Backup Documents 03/09/2021 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E 3
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 Office a$ 3 f 9 12
4. BCC Office Board of County by
Commissioners J t} 3-0.) 1
5. Minutes and Records Clerk of Court's Office P-YA) I
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 Kathy Heinrichsberg Phone Number 252-3622
Contact/ Department
Agenda Date Item was March 9,2021 Agenda Item Number 16E3
Approved by the BCC
Type of Document Permit and Certificate Number of Original 2 -- 0-C c,1-.
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? 5' NA
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 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 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 March 9,2021 and all changes made KH N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the KH N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the 9(J,k an option for
Chairman's signature. this line.
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
16E 3
MEMORANDUM
Date: March 11, 2021
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: Renewal of Class "3" COCPN
North Collier Fire Control and Rescue District
Attached is a certified copy of the document as referenced above, (Item #16E3) as
approved by the Board of County Commissioners on Tuesday, March 9, 2021.
The Minutes & Records Department has kept a copy of the original to be kept as
part of the Board's Official Records.
If you have any questions, please contact me at 252-7240.
Thank you.
Attachment
16E 3
COLLIER COUNTY FLORIDA
Renewal of Class "3" COCPN
This Permit is effective March 30,2021 and
Expires March 30,2022
Name of Service: North Collier Fire Control and Rescue District
Name of Owner: North Collier Fire Control and Rescue District
Principle Address of Service: 1885 Veterans Park Drive,Naples, FL 34109
Business Telephone: 239-597-3222
Description of Service: Non-Transport Advanced Life Support
Number of Ambulances: 25 Ground Units available.
See Application for Description of Vehicles
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Non-transport ALS Service to operate within the North.Collier Fire Control and
Rescue District response boundary and pursuant to the Collier County Fire Chiefs Local
Mutual Aid Agreement until the expiration date 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
applicable to North Collier Fire Control and Rescue District.
Issued and approved thisiday of aAc 2021.
ATTEST: BOA D OUNTY CO ISS ONERS
CRYSTAL K. KINZEL, CLERK COL OUNTY, FLO
All as to Chairmantteput lei Penny Taylo ; Chairman
S'n„: rn only,
Approved as to form and legality:
(`X.)(1
Je r A. Belpedi
Assistant County Att ey
O\
(2l-EMG-00462/1593653l1]
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