Contractor shall procure, maintain and provide proof of insurance
throughout the entire duration of this Personal Services Agreement as to the
following required insurance coverages, with insurance carriers financially
acceptable and lawfully authorized to do business in the countries and states
where the Tribe, conducts any business or governmental operations. Such
coverages shall protect Contractor against claims arising from sickness,
disease, death or injury to persons, and/or physical damage to tangible
property, including loss of use, which may arise from the goods, products or
services provided by the Contractor, its agents or representatives.
Minimum Scope of Insurance
Contractor's insurance coverage shall include the following minimum limits
and coverage, unless higher limits are required by law:
l. Commercial General Liability insurance on an occurrence coverage form, at
least as broad as the Insurance Services Office Commerciol General Liability
Policy form CG 0001@, current edition. If Contractor sells or distributes
alcoholic beverages such coverage shall include Liquor or Dram Shop
Liability. If Contractor sells or distributes food or beverage products such
coverage shall include claims emanating from food-borne illness. Other than
the standard exclusions applicable to pollution, asbestos, mold, employment
practices, ERISA and Contractor liability, there shall be no additional
limitations or exclusions beyond those contained in the above referenced
policy form applicable to products and contractual liability. In addition to
procuring and maintaining this insurance during the duration of the Personal
Services Agreement, contractor agrees to continue to procure and
continuously maintain products liability insurance coverage for a minimum of
three (3) years after the date the Personal Services Agreement is completed or
terminated.
2. Automobile Liability insurance covering liability arising from the use or
operation of any auto, including those owned, hired or otherwise operated or
used by or on behalfofthe Contractor. The coverage shall be at least as broad
as the Insurance Services Ofice Business Automobile Policy, form CA 00016;.,
current edition.
3. Workers' Compensation and Employer's Liability insurance as is required by
statute or law, or as may be available on a voluntary basis.
Minimum Limits of Insurance
Contractor shall maintain the following minimum limits of insurance (unless
higher limits required by law or statute):
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Commercial General Liability (including umbrella or excess liability):
$1,000,000.00 per occurrence, bodily injury and property damage liability;
$ I ,000,000.00 per offense personal and advertising injury liability;
$1,000,000.00 products and completed operations policy aggregate and
$2,000,000.00 policy general aggregate applicable to claims other than
products and completed operations.
Automobile Liability: $1,000,000.00 combined bodily injury and property
damage liability per accident for bodily injury and property damage.
Employer's Liability: $500,000.00 accident for bodily injury by accident or
disease, including $500,000.00 disease aggregate.
Deductibles and Self-insured Retentions
The funding of deductibles and self-insured retentions maintained by
Contractor shall be the sole responsibility of Contractor. Self-insured
retentions in excess of $50,000.00 must be declared to and approved by the
Tribe.
Other Insurance Provisions
The required insurance shall contain the following additional provisions:
ADDITIONAL INSURED - The Tribe must be included as an additional
insured, by endorsement, under Contractor's Commercial General Liability as
respects Contractor's products, goods or services which are sold or distributed
to third parties by the Tribe in the course of the Tribe's business operations.
This requirement does not apply to consumable products, goods or services
which are not sold or distributed to third parties by the Tribe. Contractor
hereby consents and authorizes the Tribe to communicate fully with any
insurance carrier furnishing insurance coverage hereunder, outside of the
Contractor's presence.
WAIVERS OF SUBROGATION - Contractor agrees to waive all rights of
subrogation against the Tribe and other tenants of the Tribe, as respects loss,
damage, claims, suits or demands, howsoever caused:
a. To real or personal property, equipment, vehicles, tools, laptops, etc.,
owned, leased or used by Contractor, its employees, agents or
subcontractors; and
b. To the extent such loss, damage, claims, suits, or demands are covered,
or should be covered, by the required insurance or any other insurance
maintained by the contractor. This waiver shall apply to all first party
liability claims, including deductibles or retentions which may be
applicable thereto. The contractor agrees to endorse the required
l.
2.
aJ.
l.
2.
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 8 of 16
16.E.1.a
Packet Pg. 1007 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
insurance policies to acknowledge the required waivers of subrogation
in favor of the Tribe. Contractor further agrees to hold harmless and
indemnify the Tribe for any loss or expense incurred as a result of
Contractor's failure to obtain such waivers of subrogation from
Contractor's insurers.
3. NOTICE OF CANCELLATION - Each insurance policy shall be endorsed to
require Insurer(s) to provide thirty (30) calendar days written notice to the
Tribe by certified mail, return receipt requested, prior to any suspension,
cancellation or non-renewal of the required insurance.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. best's rating of not
less than A- VII, unless otherwise approved by the Tribe.
Verification of Coverage
Prior to the commencement of this Personal Services Agreement and at such intervals
as the Tribe reasonably deems appropriate in its sole discretion throughout the
duration of this Personal Services Agreement, Contractor shall fumish to the Tribe
immediately upon the Tribe's request a certificate of insurance evidencing the
existence of the required coverage prior to the delivery of product, goods or services
to the Tribe. The certificates are to be signed by a person authorized by the insurer(s)
to bind coverage on their behalf. Renewal certificates are to be provided to the Tribe
prior to the expiration of the required insurance policies. As an alternative to a
certificate of insurance, Contractor's broker or insurer may provide complete,
certified copies of all required insurance policies, including endorsements necessary
to affect coverage required by these specifications.
XV. ADDITIONAL TERMS AND CONDITIONS
l5.l TRIBE and CONTRACTOR have attached to this Personal Services
Agreement such Additional Terms and Conditions as they intend to apply to
the parties' respective rights, duties and obligations under this Personal
Services Agreement. The Additional Terms and Conditions are set forth and
contained on Attachment "C" which is attached to this Personal Services
Agreement, marked as Attachment "C" and is hereby incorporated by
reference.
XVI. ENTIRE AGREEMENT AND WAIVER
l6.l This Personal Services Agreement contains the entire agreement of the Parties
and supersedes all prior understandings and agreements, whether oral or in
writing, regarding the subject matter of this Personal Services Agreement. No
representations, warranties, covenants, or conditions, expressed or implied,
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 9 of 16
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Packet Pg. 1008 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8_04_006
whether written or oral, whether by statute or otherwise, other than as set forth
herein have been made by any party hereto. No waiver of any term,
provisions, or condition of this Personal services Agreement, whether by
conduct or otherwise, in any one or more instances, shall be deemed to be or
shall constitute a continuing waiver, pattern and practice or a course of
conduct, none of which shall be deemed to have any legal effect upon the
performance of the parties' obligations under this Personal Services
Agreement, and no waiver of any right, duty or obligation under this personal
Services Agreement and any Attachment hereto shall be binding unless
executed in writing by the party making the waiver and accepted and agreed
to by both parties and signed in the form and manner set forth below.
XVII. TIME OF PERFORMANCE; ACTS OF GOD AND
FORCE MAJEURE
17.l Unless otherwise stated herein, time is of the essence for the performance of
all obligations under the terms and conditions of this Personal Services
Agreement; provided, however, that neither TRIBE nor CONTRACTOR
shall be liable for failure to perform their respective obligations if such failure
is as a result of Acts of God (including fire, flood, earthquake, storm,
hurricane or other natural disaster), or a Force Majeure such as war, invasion,
act of foreign enemies, hostilities (regardless of whether war is declared), civil
war, rebellion, revolution, insurrection, military or usurped power or
confiscation, terrorist activities, nationalization, government sanction,
blockage, embargo, labor dispute, strike, lockout or interruption or failure of
electricity or telephone service. Neither an Act of God nor Force Majeure
shall, itself, shall be grounds to terminate this Personal Services Agreement.
If TRIBE or CONTRACTOR asserts Force Majeure as an excuse for failure
to perform any of their respective obligations under this Personal Services
Agreement, the nonperforming party must prove, in the absence of a written
stipulation between the parties, that the nonperforming party took reasonable
steps to minimize delay or damages caused by foreseeable events, and that the
nonperforming party substantially fulfilled all non-excused obligations, and
that the other party was timely notified of the likelihood or actual occurrence
of an event described herein as a Force Majeure.
XV[I. EXHIBITS
l8.l All exhibits and attachments referred, attached and made a part of this
Personal Services Agreement are deemed incorporated into this Personal
Services Agreement by reference, whether or not the same are actually
attached.
XIx. FURTHER ACTS AND ASSURANCES
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 10 of 16
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Packet Pg. 1009 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-005
l9.l The Tribe and the Contractor acknowledge and declare their express intention
to avoid, where possible, any situation which, more likely than not, would
frustrate the intended purpose of this Personal Services Agreement. The
parties hereto each acknowledge and agree to take such further acts and to
execute, acknowledge and deliver such documents, which may be reasonably
necessary or deemed to be reasonably necessary to carry out the terms and
conditions of this Personal Services Agreement. Each of the parties agree to
take such action and provide such further assurances and documents upon
three (3) business days prior written notice from the other party.
XX. COMPLIANCERESPONSIBILITY
20.1 Any applicable laws, regulations, or the requirements of any federal or state
contract or grant, or pass-through agreement, if any, through which funds are
provided for this Personal Services Agreement are incorporated herein by
reference as if fully set forth herein, which may include but not necessarily be
limited to, procurement, receipt, and payment for goods and services, policies
and procedures, and other certifications and assurances. By entering into this
Personal Services Agreement, CONTRACTOR acknowledges, warrants and
represents that CONTRACTOR has sufficiently familiarized itself with all
such laws, regulations or other requirements, and fully understands that
CONTRACTOR and CONTRACTOR'S employees, subcontractors, material
suppliers and other sub-recipients are required to comply with the same.
CONTRACTOR further acknowledges and agrees that CONTRACTOR will
take such steps as are necessary to ensure that its employees, subcontractors,
material suppliers, agents and sub-recipients are aware of and will fully
comply with such legal and other obligations. CONTRACTOR further
understands, acknowledges and agrees that the Tribe may have responsibility
to ensure that the CONTRACTOR fully complies with such laws, regulations,
or other requirements, by monitoring CONTRACTOR'S compliance through
an ongoing review of the CONTRACTOR'S books and records relating to this
Personal Services Agreement, and CONTRACTOR further agrees that
coNTRACToR and its employees, if any, will fuily compry with this
requirement and cooperate fully with the TRIBE and its representatives in
providing such books, records and other information as is necessary for
TRIBE to fulfill its compliance responsibilities.
XXI. EXECUTION IN COUNTERPART AND
BEST EVIDENCE OF AGREEMENT
2l.l The parties understand, acknowledge and agree that this Personal Services
Agreement may be executed in counterpart originals so long as all counterpart
signature pages are integrated into one complete Personal Services
Agreement.
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 11 of16
16.E.1.a
Packet Pg. 1010 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
In the event that the execution of this Personal Services Agreement is in
counterparts, each party authorizes representatives of the TRIBE to integrate
the signature and notarial pages, if any, for TRIBE and for CONTRACTOR to
be attached to the remaining numbered paragraphs of the Personal Services
Agreement and a copy of each of the Attachments and Exhibits to this
Personal Services Agreement. A copy of the fully integrated personal
Services Agreement or a duplicate original of this Personal Services
Agreement or a genuine copy thereof, as applicable, shall be provided by the
TRIBE to CONTRACTOR after the same is assembled to contain the original
signature pages ofeach party.
XXII. CONFIDENTIAL MATTERS AND
PROPRIETARY INFORMATION
22.1 The Contractor acknowledges and agrees that Contractor and its employees
shall keep, hold and maintain, in strictest confidence, all information relating
or incidental to this Personal Services Agreement and that which may be
acquired or obtained in connection with or as a result of the services
performed under this Personal Services Agreement and the interaction
between Contractor and representatives of the Tribe. Such information is
acknowledged and agreed by Contractor to be valuable property of the Tribe
which may be governed by applicable federal laws and regulations and
applicable tribal ordinances and resolutions. Such information includes, but is
not limited to, books, reports, photographs, slides, materials, data, whether oldor newly generated, boring logs, sample results, laboratory reports,
calculations, estimates, documents, communications, notes, proposals, scopes
of work, or materials of any kind or nature which pertain or relate in any
manner to the govemmental or business operations of the Tribe. Contractor
further understands, acknowledges and agrees that the confidentiality of such
proprietary and other information is of such importance to the Tribe that the
protections provided to such information in this paragraph form a fundamental
part of the legal consideration for this Personal Services Agreement.
Contractor further acknowledges and agrees that Contractor shall not, during
the term of this Personal Services Agreement or at any time thereafter publish,
communicate, divulge, disclose or utilize, in whole or in part, any
confidential, proprietary or other information more particularly referenced or
described in this paragraph without the prior written consent and approval of
the Tribe provided by and through a resolution of its Tribal Council duly
enacted in legal session, whether or not such information is designated as
proprietary or confidential, but particularly under circumstances where such
information is formally designated as being proprietary or confidential in
nature or where through the exercise of reasonable care and the good faith
consideration of all surrounding circumstances, including, but not limited to
the sensitivity, importance or private and non-public nature of such
information, Contractor recognizes, as a part of its professional responsibility,
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 12 of 16
16.E.1.a
Packet Pg. 1011 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
that such information ought to be treated by Contractor, in all respects, as
proprietary or confi dential.
22.2 Contractor specifically acknowledges and agrees that all matters pertaining to
the gaming operations of the Tribe, including the operation and integrity of all
games and gaming machines, and all component parts and aspects thereof, are
to be accorded the highest possible protection and, in all respects, are to be
treated by Contractor as confidential and proprietary.
22.3. Except as required by applicable law, and only after providing the Tribe with
sufficient advance written notification, Contractor acknowledges and agrees
that Contractor will not meet or confer with any member of any federal, state,
or local regulatory agency concerning the services provided or to be provided
by Contractor to the Tribe without first obtaining the express prior written
consent of the Tribe. In addition, Contractor acknowledges and agrees that
Contractor will not discuss any matter arising out of this Personal Services
Agreement or out of Contractor's relationship with the Tribe with any
member of the press or public under any circumstances and will not issue any
press release without the prior written consent of the Tribe. In the event that
Contractor becomes aware of a possible site condition or situation, which, if
confirmed, could impose a reporting requirement of the Tribe, operator,
lessee, or lessor, Contractor shall promptly notify the Tribe and provide all
details regarding such site and the reasons why Contractor believes, in good
faith, that such site condition or situation, if confirmed, courd impose a
reporting requirement on the Tribe so that the Tribe may, in its discretion
initiate such action as it deems appropriate.
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 13 of 16
16.E.1.a
Packet Pg. 1012 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Agrcement at Hollywood Seminole Indian Reservation, BroyaldpCounty, Flo5i5tj,.and Harry
wavne Lee, MD, FACEP which is effective as of the lor day of iJUe_,20r8.
SEMINOLE TRIBE OF FLORIDA
4t za/t 7
PUR20!8-04-006
IN WITNESS WHEREOF, the parties hcreto have executed this Personal Serviccs
Executive Director Safcty, Law & Onder Administration
BY:
Pcter
BY:
wit
HARRY WAYNE
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 14of16
aJsr) rU
16.E.1.a
Packet Pg. 1013 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
ATTACHMENT A
CONTRACTOR'S PROPOSED SERVICES (SCOPE OF WORK)
CONTRACTOR
Harry Wayne Lee, MD, FACEP
2856 NE 36th Street
Fort Lauderdale, FL 33308
Phone: (954) 850-8041
E-mail : bozzersg,grnai l.com
Vendor #10920
SERVICES
Contractor shall perform Medical Director duties and responsibilities as outlined below:I. Participate in the process, design, implementation, and revision of the Seminole Tribe
of Florida's (Tribe) Fire Rescue and Emergency Medical Services (EMS) program to
include but not limited to,
a. Establish a Quality Assurance and Quality Improvement Program.
b. Assist in the development of Tribal EMS protocols and procedures.
c. Perform case reviews.
d. Provide direct field observation of the delivery of Tribal EMS.
e. Provide formal and informal education to the Tribe's Fire Rescue Department,
to include all aspects of EMS for all Tribal entities, including but not limited
to Tribal gaming enterprises and establishments.
f. Respond, when available, to major emergencies to provide consultative
services.
g. Approve the narcotic purchasing and control plan.
h. Serve as a liaison within the local medical community.
i. Make recommendations to the Tribe's Fire Rescue Department regarding
EMS delivery.j. Provide the Tribe's Fire Rescue Department with written reports upon request.
k. Prepare and write reports.
l. Research information and make recommendations.
m. Conduct presentations.
n. Communicate effectively with associates and department personnel.
o. Assist in or assign trainings.
p. Counsel and direct personnel performing field level EMS duties.
q. Assume the responsibility for authorizing the use of specific medical
equipment and/or drugs and medications as may be required.
r. Support and approve EMS projects or grant programs and, as required, sign
related documentation as the Medical Director of the Tribe's Fire Rescue
Department.
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 15 of16
16.E.1.a
Packet Pg. 1014 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
PUR20l8-04-006
COST(S)
Total costs dedicated to this Agreement are not to exceed $74,988.00.
Contractor will be compensated at a rate of $2,083.00 per month as mutually agreed upon
between tribe and Contractor.
Approximate monthly payments during the contract period (June l, 2018 - May 3l,2OZl).
Jun $2,083.00 s2.083.00 $2.083.00
Jul $2,083.00 $2,083.00 $2,083.00
Aug s2,083.00 s2,083.00 $2,083.00
Sept $2,083.00 $2,083.00 $2,083.00
Oct $2.083.00 $2,083.00 $2.083.00
Nov $2,083.00 $2,083.00 $2,083.00
Dec $2,083.00 $2,083.00 $2,083.00
Jan $2.083.00 s2,083.00 $2,083.00
Feb $2,083.00 $2,083.00 $2,083.00
Mar $2,083.00 $2,083.00 $2,083.00
Apr $2.083.00 $2,083.00 $2,083.00
May $2,083.00 $2,083.00 $2.083.00
INVOICE/PAYMENT SCHEDULE
Contractor shall invoice the Tribe at the end of each month or upon completion of services. Invoices
shall be for the monthly amount specified in the COSTS section above and must reference the
Purchase Order number that corresponds with this contract. Upon the Tribe's receipt and approval of
invoices, Contractor shall be paid within thirty (30) calendar days.
Harry Wayne Lee, MD, FACEP Personal Services Agreement Page 16 of 16
Month 2018-2019 2A19-2020 2020-2021
Totals $24,996.00 $24.996.00 s24,996.00
$74,998.00
16.E.1.a
Packet Pg. 1015 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Page of
ACORif CERTIFICATE OF LIABILITY INSURANGE DATE (MM/DD/YYYY}
o4/ L2 / 20L8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTTFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AiiEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE lssultilc INSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSUREO, the policy(ies) must have ADDITTONAL INSURED pro\risions or be endorsed.
lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
rrillis of Texas, fnc.
c,/o 26 Century BIvd
P.O. Box 305191
Nashville, TN 3?2305191 USA
CONTACT
NAME:
f}tnf,..",, L-s77-e4s-73:.a llil "^,. L-saa-467-237s
iijffiEsr, certif icates0willis . con
INSURER(S) AFFORDING COVEMGE NAIC #
|NSURERA. AdEiral Insurance Company 24A56
INSUREDDr. tlarry Walae Lee, MD
c/o S4lnole tEibe of Eloiida
6300 stirling Road, sui.t€ 220
Holl]ryood, rL 33024
INSURER B :
c:
D:
INSURER E :
INSURER F
COVERAGES cERTIFICATE NUMBER: rrs885330 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WI-IICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOV1^I MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR TYPE OF INSURANCE AUUL SUHX
|NSD hrVO POLICYNUMBER POLICY EFF
IMM/DDTYYYY)
POLICY EXP
IMM/OOTYYYY LIMITS
I coMMERCTAL GENERAL LTABTLTTY
l..o,r.-rooe f i occun
I
I ercn occuRneruce
TDAMAGEToFEN-TEr
L PREMISES (Ea o@rere)
MED EXP (Anv one oerson)
lj
$rl
GEN'L AGGREGATE LIMIT APPLIES PER-l ror,., E t["ot f-],-o"
I orn.*,
I PERSoML & ADV TNJURY
I GENEML AGGREGATE
I pnooucrs - corrlplop rco
lj
$f-l$
E
AUI
ANY AUTO
O\^/NED
AUTOS ONLY
HIRED
AUTOS ONLY
COMBINED SINGLE LIMIT
lEa!q:ident)$
i BoorLY TNJURy (per person)
Foptr'rNJuRy,p"*rd"^t)
PROPERTY DAMAGEI (Per accident)
s
s
s
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS.MADE
EACH OCCURRENCE $
AGGREGATE $
oeo | | nerErurror.rs $
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITY
N/AANYPROPRIETOR/PARTNER/EXECUTIVE T----IoFFIcER/MEMBERExcLUDED? L__l(Mandatory in NH)
l, yes. desqibe under
DESCRIPTION OF OPERATIONS be|ffi
$
E.L DiSEASE - EA EMPLOYE $
E.L DISEASE - POLICY LIMIT $
A Professional Liability incl
Medj-cal Malpractice
EOo00003244 14 04/os/20L8 04/Os/20Ls Each Claim
Aggregate
DeductibLe
s1 ,000 ,0oo
$3 ,000 , 000
ss,000
DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (ACORDl0'l,Additional RemarksSchedule,maybeattachedif morespaceisrequiEd)
CERTIFICATE CANCELLA
@ 1988-2015 ACORD CORpOMTIOl,l.
The ACORD name and logo are registered marks of ACORD
Seninole Tribe of Florida
Dept. of EEergency M€dical Servj.ceg
5300 stirling Rd
Hollywood, FL 33024
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2016t031
sR rD: 15959894 BA?cs:569116
All rights reserved.
16.E.1.a
Packet Pg. 1016 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
Seminole Tribe of Florida
FY19 Budget
Fire Rescue
Gaming Contribution
Revenue
Salary & Benefits
70000-Contract Services
70045-Hardware/Software Maintena nce Contracts
*;illl'-1,'"#T'r",
".o,, u n i ca ti o n s
71010-Wireless Communications
7 13 15-Ca ble/Satell ite
05-Utilities
71500-8uilding & Grounds Maintenance
71740-Gas, Oil, & Diesel Fuel
71750-Equip Maintenance & Repair
71755-Vehicle Repair And Maintenance
05-Maintenance
71800-Equipment
71815-Medical Equipment
71835-Audio/Video Equipment
07-Equipment
72000-Equipment Rental - Short Term
72040-Vehicle Operating Leases
72050-Equipment Rental/Lease - Long Term
08-Rental & Lease
73000-0ffice Supplies
73060-Office Furniture
73070-Printing
73200-Postage & Mailing
73300-Dues, Subs & Books
73400-Department Food Supplies
73500-Departmental Supplies
73530-Uniforms
73750-Construction Materials & Suppl
09-Supplies & Material
74020-Mileage Reimbursement
74090-Parking And Tolls
74460-Airfare
74470-Hotel
74490-Meals
10-Travel
75210-Motor Vehicles lnsurance
12-lnsurance
75855-St. Lucie Co. Fire Rescue
FYI I Budget - Approved September 7, 201 8
FY19
Budget
7,L92,5OO
1,399,000
18,029,900
1,46,400
70,800
2L1,200
L9,700
32,700
4,900
57,300
4,200
140,300
50,100
328,100
532,700
226,900
15,800
3,400
246,LOO
3,800
10,000
1 1,200
25,000
4,900
11,400
5,200
1,400
15,200
t,200
196,000
47,400
1,100
293,900
1,700
100
1,500
4,200
7,400
9,900
103,700
LO3,700
25,700
16.E.1.a
Packet Pg. 1017 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
FY19 Budget
Fire Rescue
75850-City Of Hollywood Fire Rescue
14-Security & Protection
76030-Workshop[raini ng
15-Training/Meetings
76550-Com mu n ity Activities
17-Event Activities
77980-Medical Exam Screening
79o20-Food & Beverage
79100-Bad Debt Expense
79398 - Other Operating Expenses
20-Other
94000-lnterest
94030-Capital Lease Payments
31-Financing
71825-Computers & Printers
79135-Software Licenses
37-lnformation Technology
Total Expenses
Total
Seminole Tribe of Florida
FY19
Budget
309,000
334,7OO
25,400
25,4OO
700
700
400
100
255,500
216,000
492,000
10,200
159,000
159,200
78,100
2,800
80,900
2,567,600
12,015,000
FY19 Budget - Approved September 7, 2018 2
16.E.1.a
Packet Pg. 1018 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
SEMINOLE TRIBE
FIRE RESCUE DEPARTMENT
TRAINING DIVISION
Fire and EMS Trainins Matrix (2019-2020)
201 9 Topic
January Firc JPR's- JPR2 Ropes/ Knots, JPR3 Hoisting and Lowering Equipment, JPRI I SCBA, JPRI2 ppE
Comoenv Drill-NFPA l4l0 Evolution 0l
EMS Hends On Rcvicw - Patient Ilistorv. Adult Comprchcnsive Phy'sieal Assessment. Pediatrrc Phl,sical Assessrnenr
Hydrochloride ( Ilenadrl l'8')'frrqct Solutions
IiVOC- Dangers ol'Specding lbr t:VO's
Cornpany ()t'flccr- NFI'A 102 I lncident ltesponsr'Sal'etv
Gensral- Sexual Harassment Awartrness
[iMS- HII)I)A
February :r'Ei.i!' Lalror.r rx BE crnd! PtrNt S.fttvTnt le Fxititui
EEJE8! ,pR, FiE sdi@ Dd EMs Hisrory {PPE In*li' rd scaa Mdr Flt r"lir)
!U!!q4E-!!tltt!i ^i".u!.
oxrscn.rion. ad venrilaiq, Adun odracheal htutElion. P€diuric orolmchar tnrubarid, suproslonic
^@!y
D.vrce
5 l8 rlrdn'\Nondomm (Cv.nor'l'0.5 l9lpruropium ltrond. {Arhveit(,). j 22 Magm$un sutth&
STATION fMSSXT-|-S S|CN OFFT.r.t Solutiom
Cmr&yom.ets NIiPA l0! I La&6hita\.(;oup lnfluc,cclic NI-P lml Risk
^ls*mor
tulrsr
[MS- HIv/AlDs A\"en.ss ( Flido)
IIMS. R*oons l0'l eroirsm Mod# |
March Firc JPR's- JPRI0 Ventilation, JPR9 Forcible Entry, JPR l3 Power Tools
Comornv Dril!-NFPA l4l0 Evolution 03
EMS Hrnds On Rcvicw -'['rauma Phlsical Asscssmcnt. l)leural l)ecompressitxr. Spirral lmmolrilizatron. Joint Splinting
Tersct Solutions
Ijire- NIrPA l00l Ventilation
I laz-Mat- ('orrprcssed ( ias Salbq
EMS- Medication l:rrors
EMS- Ivledical, Irthie'al and l-cgal lssues
Keep Training and Stay Safe
16.E.1.a
Packet Pg. 1019 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
SEMINOLE TRIBE
FIRE RESCUE DEPARTMENT
TRAINING DIVISION
Fire and EMS Trainine Matrix (2018-2020)
2019 Iqpic
April Fire JPR'g- JPR8 Search and Rescue, JPRI 7 Thermal t.u
Comomv Drill- Denver Drill
fMS qqds On Rcvtcw -'liactior Splintine. Hemorrhagc Corrtrol. Medrcal l)hy-sical r\ssr'ssmerrt. Intravenous 'ftcrapy. Intraosseous 1'hcrapv
Trrstt Solutions
Iiire- NIiPA l(X)l Sexual Ilarassntent Au,arencss
I :VO('- [:nrcrtsencv Vehrclc C'harretcrrstrcs
Sall.ty- llack lnjurv Prevenrion
liMS- lrMS Inr:idcnt Command Svsren'r
May *Treininp Rotation ai thc Bis Cvoress Pu
(EMS Training - Departmenr Skills Lab Sign Oft)
Fire JPR's- JPR4 Lock-Out-Tag-Out, JPR5 Ilose Rolls
6 lO.3 'l yD€s ol EMS Unrts
!r4itli!![iE!
Cromtany OoisF NFP/\ l01l lrE-ln.dcnr Planning
s.f.rv- Slipr TriDs ahd Fulls
HMS- tuspm* To rquim Mdj,
June EircJPR's:JPR7WaterSupply,JPR22Pumpingoperations,JPR23
Comornv Drill- SCBA Competency Drill
EMS Hrnds On Rcvicw - lntranasal Medicatron Adminrstration, lnhalt'tl Mcclication Adrnrnislr.rtion. (ilucomt'tcr
(r. l3 IV Drip Calculations.6.l"l Medrcal Ablrrcliatrons.6. l5 Medical 'lernrinokrgl.6.16 l,edrarric Vital Signs
ST.{TION EMS SKILLS SIGN OFF
I'arset Solutions
Fire- Portablc I:xtingurshers
I:VOC- I.egal ('onsideratrons tbr l-lVO's
[.-ire- Lock-Our i'lag-Out
(ieneral- Cullulal Diversitv
Keep Training and Stay Safe
16.E.1.a
Packet Pg. 1020 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
SEMINOLE TRIBE
FIRE RESCUE DEPARTMENT
TRAINING DIVISION
Fire and EMS Trainine Matrix (2018-2020)
20t9 Topic
July E!gg-JE& JPR2 RopeV Knots, JPR3 Hoisting and Lowering Equipment, JPRI I SCBA, JPRI 2 PPE
Comornv Drill- Foam Evolution
EMS Hrnds On Rcview - Nornral l)cliverv and Newtrorn Care, Abnormal l)elirer and Nervborn Care, Strttcher Operatrons. AljD. Autovott
lixposurc lChemrcals). 7 I I Acids and Acid Mists, 7 1.2 Alkalrno ('ompounds
ferset Solutions
Companl Otllccr- NIrPr\ 102 | lncrdcnt Scenc Manauemcnt
I laz-Mat- I lazard ('omnrunrcatron
l:MS- I Iaz.ard Communication
(icneral- Workrrllcc Diversitl
August *Trrinins Rotttion tt the Biq Cvorcss Public Srfctv Treinine Frcilitvr
(Fire)
Firt JPR's- JPR24 Salvage and Overhaul
EMS Hrnds On Rcview- tlasic l.it'c Support, Blood Aloohol Sampling. Brosclowand llandtcw Sy-stem. Chr'sr l)ccompression Deviccs
t:1h1'lcnc (ilycol
'ferset Solutions
lrV( )C- I:rncrScne 1 Vchrclc ( )ncratt()ns
C'onrpanv Ollicer- NIrPA lt)2 I t.egal llcsponsibilities and Liabilitios
Sati't1 - I learing flonscrvation
1:NIS- Patient Abusc
September Fire JPR's- JPR6 Fire Suppression, JPR I 5 Drafting
Comnrnv Drill- NFPA 14l0 Drill
EMS Hrnds On Rcvicw - ('O Monrtoring Deviccs. C()2 Monitorrng l)t'r,rces
Protocol Revien.l 6 l)ediatric'Ioxicokrgic l:mergcncics. .l 6 I Pt'diatrrc lrrgcsrron (Orerdosc.)
'l'arsct Solutions
flaz-Mat- ('orntrustrtrle and l;lammahle I.rqLrids
[]ire- [:irc []chavior
Ifire- []ire l:xtinguishcr Salbtv
EMS- l)harrnacologv
Keep Training and Stay Safe
16.E.1.a
Packet Pg. 1021 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
SEMINOLE TRIBE
FIRE RESCUE DEPARTMENT
TRAINING DIVISION
Fire and EMS Trainine Matrix (2018-2020)
Training
2019 Topic
October Firc JPR's- JPR20 Emergency Vehicle Operations, JPR2I Trailer Towing
Comornv Drill- Air Consumption Drill
EMS Hends On Rcview - Helmet/Faccmask Remoral. ]'rauma'l-ournitlut't, Phlsical Rcstraints
'l'reatment (iuidc 7A: Orange. Chernical 'l reatnrent (iuidc liA. l)urplc, Chcrnical 'frcatrnenr (iuidc 9A: Whitc
ST,ITION E]US SKILLS SIGN OT'F
Trrerl Solutions
l:V( )C- I)ell'rrsive [)riving firr- IiVO's
Cornpanv Ollir;er- NIrPA l02l l;ire lnvostigatron
l:MS- Managing lllass Casualty. lncidcnts
ljMS- Rlood btlrne l)athogens Sat'ctv
November rTrrinins Rotetion rt thc Biq Cvorcss Public Srfetv Treininq Fecilityr
(PALS Recertification)
Firc JPR's- JPRI8 Haz-Mat Response
Hrz-Met Hrnds On Rcview - Haz-Mat Response Trailer
Tarset Soluaions
Clompanv Ollicer- NIPA l02l Rcasonahlc Suspicion ol'r\lcohol lirr Supclvisors
IrVOC- Ad justing to Changrng Conclitions firr l:VO's
lrNlS- Responsc I'o li.rrorism Mtld -J
(icneral- Worknlace Vrolcnce
December g!&.IE&JPRI4 Ground ladders, JPRI6 Detection Monitors, JPRIg Wildland
Comornv Drill- NFPA I4l0 Drill
EMS Hends On Rcview - l2-l.cad l:C(i. Slnchrorrizcd Cardiorersron- I)etihrillarion,'l'ranscutaneous Pacing
'l'rauma'lirurniquet
l'erqet Solulions
l;ire- Wildland Mql -l
I Iaz- Ivlat- Rad iation Sat'et1'
Iiire- Wildland Rclicsher [Jpdarcs
liMS- [tesponsr:'lir'l'errorism Motl 4
Keep and Stay Safe
16.E.1.a
Packet Pg. 1022 Attachment: 2019 SemTribe CoPCN Renewal Application (7901 : Seminole Tribe CoPCN)
COLLIER COUNTY FLORIDA
Class "l" and Class "2'COPCN
Name of Service: Seminole Tlibe of Florida
Name of Owner: Seminole Tribe of Florida
Principle Address of Service: 6300 Stit'line Road
Hollywood. FL 33024
Business Telephone: (95+) 966-6300
Description of Service: C1ass "1" Emergency Medical Transporq Class "2" lntra-faci]itv' *O ort-of-**qv tr*sport for triUui*n"*U"r*
Number of Ambulances/Vehic les :
(2) Two. (1) One Fire Eneine 1250 GMP Pumper. (l) Fire
Brush Truck/Utility Vehicle. (1) Squad Truck and (l) One
Fire/EMS Supervisory Vehicle.
See attachment "A" for description of vehicles.
This perrrit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Ambulance Service to operate intra-facility and out of county transports for afee or
charge for the following area(s): Seminole Tribe of Florida Fire Rescue Department
boundaries for one year from the date executed 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 day of ,2019
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K, KINZEL, CLERK COLLIER COUNTY, FLORIDA
,Deputy Clerk W.L. McDaniel, Jr., Chairman
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
I l9-EMG-00423/ t 4s5434 I 1l
16.E.1.b
Packet Pg. 1023 Attachment: 2019 Seminole Tribe Permit (7901 : Seminole Tribe CoPCN)
WHEREAS,
WHEREAS,
ATTEST:
CRYSTAL K. KINZEL, CLERK
, Deputy Clerk
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attomey
SEMINOLE TRIBE OF'FLORIDA FIRX RESCI.IE
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
WHEREAS, the SEMINOLE TRIBE OF FLORIDA FIRE RESCUE (hereinafter "Seminole Tribe")
wishes to provide intra-facility transports and out ofCounty transports for a fee or charge; and,
it has been demonstrated that there is a need for this ambulance service to operate within the boundary of
the Seminole Tribe in lmmokalee
the above mentioned service has indicated that it will comply with all requirements of Chapter 40 l, Florida
Statutes, governing emergency medical telecommunications and tansportation, the Board of County
Commissioners of COLLIER COLNTY hereby issues a Certificate of Public Convenisnce and Necessity
to this ambulance service for one year from effective date. In issuing this certificate, it is understood that
the above named ambulance service will meet the requirements of Ordinance 2004-12, as amended"
applicable Iaws and regulations and provide service on a24 hour basis.
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
W. L. McDaniel, Jr., Chairman
Date Signed
Effective Date: April 29, 2019
Expiration Date: April 28,2020
I I 9-EMG-00423i t4s s 43 s I t)
16.E.1.c
Packet Pg. 1024 Attachment: 2019 Seminole Tribe Certificate (7901 : Seminole Tribe CoPCN)
20I9 VEHICLE IDENTIFICATION LIST
. (2) Two Medical Rescue Units (Ambulances)
o Rescue 38: Class l&2 ALS Transport and Inter-Facility (FL-ALS Permit # 19549)
o Rescue 238: Class l&2 ALS Transport and Inter-Facility (FL-ALS Permit # 14456)
. ( l) One Fire Engine 1250 GMP Pumper - Engine 38: Class 3 ALS Non-Transport (FL-ALS Pennit
#1s633)
. (l) One Fire Brush Truck/Utility Vehicle - Utility 38: Non-ALS, Non-Transpoft, Suppression Unit
. (l) One Squad Truck Squad 38 - Non-ALS, Non-Transpoft, Air Truck (SCBA Cascade
Compressor with Air Tanks)
. (l) One Fire/EMS Supervisory Vehicle.
I l 9-EMG-00423 I t 4ss436l ll @
16.E.1.d
Packet Pg. 1025 Attachment: 2019 Seminole Tribe VIN List (7901 : Seminole Tribe CoPCN)