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Agenda 12/14/2021 Item #16F 2 (Renewing the annual COPNC - Care Med Transportation, LLC)16. F.2 12/14/2021 Recommendation to renew the annual Certificate of Public Convenience and Necessity for non - emergency Class 2 - Basic Life Support (BLS) inter -facility ambulance transports to Care Med Transportation, LLC for the purpose of providing post -hospital and inter -facility medical ambulance transfer services. OBJECTIVE: To recommend the renewal of Certificate of Public Convenience and Necessity -Class 2, Basic Life Support (BLS) post -hospital, inter -facility ambulance transports to Care Med Transportation, LLC, hereinafter referred to as "Care Med." CONSIDERATIONS: A COPCN may be approved routinely by the Board as provided by Section 50- 60 of the Collier County Code of Laws and Ordinances governing medical transportation services. Care Med was granted a Certificate of Public Convenience and Necessity on February 25, 2020, by the Board and is to be renewed annually. Staff has deemed Care Med's renewal application as complete and recommends that the COPCN be renewed for one year. A BLS Class 2 operator provides post -hospital and inter -facility medical transfer services, both within and transports originating in -county to outside of the County. Section 50-60 of the Code of Laws and Ordinances provides: Each certificate holder shall file within 90 days of expiration, an application for renewal of his certificate. Renewals shall be based upon the same standards, as the granting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a $250.00 renewal fee. The renewal certificate may be approved routinely by the board, upon advice of the administrator, or the board may hold a hearing on same. These requirements have been met and the administrator recommends renewal. The Emergency Medical Authority reviewed the application on November loth. 2021, and by a majority vote recommends to the Board that the Certificate be renewed with three vehicles providing services. FISCAL IMPACT: There is no fiscal impact to the Board for the granting of this certificate. The Board is requested to accept and recognize as revenue in Fund (001) the $250.00 application fee with the corresponding application. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from this action. LEGAL CONSIDERATIONS: Regarding the consideration of this item, Section 50-57 of the Code of Laws and Ordinances states: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) That there is a public necessity for the service. In making such determination, the Board of County Commissions shall consider, as a minimum, the following factors: a. The extent to which the proposed service is needed to improve the overall Emergency Medical Services (EMS) capabilities of the County. Packet Pg. 2163 16. F.2 12/14/2021 b. The effect of the proposed service on existing services with respect to quality of service and cost of service. C. The effect of the proposed service on the overall cost of EMS service in the County. d. The effect of the proposed service on existing hospitals and other health care facilities. e. the effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. (2) That the applicant has sufficient knowledge and experience to properly operate the proposed service. (3) That, if applicable, there is an adequate revenue base for the proposed service. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area." This item is approved as to form and legality and requires a majority vote for Board approval. -JAB RECOMMENDATION: That the Board of County Commissioners: 1. Approve the Certificate of Public Convenience and Necessity for Care-Med Transportation LLC Inc. for up to (3) three Basic Life Support ambulances during the term of the permit. 2. Authorize the Chairman to execute the Permit and Certificate. 3. Approve a Budget Amendment to recognize and appropriate the $250.00 application fee. PREPARED BY: Dan E. Summers, Director, Bureau of Emergency Services ATTACHMENT(S) 1. Revised CareMed Application (EMA Recommended) (PDF) 2. Permit 2022 CAO Stamped (PDF) 3. Care Med VIN List (PDF) 4. Certificate Stamped (PDF) Packet Pg. 2164 16. F.2 12/14/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.17.2 Doe ID: 20744 Item Summary: Recommendation to renew the annual Certificate of Public Convenience and Necessity for non -emergency Class 2 — Basic Life Support (BLS) inter -facility ambulance transports to Care Med Transportation, LLC for the purpose of providing post -hospital and inter -facility medical ambulance transfer services. Meeting Date: 12/14/2021 Prepared by: Title: Executive Secretary — Emergency Management Name: Kathy Heinrichsberg 12/02/2021 1:50 PM Submitted by: Title: Division Director - Bureau of Emer Svc — Emergency Management Name: Daniel Summers 12/02/2021 1:50 PM Approved By: Review: Emergency Management Agenda Clerk Preview County Attorney's Office Office of Management and Budget Office of Management and Budget County Attorney's Office County Manager's Office Board of County Commissioners Daniel Summers Director Review Michael Cox Agenda Item Preview Jennifer Belpedio Level 2 Attorney of Record Review Debra Windsor Level 3 OMB Gatekeeper Review Laura Wells Additional Reviewer Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Amy Patterson Level 4 County Manager Review Geoffrey Willig Meeting Pending Completed 12/02/2021 2:07 PM Completed 12/03/2021 8:04 AM Completed 12/06/2021 10:50 AM Completed 12/06/2021 10:57 AM Completed 12/06/2021 1:25 PM Completed 12/06/2021 1:51 PM Completed 12/06/2021 3:02 PM 12/14/2021 9:00 AM Packet Pg. 2165 1 6.F.2.a Care Med Transportation CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY RENEWAL APPLICATION 2022-2023 FISCAL YEAR OCTOBER 20, 2021 CARE MEd TRANSPORTATION, LLC 740 Goodlette Frank Road, Suite 240, Naples, FL 34102 z U a 0 U CD U CD Pk Packet Pg. 2166 16.F.2.a Care Med Transportation, LLC INTRODUCTION Care Med is excited to renew its BLS license and continue providing safe, reliable, and efficient BLS transportation service to the Collier County community. Care Med has been licensed and certified to provide Basic Life Support ambulance service in Collier County by the Florida Department of Health since March of 2020. Care Med received its Certificate of Public Convenience and Necessity by the Collier County Board of Commissioners on February 24, 2021, and the effective expiration date is February 24, 2022. Care Med is compliant with Florida Statute 401 and Florida Administrative Code 64J in accordance with standards set forth by the Bureau of EMS and the Department of Health. Care Med is an approved Medicare provider and accepts most major insurance plans. We have seen a tremendous increase in transportation from last fiscal year. The positive trend has shown a great need for Care Med Transportation to continue to operate and serve Collier County residents. A copy of our state license is attached hereto as f Attachment A). Pursuant to Sec. 50-SS "Procedure for obtaining the COPCN," an applicant for a certificate shall provide the Administrator with the following information in order for a request for a certificate to be considered: (1) The name, age, and address of the owner of the ambulance or AL5 Operator, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more than 25% of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. OFFICERS Nerlyne Saintyl Agenor, RN, 43, 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Jean Marie Saintyl, CPA, 42, 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Evelyn Predelus, LCSW, M. Psych, 38, 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Vladimir J Mathieu, MD, 52, 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Owner -Founder Owner-CEO/CFO Director of Ops Medical Director Z V a 0 U m a� L R U v 0 N Page 1 1 Packet Pg. 2167 16.F.2.a Care Med Transportation, LLC (2) The boundaries of the territory desired to be served TERRITORY DESIRED TO SERVE Collier County, Florida z V a 0 U (3) The number and brief description of the ambulances or other vehicles the applicant will have -0 m available. a� L U AMBULANCES AND OTHER VEHICLES AVAILABLE o N Care Med Transportation has a total of 3 State licensed vehicles, they are licensed BLS vehicles. (4) The address of the intended headquarters and any substations. OFFICE LOCATION Care Med Transportation currently operates at: (See Attachment B) 704 Goodlette Frank Road Ste 240, Naples, FL 34102 (5) The training and experience of the applicant. TRAINING & EXPERIENCES Care Med Transportation believes that staff development is key to develop the knowledge, skills, and competencies of our staff. Our team of professionals stay abreast of new techniques, protocols, and policies. We have implemented BLS CPR course, Emergency Vehicle Operator Course, Infection Control, and ensure that all EMTs and Paramedics stay up to date with continuing education requirements. Care Med uses Department of Health board approved Continuing Education courses for our team. Page 1 2 Packet Pg. 2168 16.F.2.a Care Med Transportation, LLC (6) The names and addresses of three Collier County residents who will act as references for the applicant. COLLIER COUNTY REFERENCES Three (3) Collier County Residents to act as references: Duane Smith 3180 Beck Blvd, Naples, FL 34114 Kevin P Cairns 9940 Purple Martin Court, Naples, FL 34120 Kyle N. Williamson 4932 Rustic Oaks Circle, Naples FL 34105 (7) A schedule of rates which the service intends to charge. FEE SCHEDULE (See Attachment C for a schedule of fees charged) (8) Such other pertinent information as the administrator may require. Not Applicable (9) An application or renewal fee of $250.00. (Exception Collier County EMS). Check enclosed (10)Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. Year to Date financial statement enclosed as Attachment D Z 0 U m R U v v 0 N Page 1 3 Packet Pg. 2169 ,.i 4 j1E 16�. F.2. a �7i Qi a v a I > �. C a° tj CDCA n L Packet Pg. 2170 1 6.F.2.a Care Med Transportation, LLC Attachment 8 Permit Number Type Year Make Model VIN z v a 0 U 6053 BLS 2007 Ford E450 1FDXE45P37DA69129 m a� L 6054 BLS 2010 Ford E450 1FDXE4FP6ADA09870 C) v v r- 6460 1 BLS 20211 Dodge RAM Promaster I 3C6LRVDG6ME540223 CD N Packet Pg. 2171 1 6.F.2.a Care Med Transportation, LLC Attachment C le 0 N N C N E E O v N Q W C O r R v .Q a L V CD Nd LPL d E t V a Q Page 1 5 Packet Pg. 2172 1 6.F.2.a Care Med Transportation, LLC Attachment D Q Page 1 6 Packet Pg. 2173 16.F.2.a Care Med Transportation LLC Balance Sheet As of October 17, 2021 ASSETS Current Assets Bank Accounts Bank of America Checking - 4566 Bank of America Checking - 6906 Total Bank Accounts Accounts Receivable Accounts Receivable (A!R) Total Accounts Receivable Total Current Assets Fixed Assets Vehicles Total Vehicles Other Assets Total Other Assets Total Fixed Assets TOTAL ASSETS LIABILITIES AND EQUITY Liabilities Current Liabilities Credit Cards Bank of America Credit - 2092 Total Credit Cards Other Current Liabilities Due to Premier Tax Advising Group LLC Total Other Current Liabilities Total Current Liabilities Long -Term Liabilities Notes Payable Notes Payable - Ally Bank 2019 Dodge Caravan Notes Payable - E@L Notes Payable - Stryker Total Notes Payable Total Long -Term Liabilities Total Liabilities Equity Owner's Investment Retained Earnings Net Income Total Equity TOTAL LIABILITIES AND EQUITY Total Z 138,436.67 V a 100.00 V $ 138,536.67 d 100.426.00 c� $ 100,426.00 $ 238,962,67 0 N 156,236.74 $ 156,236.74 57,937.35 $ 57,937.35 E E $ 214,174.09 0 $ 453,136.76 W Q W C O R v .Q 19,730,90 Q $ 19,730.90 m d 5,353.23 V $ 5,353.23 $ 25,084.13 N m LY c 27.657.12 E 313.900.00 t v 19,821.00 r Q $ 361,578.12 $ 361, 578.12 $ 386,662.25 135.250.03 -80, 001.49 11,225, 97 $ 66,474.51 $ 453,136.76 Packet Pg. 2174 16.F.2.a ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDfYYYY) _ 11812021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement or this certificate does not confer rights to the certificate holder in lieu of such endorsement) PRODUCER CONTACT CCMSI NAME: Kaftlyn Atwell clo CLEAR SPRING PROPERTY & CASUALTY COMPANY PHONNQ � I: {217} 44Q.1124 fine No) E-MAIL 2 fast Main Street Ste 208 E-MAILADDRESS, katwell ccrosLcom Danville, IT. 61332 INSURERS AFFORDINGCOVERAGE NAIC# INSURER A: CLEAR SPRlNGPROPERTY&CASUALTY COMPANY 15563 INSURED KEY HR, LLC INSURER B : 605 E. ROBINSON ST., STE 500 INSURER C : ORLANDO, FL 32801 INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NI IIIARGI7• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ApDLSUBR POLICY NUMBER POLICY EFF POLICY EXP MMIDDlYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES fEa occurrence MED EXP (Any one person) i $ PERSONAL & ADV INJURY $ GEML AGGREGATE LIIAITAPPLIES PER: POLICY ❑ PROJECT ❑ LOC GENERAL AGGREGATE $ PRODUCTS - COMPlOPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 1 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY E PROPERTYDAMAGE Per accident $ $ — UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENT{ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPR[ETORIPARTIIPJIXECUTIVE ❑ OFFCERIMEM ER EXCLUDED? N7A WCSBK2400010004 11112021 11112022 _ X STATUTE I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Addifional Remarks Schedule, may be attached if more space is required) COVERAGE PROVIDED FOR ALL LEASED EMPLOYEES BUT NOT SUBCONTRACTORS OF: Care Med Transportation CLIENT EFFECTIVE: 1/1/2021 CERTIFICATE HOLDER CANCELLATION CARE MED TRANSPORTATION 3510 KRAFT ROAD STE 200 NAPLES, FL 34105 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �n Q�il�Q © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Packet Pg. 2175 16.F.2.a E F CERTIFICATE OF LIABILITY INSURANCE DA 411312021 YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZ REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endors, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME: Certificate Team -Fort Myers _ Acentria Insurance - Ft. Myers PHONE239-939-1010 FAX No :239-939-7172 CN E . 28 Barkley Circle E-MAIL Fort Myers FL 33907 ADDRESS: coifm@acentria.com INSURER(S) AFFORDING COVERAGE NAIC INSURER A: Western World Insurance INSURED UAHtMtu-uz Care Med Transportation LLC INSURER B 3510 Kraft Road INSURERC: Suite 200 INSURER D : Naples FL 34105 INSURERS: INSURER F : COVERAGES CERTIFICATE NUMBER. 1427679394 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TEi EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF INSURANCE A13DL SUBR POLICY NUMBER POLICY EFF MMIDWYYYY POLICY EXP MMlDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE C OCCUR NPP8791645 3/16/2021 3/16/2022 EACH OCCURRENCE S 1,000,000 DAMA N TED PREMISES i occurrence $ 100,000 MED EXP (Any one person) $ 5.000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 ❑ POLICY JE 0 toc X PRODUCTS - COMPIOP AGG $ 0 S OTHER: AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT Ea accdent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS P BODILY INJURY (Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident S UMBRELLALIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DIED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTEI ER E.L. EACH ACCIDENT $ ANYP90PRIETORlPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in Ni It Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability Aggregate 1,000,000 Deductible 250 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO THE EXPIRATION HATE THEREOF, NOTICE WILL BE DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. For Reference Only AUTHORIZED REPRESENTATIVE c � /-/ f4� (91968-2015 ACORD CORPORATI ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg. 2176 16.F.2.a AC I70 " CERTIFICATE OF LIABILITY INSURANCE DATE(MM12021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER?TF CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P01_ICII BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZI REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pOlicy(les) must be endorsed. If SUBROGATION IS WAIVED, subject tot terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to tl certificate holder In lieu of such endorsement(s). PRODUCER Rich Mathews StatE? Farm con AC NAME• Rich Mathews 9510 Corkscrew Palms Cir, PHONE 23 -992 &8 6 AtC= Nal: 23�91 Z9a StateF<�rrn Estero, FL 33928 ano s:alsa.►iveros.vac pnastatefarm.cam INSURERS AFFORDING COVERAGE Z NAIC S V INSURED are a ranspartatl0n INSURER A: State Farm Mutual Automobile Insurance Com an 5 8 O 3510 Kraft Rd. Suite 200 IN$URERB; - U ENSURER C_: 'O Naples, FL 34105 INSURER D ; _ INSURERE:` --- - -----� N 7 L INSURER F ; � COVERAGES CERTIFICATE NUMBER: V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENAMED ABOVE FOR THE POLICY PERIO INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI p CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PArn rI AILAc TYPE OF GENERAL LIABILITY MtRUML GENERAL LIABILITY CLAIMS.MADE I I OCCUR PEN'L AGGREGATE LIMIT APPLIES PER: A MOMOBILE LIABILITY ❑Y Y G909342-F1S.59 X ANY AUTO ALL OWNED X scTgOULED ASJros NON -OWNED X J02 8936-C25v9 G76 6319-E03-59H HIREDAUTOS x AUTQS UMBRELLA LIAR OCCUR EXCESS LIAR .,.... WORKERS COMPENSATION AND EMPLOYERS' LMILITY ANY PROPRIETORiPARTNERIEXECuTP/E YIN OFFICEIMEMBER E(CLUDED9 ❑ N 1A (Mandatwy rn NH) If yes, describe undef LIMITS � OCCURRENCE s PREMISES M accurr ._ $ MED EXP (Any one peraanl 3 PERSONAL 6 ADV INJURY j GENERAL AGGREGATE g PRODUCTS - COMPIOP AGG f i 06-16-2021 1 12-16-2021 09-25-2021 03-25-2022 LBODILY INJURY (Per persan) 11-03-2021 05-03-2022 BODILY INJURY (PCI aaddeat) DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101. Addltlanel Remarks Schadvie, ff more space Is p required) EACH E.L. EACH ACCIDENT E.L. DISEASE - EA EM LAIIATIN $ 1,000,000.01 E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY_ PRg1/LSIONS. ACORD 25 (2010105) '-ff1988-2010 ACI The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserve 1001486 1 Packet Pg. 2177 16.F.2.a '4 CERTIFICATE OF LIABILITY INSURANCE °o9/27/ THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Tk 7CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. INSURER(S), AUTHORIZI IMPORTANT: If the certificate holder Is an ADpITIONAL INSURED, the pollcy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to t terms and conditions of the policy, certain policies may require Certificate holder In lieu Of such endorsement(s). an endorsement. A statement on this certificate does not confer rights to t PRODUCER Rich Mathews State Farm CONTACT NAmz: Rich Mathews 9510 Corkscrew Palms Cir, #4 PHONE FAX 1Al No : 239- L 9 992-8896 ABC 9� SLTtefarm EMA Estero, F! 33928 I _- ADDRes i:efsa.nveros.vac_qpn statefarm.com INSURERS) AFFORDING COVERASE NAIL / Z V INSURED are a ransPOrtatI n INSURER NSURER A: State Farm Mutual Automobfie Insurance CBm an sus a o 3510 Kraft Rd. Suite 200 FNSURER B : V Naples, FL 34105 IIlsURERc: INSURER D A — —� INSURER E : — �— (D L r INSURER F : COVERAGES CERTIFICATE NUMBER: � V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIAMQO ABOVE FOR THE POLICY PERIO NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE CERTIFICATE � OR OTHER DOCUMENT WITH RESPECT TO WHICH THI MAY O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMf EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED N TR TYPE OF INSURANCE GENERALLIABILITY r L �� BY PAID CLAIMS. POLICY EFF POLfCY ErtP POLFCY efUMBER MMlOB - (MMM11) MERCUSL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR L AGGREGATE LIMIT APPLIES PER: POLICY PRO - F—iILOC A AUTOMOBILE IIABILrTy X ANY AUTO ALL OWNED AUTOS X SCHEDULED X - HIRED AUTOS X AUTOS NON -OWNED AUTOS I UMBRELLA LIAR OCCUR j EXCESS LU18 WORKERS COMPENSATION AND EMPLOYERS, LLABILRY ANY PROPRIETORIPARTNERIEXECUTIVE Y!N OFfICElMEMBEREXCLUDED? ❑ N! IMandatory In NH) Ir yea, de=ibe under EACH OCCURRENCE ; PREMISES (Ea q. nnca S MEO EXP (My one person) _ ~ PERSONAL f1 ADV INJURY $ GENERAL AGGREGATE PRODUCTS - COMPIOPAGG S t_a xddentl .. S J49 4299-Al2-59A 07-12 2021 01-12-2021 BODILY INJURY (Por person) $ 1,000,000 D176139-E03-59G 11-03-2021 05-03-2D22 BODILY INJURY (Per acddent) S t,06p,000 PR ERTY AMAGL Perectjden S 1,000,000 S EACH OCCURRENCE $ DESCRIPTION OF OPERATIONS! LOCATWNS r VEHICLES (Attach ACORD 101, Addhional Remarks Srh*dufe, Ninon spau Is requlred) E.L.EACHACCIDENT 3 E.L. DISEASE. EA EMPLO 3 — E.L. OFSEASF .. CM1I iry i user I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE wILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (20f0/0;s) / hts Deserved. W 1988.2010 ACORD TheORATION. All rigACORD name and logo are register Zt`rrlarks Of ACORD 1001486 1 Packet Pg. 2178 16.F.2.b COLLIER COUNTY FLORIDA Class "2" COPCN BLS Transport Name of Service: Care Med Transportation, LLC. Name of Owner: Nerlyne Saintyl-Agenor Principle Address of Service: 740 Goodlette Frank Road Ste 240 Naples, FL 34102 Business Telephone: 239-599-5606 Description of Service: Interfacility and out -of -county Basic Life Support BLS) transport for Collier County Number of Ambulances: Three 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 Class 2 Basic Life Support transports for a fee or charge for the following area(s): Collier County for one year from February 24, 2022, 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 ATTEST: CRYSTAL K. KINZEL CLERK , Deputy Clerk Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney 2021 BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA Penny Taylor, CHAIRMAN [19-EMG-00436/1510051/11 Packet Pg. 2179 1 6.F.2.c Care Med Transportation, LLC // o Attachment A 6053 1 BLS 60541 BLS 6460 1 BLS 2007 1 Ford 2010 1 Ford 2021 1 Dod E450 E450 1FDXE45P37DA69129 1FDXE4FP6ADA09870 RAM Prornaster 13C6LRVDG6ME540223 Q Page 14 Packet Pg. 2180 1 6.F.2.d rj -0 -� 0 0 a Co V C ¢ O CO0 O O N O0 Ce a 0 .N. w ° .� c CA z a� U c .'"� C O •O O. � a.' y fS. s W ci y 00 E F- U E c o :. ❑ wU E "a.Z. Y � �I •• � ccO W r Cd 55 �r > Q a N s � •o E^ � � a. E E••� o ; s o ro A O U M ° N o � ' ab � •. � oLn W �.. � � 0 C p � •p � O V � cd W � cd V G y E 3 �' c a��i E o°n c .n a� • ao'� $ a°' E U N N s y Co N .o, co E p _� s " N O. U ° `•� W .a U 1 W N Q Q Q W 3 3 3 ¢u in N N O N M iy O �y N N u- Cd w o V 0 �Q Packet Pg. 2181