Backup Documents 03/24/2009 Item #16F 3
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 F ~
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO ~
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document Original documents should bt' hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only arlIT the Hoard ha'l taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate tor additional signatures, dates, and/or information needed. If the document is already complete with the
exceotion of the Chairman's sie.n.ature, draw sline throutd1 routing lines # I throullh #4, oomolete the checklist, and forward to Sue Filson Oine #5),
Route to Addressee(s) Office Initials Date
(List in routine: order)
1.
-
2.
3.
4. ;S I~"f/a,
..~ Cnc.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending Bee approval. Nonnally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original docwnents needing the BeC Chairman's signature arc to be delivered to the Bee office only after the BCC has acted to approve the
item)
Name of Primary Staff Artie Bay Phone Number 252-8459 - Please call
Contact for Pick-up
Agenda Date Item was 3/24/09 Agenda Item Number 16F3
Aooroved bv the BCC
Type of Document Grant Request Number of Original 1 - Please return
Attached Documents Attached original
I.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/ A" in the Not Applicable column, whichever is
a ro nate.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman. with the exception of most letters. must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances.
resolutions. etc. signed by the County Attorney's Office and signature pages from
contracts. agreements. etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final ne otiated contract date whichever is a Hcable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si ature and initials are re uired.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of our deadlines!
The document was approved by the BCC on _ 3/24/09 _(enter date) and all
changes made during the meeting have been incorporated in the attached document.
The Coun Attorne 's OfJ"lCe has reviewed the chan es, if a licable.
Yes
(Initial)
N/A (Not
A licable)
2.
3.
4.
5.
6.
CflC..
CJ
elJ.c.
CI3e---
c.re
I: Formsl County Formsl BCC Formsl Original Documents Routing Slip WWS OriginaJ 9.03.04, Revised 1.26.05, Revised 2.24.05
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MEMORANDUM
Date:
March 25, 2009
To:
Artie Bay
EMS, Operations Analyst
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Grant Request
Attached please find one (1) original of each document referenced above, (Agenda
Item #16F3) approved by the Collier County Board of County Commissioners on
Tuesday, March 24, 2009.
If you have any questions, please call me at 252-7240.
Thank you.
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Co~er County
u ,. -""'-_ ~ __
Bureau of Emergency Services
To Whom It May Concern:
The following request is respectfully submitted under the Wal-Mart Community Grants Program.
Who are we?
Collier County EMS/Fire provides emergency medical services for all of Collier County, Florida,
which is the largest county in the state, encompassing 2025 square miles. This agency responded
to 34,495 calls for emergency medical services and provided 22,884 transports in FY 2008.
Emergency medical services are provided to the County via 150 full-time Paramedics and EMTs,
along with 12 field supervisors.
Who do we serve?
Collier County is located on the southwest coast of Florida with a permanent population of
251,000 (based on the 2000 census). Approximately 20,000 workers increase the population
each day. In addition. the moderate climate, miles of beaches, four airports and numerous
marinas attract a multitude of visitors each day, swelling the population level to an estimated
420,000 (Collier County Planning Department estimate for 2009) during peak season.
What is the problem we are trying to solve?
The Collier County EMS/Fire Special Operations Response Team (SORT) IS tasked with
providing:
· Hazardous materials/weapons of mass destruction decontamination
. Tactical Medic services for the Sheriff's Office
. Fire/emergency scene rehabilitation of rescue workers
. Medical response for search and rescue
. Mass casualty medical response
· Biological emergencies response with the Collier County Health Department
These programs require basic supplies, tools and equipment to effectively meet the operational
requirements necessary to provide a safe and comprehensive response to some of the most
dangerous emergency events that occur in the County.
Nearly 80% of the Collier County EMS/Fire budget covers personnel costs. The remaining 20%
is utilized to cover operating costs and capital purchases to replace worn equipment. The budget
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2705 Horseshoe Drive South' Naples, Florida 34104' 239-252-8459' FAX 239-252-3298' www,Golliergov,neUems
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Page 2 of2
is largely dependent on revenue. With the majority of the County being agricultural, there is a
large influx of both a migrant population and indigent patients. As such, Collier County
experiences a high volume of write-offs for ambulance services. In addition. ambulance fee
collections are taking a negative turn due to the trend by insurance companies to short-pay
claims (payments substantially less than that billed). unemployment and people's loss of group
insurance. and the economy in general. Most individuals will choose to keep their lights on and
feed their families before paying for an ambulance ride. As the revenues decrease, the offsetting
funds must come from ad valorem taxes, which are already strained due to the growth of the area
and demands on the infrastructure of the County. Especially significant is the passage of a
referendum in the State of Florida to reduce property taxes that will cripple county agencies from
obtaining necessary funding through ad valorem taxes. In fact, the County budget for Fiscal
Year 09 required a two percent reduction over the Fiscal Year 2008 budget and it is anticipated
that even further reductions (at least 15%) will be required for Fiscal Year 2010. This in itself
will seriously hamper any efforts to replace worn and unsafe equipment. let alone expand
resources.
This grant will significantly enhance the effectiveness of Collier County EMS/Fire Special
Operations Response Team to meet the challenges of the operational tasks it has been assigned.
Public Press Release:
Through the Collier County EMS/Fire Public Information Officer. we will make a public press
release about Wal-Mart's support of the Special Operations Response Team (SORT) through the
Wal-Mart Community Grant Program supporting Public Safety.
Respectfully submitted.
Drnma FliP--- d "e..
Collier County Board of County Commissioners
iliL Uy /
Jeff PagepM'
Collier County Emergency Medical Services/Fire
Approved as to form and legal sufficiency:
~MWQ0G
Colleen M. Greene
Assistant County Attorney
.'
MEMORANDUM
Date:
May 29, 2009
To:
Artie Bay, Operations Analyst
EMS
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Grant Application for the Emergency Medical Services
Special Operations Response Team through the
Wal-Mart Community Grants Program for purchasing
EMS equipment and supplies
Attached please find the original grant application referenced above,
(Agenda Item #16F3) approved by the Collier County Board of
County Commissioners on Tuesday, March 24, 2009.
Our office has kept as copy for the official record for the Board of County
Commissioners.
If I can be of any further assistance, please call me at 252-8406.
Thank you.
Attachments (l)
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16F3
WAL*MART
+
Application for Local Community Contnbutlon
Retum completed form to the Wal-Mart Store or Sam's Club where you obtained this application
Location Use Only:
Location #:
City:
8T:_ Type: WMlSam's/DCfTO
Amount Requested: $
Managers Name (signed and printed)
Date-1-1
Community Involvement Associate: Date_-1
Thl. appllcatJon must be completed and kept 011 "Ie for recorcl refentlon of thrH JIM'" .t your toeatlon
To be completed by the Organization:
Selecton.: IRSdesignatedD501(c)(3) D501(c)(4) o 501 (c)(6) 0 501(c)(19)
. OrpanlzaUonIl with current ta".."empt ststUII uncler S6ction S01c (3) 01 the Intemal Rellflnue Servfce Code and thet 818 also pubflc
charities under Section 509(a) (1) or 509(a) (2). Organizations must be listed In the most CU/'T8flt IRS 50 State Mast.r Fikl at the "me of
application.
OR:
o Public School ;!J Federal, State or Local Govemment Agency 0 Faith-Based Organization."
** Faith 8a;sed Organizatiom:fimding PllrpoS'S MIISt oddrus and H1I#Iflt tit, 1I#IftJs of/h, commllnity at /tUg,
Organization Name: Co ll\e-r Cal>"'I"'\-bt-B(' .C - Elf'\SFi ~
Federal 501 (c) (3), (4), (8), or (19) Tax 10': (9 dlglls) S~- b CQC:)&5 "8
Public Charity Status: 0 509(a)(1) D509(a)(2)
Address: ,,~3 a LT a 1'"'<' ,a l"^ \ Jr ~ i 1 €~<rl-
City: ~) e..s ST: ELZlp: 3J..} J J ~
Contact Name: ~ Pa,j~ Contact Phone: ~~ ~- "3 7l.f b
~
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Will these grant fundi directly benefit your LOCAL community? )t Yes 0 No
Aocroved as to form & legal s
Which of the following groups will this funding primarily benefit? This information is used SoTElly r fundi 9 to
specific diverse community groups and is NOT considered during the grant review or approval process
Please select only the most appropriate: Colleen Greene,
D Hispanic 0 African American 0 Asian American 0 NaUve American 0 Caucasian Assistant County Attor
l5l General Population (benefit$ the entire community) _
OrllanlZlltlond)j ntllll": 8Y3S s1g1ng l.cIu1owIlICIge thBt thla form rept........ requetll for foodlng. ana Is FlOla guatllnteta of fu~ (r:I.I~ ilpprovalls
subject to the I .. of the Wal-M8rt Fou ~AI nlzallan8 requeBtlng grant funding mull abide by lhe n.lI.. and gutdalln.. ~'fOnti' 6y !he ~tjoIl, W....
Mart Storet. I.. the W.I-Mart FOIl. sl wftI not be proc;eeaed unlese (xlITlpleted and signed by.1 partlu. ". . 'i'. -
\~ ~ r:--~ : , ,. " .P",
Signed: ! Printed: OehY\4. c.lB..J&L Date: ~;)<tt~~>
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16.F3