Backup Documents 02/26/2019 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
4 C
L
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU C
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 JAB 2/26/19
4. BCC Office Board of County t33t-+-\\ ,,.\
•
Commissioners �s/ z�s\ice
5. Minutes and Records Clerk of Court's Office
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 Dan Summers Emergency Services 252-3601
Contact/Department
Agenda Date Item was 2/26/19Z---- Agenda Item Number 16E1
Approved by the BCC
Type of Document Seminole Tribe COPCN Number of Original 1
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & C E LIST
Initial the Yes column or mark"N/A"in the Not Applicable col ,which ver is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signaturSTAMP OK JAB
2. Does the document need to be sent to another agency for additio natures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
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 JAB
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
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 2/26/19 and all changes made during the JAB
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 JAB
the BCC,all changes directed by the BCC have been made, and the document is
ready for the Chairman's signature.
C \ .c_
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
16E1
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Thursday, February 28, 2019 10:21 AM
To: HeinrichsbergKathy
Subject: Items#16E1 E5
Attachments: Items#16E1 E5.pdf
Hi agaivt Kathy,
Copies of Items #1-6E1 Sr #1-6E5 frowt
Tuesday's Board Meetivtg are attached for your records.
Ann Jennejohn
Senior Deputy Clerk
Office:239-252-8406
Fax:239-252-8408(if applicable)
Ann.Jenneiohn@CollierClerk.com
t"'" :<"_ Office of the Clerk of the Circuit Court
&Comptroller of Collier County
3299 Tamiami Trail,Suite#401
Naples, FL 34112-5324
www.CollierClerk.com
Thavtk you!
1
16E1
COLLIER COUNTY FLORIDA
Class "1" and Class "2" COPCN
Name of Service: Seminole Tribe of Florida
Name of Owner: Seminole Tribe of Florida
Principle Address of Service: 6300 Stirling Road
Hollywood, FL 33024
Business Telephone: (954) 966-6300
Description of Service: Class "1" Emergency Medical Transport; Class "2" Intra-facility
and out-of-county transport for tribal members.
Number of Ambulances/Vehicles:
(2) Two, (1) One Fire Engine 1250 GMP Pumper, (1) Fire
Brush Truck/Utility Vehicle, (1) Squad Truck and (1) One
Fire/EMS Supervisory Vehicle.
See attachment"A" for description of vehicles.
This permit, 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 a fee 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 7J, day of ' \x3., , 2019
ATTEST: BOARDOF • 1 TY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLL �'` '.ORID a
itthst
. as to iu y Clerk" ' W. , cDaniel, r,CChairman
e r
signature Caty.
Approved as to-form and legality: it+errt# `10 E
111.
Agenda •
,
Jennifer A. Be pe. Date 2, ' �
Assistant County Attorney Date 2—21.,-`
Rec'd
I
[19-EMG-00423/1455434/1] Deputy lark ,
41
16E1
2019 VEHICLE IDENTIFICATION LIST
• (2)Two Medical Rescue Units(Ambulances)
o Rescue 38: Class 1&2 ALS Transport and Inter-Facility(FL-ALS Permit# 19849)
o Rescue 238: Class 1&2 ALS Transport and Inter-Facility(FL-ALS Permit# 14456)
• (1)One Fire Engine 1250 GMP Pumper-Engine 38: Class 3 ALS Non-Transport(FL-ALS Pennit
#15633)
• (1)One Fire Brush Truck/Utility Vehicle-Utility 38:Non-ALS,Non-Transport, Suppression Unit
• (1) One Squad Truck Squad 38 - Non-ALS, Non-Transport, Air Truck (SCBA Cascade
Compressor with Air Tanks)
• (1) One Fire/EMS Supervisory Vehicle.
EXHIBIT
Page
[19-EMG-00423/1455436/1]
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