Backup Documents 02/25/2020 Item #16E 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
bE6
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 2/25/2020
4. BCC Office Board of County i5S (99
Commissioners M+J51 a-°13'
5. Minutes and Records Clerk of Court's Office a
PRIMARY CONTACT INFORMATION r2)014-130
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 asa, �6 d
Contact/Department
Agenda Date Item was 2/25/2020 / / Agenda Item Number 16E6 1/
Approved by the BCC
Type of Document Care Med COPCN Number of Original 2 (1 each)
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 cs . ,wn -ver is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signa e STAMP OK N/A
2. Does the document need to be sent to another agency for a•. •. • _ • Ores? Return a JAB
copy to Robin Menard as per the enclosed letter.
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 final 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 tP Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware 9f your deadlines!
8. The document was approved by the BCC on 2/25/20and 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 (3�
ready for the Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16E6
MEMORANDUM
Date: February 27, 2020
To: Dan Summers, Director of Emergency Services
Bureau of Emergency Services & Emergency Management
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: COPCN w/Care Med
Attached for your records is the original of the document as referenced above, (Item
#16E6) adopted by the Board of County Commissioners on Tuesday, February 25, 2020.
If you have any questions, please feel free to call me at 252-8411.
Thank you.
Attachment
16E6
COLLIER COUNTY FLORIDA
Class "2" COPCN
BLS Transfer
Name of Service: Care Med Transportation, LLC.
Name of Owner: Nerlyne Saintyl-Agenor
Principle Address of Service: 3510 Kraft Road
Ste 200
Naples, FL 34105
Business Telephone: 239-599-5606
Description of Service: Interfacility and out-of-county BLS transport for Collier County
Number of Ambulances: Two Ground Units
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 interfacility and out of county BLS 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 p2, f day of rebr UQ,r y , 2020
ATTEST: ' BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL COLLIE COUNTY, FLORIDA
Z.... .)31Ate:t
czc
fr.„4,4-4,1,004.-
Attest
as to,Chgrei5sClerk BURT L. SAUNDERS
signature only. CHAIRMAN
Approved as to form and legality:
Lk_...,\__,....s,
Jennifer A. Belpedi n�'
Assistant County Att ey •\�
[19-EMG-0043 6/1 5 1 005 1/I]
16E6
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