Backup Documents 05/25/2021 Item #16K3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 K 3
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 JAK 5/25/21
4. BCC Office Board of County 'VT"
Commissioners ,�44M 5 tP(Q'ai
5. Minutes and Records Clerk of Court's Office 5144 ki
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 Wanda Rodriguez,ACP Phone Number 252-8123
Contact/ Department Office of the County Attorney
Agenda Date Item was 5/25/21 Agenda Item Number 16-K-3
Approved by the BCC
Type of Document Resolution appointing a member to the Number of Original one
Attached Emergency Medical Authority Documents Attached
PO number or account N/A �� / t r�i
number if document is "'t
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?STAMP Ok N/A
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
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 N/A
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 JAK
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 JAK
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 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 5/25/21 and all changes made during the
meeting have been incorporated in the attached document. The County Attorney's JAK
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the 011
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
16K3
MEMORANDUM
Date: May 27, 2021
To: Wanda Rodriguez
Office of the County Attorney
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: Resolution 2021-104: Appointment to the
Emergency Medical Authority
Enclosed please find a scanned copy of the resolution (Agenda Item
#16K3) referenced above, approved by Board of County
Commissioners on Tuesday, May 25, 2021.
If you should have any questions, please contact me at 252-8411.
Thank you.
Enclosure
16K3
RESOLUTION NO. 2021 - 1 0 4
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, APPOINTING DANIEL JOHNSON TO
THE COLLIER COUNTY EMERGENCY MEDICAL AUTHORITY.
WHEREAS, on December 13,2016,the Board of County Commissioners adopted Ordinance No.
2016-44, establishing the Collier County Emergency Medical Authority ("Authority")from the formerly-
named Public Safety Authority, to address issues affecting pre-hospital emergency medical services in
Collier County; and
WHEREAS, Ordinance No. 2016-44 establishes the membership of the Authority as a five-
member citizens committee, with members having no affiliation with any hospital, fire district, EMS,
municipality,or the Collier County Sheriff's Office; and
WHEREAS,there is one current vacancy on the Authority; and
WHEREAS, the Board of County Commissioners has provided public notice soliciting
applications from interested parties;and
WHEREAS, the Authority has provided the Board of County Commissioners with its
recommendation for appointment.
NOW, THEREFORE,BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA, that DANIEL JOHNSON is hereby appointed to the Collier
County Emergency Medical Authority, to fill the remainder of a vacant term expiring on December 31,
2022.
THIS RESOLUTION ADOPTED upon majority vote on the 25th day of May, 2021.
®4, BOARD OF COUNTY COMMISSIONERS
CRYSTAL X,MilhEs Clerk COLLIER 0 TY, FLORIDA
A j
B ,�_____ By:
0,14;c 011)I3PaNy$Clerk Pe y'Taylor, air
signature only.
Approve• . to(F•rm and legality:
Jeffrey A. Gm, , County Attorney Agenda '.:44
I I Date •�Dee ( �
Rec
),:;),j+Cee k