Backup Documents 02/26/2019 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 OfficeaJG a4p M
4. BCC Office Board of County
Commissioners Nffi` /
5. Minutes and Records Clerk of Court's Office �p�„`''� a�a��
` c 3:� ,n
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 / Phone Number 252-3622
Contact/ Department Kathy Heinrichsberg
Agenda Date Item was February 26,2019 Agenda Item Number 16E5
Approved by the BCC n
Type of Document Permit and Certificate [ •- 'LA_-( Number of Original 2
Attached Documents Attached
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whi hev -is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? 7-- --6,0,19
o '
2. Does the document need to be sent to another agency for additi nal signatures? If yes,) N/A
provide the Contact Information(Name;Agency;Address;Phon on an attached she-
3. Original document has been signed/initialed for legal sufficiency. (A documents toe KH
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 KH
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 KH
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into
MinuteTrac. 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 February 26,2019 and all changes made KH
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 KH
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,Rased 2.24.05:Revised 11/30/12
Return to Kathy Heinrichsberg — BES
16E5
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 again Kathy,
Copies of Items #16E1 & 416E5 From
Tuesday's Board Meeting are attached for your records.
Ann Jennejohn
Senior Deputy Clerk
Office:239-252-8406
Fax:239-252-8408(if applicable)
Ann.Jenneiohn@CollierClerk.com
•'`"+Pr�R A`'' yF Office of the Clerk of the Circuit Court
&Comptroller of Collier County
3299 Tamiami Trail,Suite#401
Naples, FL 34112-5324
www.CollierClerk.com
Thank you!
1
16E5
COLLIER COUNTY FLORIDA
Class "2" COPCN
Name of Service: Just Like Family Concierge Medical Transport Services.LLC
d/b/a Concierge Medical Transport
Name of Owner: Paul Hobaica
Brewster Ambulance Service,Inc.
Jeffery Panozzo
Charles Bacon
Principle Address of Service: 1061 Collier Center Way
Naples,Fl 34110
Business Telephone:(239) 682-8907
Description of Service: Inter-facility for Collier County
Number of Ambulances:(5)Five
See attachment: See application for vehicle information
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Ambulance Service to operate inter-facility transports for a fee or charge for the
following area(s): Collier County 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: CLERK BOARD OF �7 OMMISSIONERS
CRYSTAL K. MNZFL COLLI ' r• Ir • DA
tio•
.moi. 1 •Lbil_j_LLMA—
Attest as tai ti' s°' 'M rk W.L. cDaniel,Jr., airman
rei
Appra t c iX and legality:
111
Jennifer A.Belpe
Assistant County Attorney �...`4*
16E5
JUST LIKE FAMILY, LLC
D.B.A. CONCIERGE MEDICAL TRANSPORT
LIST OF VEHICLES IN FLEET- 2019
VIN TYPE OF LICENSE PERMIT NUMBER ISSUE DATE
WD3PE7CD9FP121112 ALS/BLS 21469 5/16/2018
1FDYR2CM1HKA15492 ALS/BLS 21470 5/16/2018
WD3PE7CD8FP118959 ALS/BLS 21809 09/26/2018
1FDYR2CMXJKA87880 ALS 21899 11/28/2018
1FDYR2CM2JKA81006 ALS 21900 11/28/2018
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