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Agenda 09/27/2022 Item #16E 6 (Certificate of Public Convenience and Necessity for ALS non transport services for one year to the Greater Naples Fire Rescue District)09/27/2022 EXECUTIVE SUMMARY Recommendation to recommend a Certificate of Public Convenience and Necessity for Advanced Life Support (ALS) non-transport services for one year to the Greater Naples Fire Rescue District concurrent with the approval of an accompanying Interlocal Agreement (ILA) and authorize the Chairman to execute the ILA, Permit, and Certificate. OBJECTIVE: To execute an Interlocal Agreement for Advanced Life Support traditionally used with participating fire service organizations and authorize t he issuance of a Certificate of Public Convenience and Necessity (COPCN) to Greater Naples Fire Rescue District for Class 3 Advanced Life Support (“ALS”) non-transport services in Collier County for a period of one year with a staffing stipulation noted below. CONSIDERATIONS: Greater Naples Fire Rescue District has filed an application for a Certificate of Public Convenience and Necessity to operate ALS services within its district. Critical to the consistent delivery of pre -hospital care, Collier County Emergency Medical Services (EMS) further request an Interlocal Agreement for ALS be signed by both parties to ensure the highest level of quality assurance with its approved protocol and medical direction approved by the County’s Medical Director, Dr. Rob ert Tober. The Director of the Bureau of Emergency Services and the Chief of Collier EMS support awarding the COPCN for ALS services to Greater Naples. Greater Naples is striving for full ALS staffing from all stations or zones served by Greater Naples b y September 1st. 2023. Full ALS staffing is defined as (1) one fully qualified and equipped paramedic approved by the County Medical Director assigned to each station within the Greater Naples Fire Control and Rescue District 24 hours a day, 365 days per y ear. The Emergency Medical Authority has reviewed the application and at its July 13, 2022, meeting unanimously approved the application contingent upon an Interlocal Agreement between Collier County and Greater Naples outlining the provisions of the COP CN. If this item which includes a fully executed Advanced Life Support Interlocal Agreement and the Certificate of Public Necessity and permit is approved by the Board, the COPCN will commence on September 30, 2022, and expire on September 29, 2023. 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 General Fund (001) the $250.00 application fee with the corresponding application. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact. LEGAL CONSIDERATIONS: Ordinance 04-12 provides in relevant part as follows: 7. 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: 16.E.6 Packet Pg. 1612 09/27/2022 A. That there is a public necessity for the service. In making such determination, the Board of County Commissioners shall consider, as a minimum, the following factors: 1. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the County. 2. The effect of the proposed service on existing services with respect to quality of service and cost of service. 3. The effect of the proposed service on the overall cost of EMS service in the County. 4. The effect of the proposed service on existing hospitals and other health care facilities. 5. 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.” In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions because of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only. With that noted, this item is approved as to form and legality and requires a majority vote for approval. - JAK RECOMMENDATION: That the Board of County Commissioners: 1. Accepts the Director of the Bureau of Emergency Services findings. 2. Approves and authorizes the Chairman to execute a Permit and COPCN to Greater Naples Fire Control and Rescue District for ALS Non-Transport with the staffing stipulation as referenced above. 3. Approves and authorizes the Chairman to Execute an ALS Interlocal Agreement between Collier County and the Greater Naples Fire Control and Rescue District. Prepared by: Dan E. Summers, Director of Bureau of Emergency Services 16.E.6 Packet Pg. 1613 09/27/2022 ATTACHMENT(S) 1. GNFRD COPCN Application Revised 7 13 Revised (002) (PDF) 2. GNF Partially Executed ILA (003) (PDF) 3. Greater Naples Fire Rescue District COPCN Certificate CAO approved (PDF) 4. Permit Class 3 COCPN (PDF) 5. VIN List (PDF) 16.E.6 Packet Pg. 1614 09/27/2022 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.6 Doc ID: 23454 Item Summary: Recommendation to recommend a Certificate of Public Convenience and Necessity for Advanced Life Support (ALS) non-transport services for one year to the Greater Naples Fire Rescue District concurrent with the approval of an accompanying Interlocal Agreement (ILA) and authorize the Chairman to execute the ILA, Permit, and Certificate. Meeting Date: 09/27/2022 Prepared by: Title: Executive Secretary – Emergency Management Name: Kathy Heinrichsberg 09/21/2022 1:05 PM Submitted by: Title: Division Director - Bureau of Emer Svc – Emergency Management Name: Daniel Summers 09/21/2022 1:05 PM Approved By: Review: Emergency Management Daniel Summers Director Review Completed 09/21/2022 1:06 PM County Attorney's Office Geoffrey Willig Additional Reviewer Skipped 09/21/2022 3:03 PM Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/21/2022 3:09 PM Office of Management and Budget Susan Usher Additional Reviewer Completed 09/21/2022 3:17 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/21/2022 3:37 PM County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/21/2022 4:06 PM Board of County Commissioners Geoffrey Willig Meeting Pending 09/27/2022 9:00 AM 16.E.6 Packet Pg. 1615 GREATER NAPLES FIRE RESCUE DISTRICT Applicant for Certificate: Class 3 ALS Non-Transport ABSTRACT Please accept the following Class 3: ALS Non- Transport applicant for certificate per Collier County, FL Code of Ordinances, Chapter 50 - Emergency Services. Fire Chief: Nolan Sapp For: July 13, 2022, EMA Meeting 16.E.6.a Packet Pg. 1616 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) Table of Contents I. Introduction ……………………………………………………………………………………………………Page 3 II. Goals and Objectives ………………………………………………………………………………………Page 4 III. Collier County Code of Ordinances Section 50-55 …………………………………………..Pages 5-6 IV. Collier County Code of Ordinances Section 50-57 …………………………………………..Pages 7-8 V. Exhibit 1 – District Map …………………………………………………………………………………..Page 9 VI. Exhibit 2 – District Apparatus Availability ……………………………………………………….Page 10 VII. Exhibit 3 – 2020-2021 District Paramedic/EMT Training Hours ………………………Pages 11-25 VIII. Exhibit 4 - District Financials ………………………………………………………………………….Pages 26-33 IX. Exhibit 5 - Value Added through Data Analysis……………………………………………….Pages 34-37 X. References …………………………………………………………………………………………………….Page 38 XI. Appendix………………………………………………………………………………………………………..Pages 39-41 16.E.6.a Packet Pg. 1617 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 3 | Page Introduction A quality Emergency Medical System, as Williams (2006) purports, has foundational roots in the local government experience. The service provision(s) and how said service is implemented varies from locale-to-locale, with many opinions expressed on the optimal service model based on personal and political exposure/experiences. From a pragmatic standpoint, there is not a one model approach that fits every need, rather, “…local factors that determine” the proper EMS delivery method for a community (Williams, 2006). Furthering the EMS service provision and implementation dialogue, Kimmel and Persse (2015) assert that emergency medical systems throughout the years evolved from the philosophical base of load-and-go, to a system of highly integrated professionals employing advanced medical knowledge within the pre-hospital environment. In essence, EMS models evolve in relation to the practice of pre-hospital medicine for the one goal of providing good care. In providing “good care” for our Collier County citizenry, since 2015 through August 2021, the Greater Naples Fire Rescue District provided ALS Non-transport services throughout its jurisdictional boundaries and countywide as needed; moreover, it’s our continued intent to provide the highest caliber EMS basic and advanced life support Non-transport services in conjunction with our neighboring jurisdictions and Collier County EMS. With that said, please accept the following packet as confirmation for the Greater Naples Fire Rescue District to ascertain a Class 3: ALS Non-Transport certificate as specified within the Collier County, FL Code of Ordinances, Chapter 50 – Emergency Services. 16.E.6.a Packet Pg. 1618 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 4 | Page Goals and Objectives As Salonish and Allen purport (2018), key performance indicators (KPIs) provide organizations with a measurable demonstration on how effective (and in some cases efficient) an entity is achieving key objectives. These measures (i.e., KPIs) encompass the agencies divisions and activities undertaken to achieve the overall service mission. “In many cases, success is simply the repeated, periodic achievement of some level of an operational goal” (Salonish and Allen, February 21, 2018, JEMS 911). In an effort to ascertain said success, Greater Naples Fire Rescue supports and believes in the EMS Agenda 2050 mantra of a “people-centered vision” for the future of EMS. This includes collaborative networks and partnerships espousing evidenced-based, data-driven EMS systems, that is integrated within the nation’s healthcare system. Moreover, the aforementioned agenda properly aligns with the State of Florida Bureau of Emergency Medical Oversight’s Emergency Medical State Plan (2016-2021) of one vision including a unified EMS system “…that provides evidence-based prehospital care to the people of Florida” while becoming a recognized leader in the United States EMS system (EMS State Plan, Florida Department of Health). To measure the success for Greater Naples Fire Rescue, the following goals and objectives are presented in conjunction with our Class 3: ALS Non-Transport Certificate: 1. Enhance the community public benefit through adding value to the current EMS system: a. During CY 2022, continue providing travel times within our zones in under 8- minutes for 70-90% of the time (as shown in the three ‘Travel Time’ tables). 2. Strategically locate ALS Engines and Squads to augment the current EMS response system: a. During CYs 2022 and 2023, align our response metrics to include more squads in our rural stations to keep times under 12 minutes 90% of the time. b. Commence with a district-wide system deployment analysis to include a fixed vs. flexible and static vs. dynamic modeling exercise. 3. Enhance the EMS and Fire collaborative networks: a. Commence with monthly or quarterly stakeholder meetings to review training curriculum/protocols, community response metrics, and response data analytics. 4. Procure an updated EMS records management system (RMS) a. During CY 2022, procure an updated RMS platform that allows the District to monitor our EMS system performance measures. 5. Improve the quality, effectiveness, and efficiency of our EMS ALS response system: a. Follow the goals and objectives as outlined in # 1-4. 16.E.6.a Packet Pg. 1619 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 5 | Page Collier County, FL Code of Ordinances – Section 50-55. Procedure for Obtaining Certificate 1. The name, age, and address of the owner of the ambulance or ALS 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. a. Name: The Greater Naples Fire Rescue District b. Age: January 2015 – Florida Law - Chapter 2014-240 c. Address: Administrative Headquarters: 14575 Collier Blvd. Naples, FL. 34119 d. Board of Commissioners as of January 2022: i. Kevin Gerrity – Chairman ii. David Stedman – Vice Chairman iii. Al Duffy – Commissioner iv. Nick Biondo – Secretary v. Charlie Cottiers – Treasurer 2. The boundaries of the territory desired to be served. a. See Exhibit 1 – District Map 3. The number and brief description of the ambulances or other vehicles the applicant will have available. a. See Exhibit 2 – Apparatus Availability MS Excel Spreadsheet 4. The address of the intended headquarters and any substations. a. Headquarters: 14575 Collier Blvd., Naples, FL. 34119 b. Fire Station 20: 4798 Davis Blvd., Naples, FL. 34104 c. Fire Station 21: 11121 Tamiami Trail East., Naples, FL. 34113 d. Fire Station 22: 4375 Bayshore Drive., Naples, FL. 34112 e. Fire Station 23: 6055 Collier Blvd., Naples, FL. 34114 f. Fire Station 24: 2795 Airport Pulling Road North., Naples, FL. 34105 g. Fire Station 25: 3805 The Lords Way., Naples, FL. 34114 h. Fire Station 60: 201 Buckner Avenue., Everglades City, FL. 34139 i. Fire Station 61: 525 Newport Drive., Naples, FL. 34114 j. Fire Station 63: MM63 Interstate 75., Ochopee, FL. 34141 k. Fire Station 70: 4741 Golden Gate Parkway., Naples, FL. 34116 l. Fire Station 71: 100 13th Street SW., Naples, FL. 34117 m. Fire Station 72: 3820 Beck Blvd., Naples, FL. 34114 n. Fire Station 73: 14565 Collier Blvd., Naples, FL. 34119 o. Fire Station 75: 4590 Santa Barbara Blvd., Naples, FL. 34104 16.E.6.a Packet Pg. 1620 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 6 | Page p. Fire Station 76: 790 Logan Blvd., Naples, FL. 34119 q. Fire Station 90: 175 Capri Blvd., Naples, FL. 34113 5. The Training and experience of the applicant. a. Paramedic and EMT Training Hours 2020 through 2021 – See Exhibit 3 b. Applicant Experience: i. Working under the Class 1 Certificate of Collier County EMS from January 2015 through August 2021, GNFRD provided ALS Non-Transport services (currently 70 shift Paramedics) from the 15 aforementioned fire and EMS stations as stated in item #4 (exception is Station 25 as we are moving into said facility February 28, 2022). From 2015 – 2021, GNFRD’s apparatus with accompanying paramedics and EMT’s recorded 42,363 EMS/ALS Response Calls. This is how our agency enhances, adds value, and augments the entire countywide EMS/ALS response system- working in unison and sync with Collier County EMS and our neighboring agencies. With a finite amount of financial, capital, and personnel resources, one agency cannot supply the needed amount to handle the ALS and BLS response volume countywide. ii. Discussion on Exhibit 5 – Value Added through Data Analysis (2015-2021) 6. The names and addresses of three Collier Count residents who will act as references for the applicant. a. Jim and Eileen Craft., 3535 3rd Ave South. Naples, FL. 34117 b. Jeffrey Macasevich., 1885 Florida Club Drive Apt. 8305. Naples, FL. 34112 c. William Douglas., 600 Saint Andrews Blvd. Naples, FL. 34113 d. Barry and Marilyn Gerenstein., 7621 Garibaldi Ct. Naples, FL. 34114 7. A schedule of rates which the service intends to charge. a. There is no schedule of rates associated with our applicant request for a Class 3: ALS Non-Transport certificate. 8. Such other pertinent information as the administrator may require. a. Per Dan Summers’ March 3, 2022 E-mail, please see the new Appendix section. 9. An application or renewal fee of $250.00. a. Attached 10. Financial data including assets and liabilities of the operator. A schedule of debts encumbering any equipment shall be included. a. See Exhibit 4 – Various Balance Sheet Accounts as of 12/31/2021 and Loans/Leases as of May 12, 2021. 16.E.6.a Packet Pg. 1621 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 7 | Page Collier County, FL Code of Ordinances - Section 50-57. Requirement for board approval in granting certificate. 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 Commissioners 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. i. The proposed service is deemed a public necessity based on the past 7 successful years of participation in the County’s EMS/ALS program, and does improve the overall Collier County EMS capabilities as depicted within the longitudinal-trend data presented. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. i. The cost of service does not change as we are already providing ALS-Non Transport service (from January 2015 – August 2021); ii. The quality of service improves as our agency establishes future goals and objectives in alignment with Collier County EMS, EMS Agenda 2050, and the State of Florida’s Emergency Medical Services State Plan (2016-2021). c. The effect of the proposed service on the overall cost of EMS service in the county. i. NONE d. The effect of the proposed service on existing hospitals and other healthcare facilities. i. NONE 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 existing services. i. NONE 2. That the applicant has sufficient knowledge and experience to properly operate the proposed service. a. Please reference item #5, the “Applicant Experience,” on page 6. 16.E.6.a Packet Pg. 1622 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 8 | Page 3. That, if applicable, there is an adequate revenue base for the proposed service. a. The proposed revenue base has been, and currently is, built into the District’s annual budget revenue and expenditure streams. This includes personnel, training, and capital equipment needs to provide ALS-Non Transport services – FY’s 2015-current. 4. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. a. The current operational staffing roster consists of 190 front-line sworn personnel operating from 16 fire stations over a three-platoon/shift response platform. As shown in Exhibit 2, GNFRD has 18 various response-type apparatus to augment the current district-wide EMS response system. This particular EMS system has served the Collier County residents well for several decades in various iterations as fire districts merged through the years. b. As an additional note, regarding the wildland/urban interface call volume our agency experiences, EMS is not automatically dispatched on the call until requested by the respective agency (authority having jurisdiction). There are instances where our units/personnel are more than 20 minutes from any EMS assistance due to topography, geography, and travel distance; hence, our personnel provide medical assistance as needed until EMS safely arrives. 16.E.6.a Packet Pg. 1623 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 9 | Page 16.E.6.a Packet Pg. 1624 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 10 | Page Exhibit 2 - GNFRD Apparatus Availability (Staffing metric pre-ALS termination on December 2021) Apparatus Year/Make Model VIN State Plate # BLS/ALS Engine 20 2021 E-One Res Pumper 4EN6AHA84N YJ47 BLS Ladder 21 2015 Pierce Quantum 4P1BCAGF1F YB371 ALS-2 Squad 21 2009 Ford F-250 1FTSX21529E TB6019 ALS-2 Engine 22 2018 E One Res Pumper 4EN6AAA89J XL996 ALS-1 Engine 23 2018 E One Res Pumper 4EN6AAA87J YJ520 ALS-1 Engine 24 2009 Ferrera Ignitor 1F94047269H YI864 BLS Engine 25 2018 E One Res Pumper 4EN6AAA85J XL996 BLS Squad 25 2020 Ford F-250 1FT7X2B63LE YI860 ALS-2 Engine 60 2006 E One Tradition 1HTMKAZR6 236657 ALS-2 Engine 61 2006 E One Tradition 1HTMKAZR6 236656 ALS-1 Engine 63 2015 E One Cyclone II 4ENLAAA8XF YJ502 ALS - State Engine 70 2018 E One Res Pumper 4EN6AAA80J YJ519 BLS Engine 71 2018 E One Res Pumper 4EN6AAA82J YJ518 ALS-2 Ladder 72 2016 Pierce Enforcer 4P1BCAFF3G YB374 ALS-2 Engine 73 2017 E One Res Pumper 4EN6AHA81H YL995 ALS-1 Engine 75 2014 Pierce Saber 4P1BAHFF9E YB373 BLS Squad 76 2018 Ford F-250 1FT7W2B65J YN174 ALS-1 Engine 90 2005 E One Typhon 4ENRAAA805 227125 ALS-1 NOTE: See Appendix section for answer regarding differences in ALS1, ALS 2, and State units. 16.E.6.a Packet Pg. 1625 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 11 | Page EXHIBIT 3 2020 - 2021 Monthly Paramedic and EMT Training Curriculum and Hours 16.E.6.a Packet Pg. 1626 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 12 | Page Paramedic Hours EMT Hours January 2020 EMS Abdominal Trauma Advanced 1 EMS Acute Coronary Syndrome (Advanced) 1 EMS Epilepsy 1 EMS Acute Coronary Syndromes 1 EMS General Science (Advanced) 1 GN- SOG 101.19 District Identification and Medical Licensure 0.25 GN- OLAES BANDAGE INSTRUCTIONS 0.5 EMS Pediatric Assessment 1 GN- SOG 101.19 District Identification and Medical Licensure 0.25 EMS Pediatric Cardiac Emergencies (Basic) 1 EMS Assessing the Patient with Major Trauma 2 EMS Obstetrical Emergencies Advanced (2 hour) 2 EMS Acute Coronary Syndrome (Advanced) 1 EMS Carbon Monoxide Poisoning 1 EMS Altered Mental Status Advanced 1 EMS Poisoning and Overdose 1 ACLS - Advance Cardiac Life Support GN- OLAES BANDAGE INSTRUCTIONS 0.5 General Medical Training 4.5 EMS Altitude Emergencies 2 EMS Bariatric Patients 2 EMS Emergency Responder Rehabilitation for the EMT 1 EMS Bomb Blast Injuries Advanced 1 EMS Cardiac Emergencies Basic 1 EMS Child Abuse: An EMS Professionals Role & Responsibilities 1 EMS Operating an AED 1 EMS Asthma Part 1 1 EMS Slips, Trips and Falls 1 EMS Asthma Part 2 1 EMS Airway Management Basic 1 EMS Nose Bleeds (Advanced) 1 GN- OLAES Modular Bandage 0.5 EMS Patient Care Report Essentials (Advanced) 1 EMS Aquatic Emergencies 2 EMS Understanding and Restraining Patients with Excited Delirium (Advanced) 1 EMS Assessing the Patient with Major Trauma 2 EMS Complementary and Alternative Medicine (Advanced) 1 EMS Date Rape Drugs 2 EMS Stroke Assessment & Treatment (Advanced) 1 EMS Dementia 1 EMS Assessment, Treatment and Transport of Morbidly Obese Patients (Advanced) 1 EMS Geriatric Behavioral Emergencies 2 EMS Crime Scene Awareness 2 EMS Patient Abuse and Assault 2 EMS Toxicology and Substance Abuse Advanced 2 EMS Stroke Assessment & Treatment 1 EMS Allergic Reaction Management 1 EMS Allergies and Anaphylaxis Basic 1 EMS Altitude Emergencies 2 EMS Bariatric Patients 2 EMS Back Injury Prevention 1 EMS Bleeding and Shock Basic 1 16.E.6.a Packet Pg. 1627 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 13 | Page EMS Cervical Spine Injuries Part 1 (Advanced) 1 EMS Crime Scene Awareness 2 EMS Poisoning and Overdose 1 General Medical Training 1 EMS Acute Respiratory Distress Syndrome Advanced 1 EMS Cultural Diversity for EMS Providers 2 EMS Behavioral Emergencies Advanced 1 EMS Emergency Response to Terrorism (MOD #1) 1 EMS Behavioral Emergencies Basic 1 EMS Gunshot Wounds 2 EMS Medical Extrication & Rescue 2 EMS Pediatric Emergencies Basic 2 EMS Pediatric Airway Management Advanced 2 EMS Workplace Stress 1 EMS Patient Abuse and Assault 2 EMS Environmental Emergencies Basic 1 General Medical Training 1 EMS Abdominal Trauma Basic 1 EMS Geriatric Behavioral Emergencies 2 EMS Death and Dying 1 EMS Blind Nasotracheal Intubation 1 EMS Medical Extrication & Rescue 2 EMS Calcium Channel Blocker Overdose (Advanced) 1 EMS Allergic Reaction Management 1 EMS Pediatric Ingestions (Advanced) 1 EMS Driving Safety 1 GN- OLAES Modular Bandage 0.5 EMS Incident Command System 1 EMS Abdominal Trauma Basic 1 GN-MANGO Stroke Assessment 1 EMS Dementia 1 EMS Sudden Infant Death Syndrome (SIDS) 1 EMS Methamphetamine 2 EMS Pediatric Airway Management Advanced 2 EMS Nose Bleeds 1 EMS Back Injury Prevention 1 EMS Pediatric Fever for the Paramedic (Advanced) 1 56.25 EMS Allergies and Anaphylaxis Basic 1 EMS Mechanics of Breathing 1 EMS Acute Coronary Syndromes 1 EMS Aquatic Emergencies 2 EMS Pain Transmission, Perception, and Assessment (Advanced) 1 EMS Respiratory System A&P Review 1 EMS Amputation Injuries Advanced 1 EMS Carbon Monoxide Poisoning 1 EMS Respiratory Emergencies Advanced 1 EMS Respiratory Emergencies Basic 1 EMS Pediatric Assessment 1 60 16.E.6.a Packet Pg. 1628 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 14 | Page Paramedic Hours EMT Hours February 2020 EMS Non-Traumatic Chest Pain 1 EMS Abdominal Trauma Advanced 1 GN-MANGO Stroke Assessment 1 EMS Acute Respiratory Distress Syndrome Advanced 1 EMS The Human Body Part 1: Critical Systems 1 EMS Airway Management Advanced (2 hours) 2 EMS Myths and Realities of Drug Seeking Behavior (Basic) 1 EMS Confined-Space Awareness 1 EMS Renal Failure Advanced 1 EMS Allergies and Anaphylaxis Advanced 1 EMS Sepsis 1 EMS Response to Mass Casualty incidents 1 EMS TCA Overdose (Advanced) 1 EMS Asthma Part 1 1 EMS The Human Body Part 1: Critical Systems (Advanced) 1 EMS Infectious Disease Control 1 EMS The Human Body Part 2: Other Systems 1 EMS Sepsis 1 EMS Date Rape Drugs 2 EMS Burn Management Basic 1 EMS Airway Management Basic 1 EMS Geriatric Hip Injuries 1 EMS Heat Illness and Emergencies 1 EMS TCA Overdose 1 EMS The Human Body Part 2: Other Systems (Advanced) 1 EMS Altitude Illness 1 EMS Airway Management Advanced (2 hours) 2 EMS Altered Mental Status Advanced 1 EMS Allergies and Anaphylaxis Advanced 1 EMS Child Abuse: EMS Roles & Responsibilities 1 EMS Diet & Nutrition 1 EMS CNS Injuries Basic 1 EMS Gunshot Wounds 2 EMS Nose Bleeds 1 EMS Burn Management Advanced 2 EMS Femur Fractures 1 EMS Response to Mass Casualty Incidents (Advanced) 1 EMS Mechanics of Breathing 1 EMS Advanced Airways: Intubation and Beyond (2 hours) 2 EMS Pediatric Fever for the EMT 1 EMS Pelvic Fractures Advanced 1 EMS Methamphetamine 2 EMS Altitude Illness 1 23 EMS Altitude Illness (Advanced) 1 EMS Assessment and Treatment of Submersion Injuries 1 EMS Assessment and Treatment of Submersion Injuries (Advanced) 1 EMS Assessment, Treatment and Transport of Morbidly Obese Patients 1 16.E.6.a Packet Pg. 1629 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 15 | Page EMS Asthma Advanced 1 EMS Pharmacology Special Considerations (Advanced) 1 EMS Burn Management Basic 1 EMS Cardiac Emergencies Basic 1 EMS Cardiovascular Anatomy & Physiology Review 1 EMS HIV/AIDS Awareness 2 EMS Pharmacology Basic 1 EMS Bleeding and Shock Basic 1 EMS Intro to Arrhythmias: Escape Rhythms and Premature Complexes 1 EMS Neonatology Advanced 2 EMS Pediatric Shock Advanced (2 hours) 2 EMS Therapeutic Communications 2 EMS Child Abuse: An EMS Professionals Role & Responsibilities (Advanced) 1 EMS Death and Dying (Advanced) 1 EMS Emergency Responder Rehabilitation for the Paramedic (Advanced) 1 50 16.E.6.a Packet Pg. 1630 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 16 | Page Paramedic Hours EMT Hours March 2020 EMS Pediatric Burns Advanced 1 EMS Amputation Injuries Advanced 1 EMS Pediatric Trauma Advanced 2 EMS Behavioral Emergencies Basic 1 EMS Infectious Disease Control 1 EMS Cardiovascular Anatomy & Physiology Review 1 EMS Sepsis (Advanced) 1 EMS Narcotics Overdose for the EMT 1 EMS Cardiac Emergencies Advanced 1 EMS Pediatric Airway Management 1 EMS HIV/AIDS Awareness (Florida) 2 EMS Pediatric Ingestions (Advanced) 1 EMS Pediatric Assessment Part 1 1 EMS Supplemental Oxygen 1 EMS Supplemental Oxygen 1 EMS Understanding and Restraining Patients with Excited Delirium 1 EMS Environmental Emergencies Advanced 1 EMS Unstable Pelvic Fractures 1 EMS Bleeding and Shock Advanced 1 EMS Weapons of Mass Destruction - An Intro to WMD Agents 1 EMS CNS Injuries Advanced 1 EMS Assessment and Treatment of Submersion Injuries 1 EMS Head & Facial Injuries Advanced 1 EMS Ecstasy Abuse Management 1 EMS Pharmacology Advanced 2 EMS Hip Fractures 1 General Medical Training 0.5 EMS Hip Fractures (Advanced) 1 Medical Protocol Review 0.25 EMS Behavioral Emergencies Advanced 1 EMS Pediatric Airway Management 1 EMS Ethics for the EMS Provider (BLS) 1 EMS Pediatric Fever for the EMT 1 EMS HIV/AIDS Awareness (Florida) 2 EMS Pediatric Assessment Part 2 1 EMS The Human Body Part 1: Critical Systems 1 EMS Pediatric Emergencies Advanced 2 EMS Altitude Illness (Advanced) 1 Air-Q Advanced Airway Device 1 EMS Epilepsy 1 EMS Traumatic Head and Brain Injuries Advanced 2 EMS Common Infectious Pathogens 1 EMS Cultural Diversity for EMS Providers 2 EMS Detailed Physical Exam 1 EMS Pharmacology & Drug Administration 1 Medical Protocol Review 0.25 EMS Capnography 1 EMS Assessment, Treatment and Transport of Morbidly Obese Patients 1 EMS Narcotics Overdose for the EMT 1 EMS Poisons and Toxins Part 1 1 16.E.6.a Packet Pg. 1631 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 17 | Page EMS Pediatric Emergencies Basic 2 Air-Q Advanced Airway Device 1 EMS Sports Medicine for EMS 1 EMS Patient Assessment Basic 1 EMS CNS Injuries Basic 1 EMS Assessment and Treatment of Submersion Injuries (Advanced) 1 GN- N95 mask fit testing 0.5 EMS Pharmacology Special Considerations (Advanced) 1 EMS Introduction to Capnography (Advanced) 1 EMS Spinal Cord Injuries 2 GN- N95 Particulate Mask Usage- Covid-19 Response 2020 0.5 EMS Clinical Decision-Making 1 EMS Death and Dying 1 EMS Cyanide Poisoning 1 EMS Driving Safety 1 EMS Diet & Nutrition 1 EMS Hazard Communication 1 GN- N95 mask fit testing 0.5 EMS Health & Wellness 1 EMS The Human Body Part 2: Other Systems 1 EMS Pediatric Respiratory Emergencies: Lower Airway for the Paramedic (Advanced) 1 GN- N95 Particulate Mask Usage- Covid-19 Response 2020 0.5 EMS Thoracic Emergencies Advanced 1 EMS Pediatric Respiratory Emergencies: Upper Airway for the EMT 1 41.75 16.E.6.a Packet Pg. 1632 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 18 | Page Paramedic Hours EMT Hours April 2020 EMS Cyanide Poisoning (Advanced) 1 EMS Bleeding and Shock Advanced 1 EMS Obstetrical Emergencies Advanced (2 hour) 2 EMS Pediatric Assessment Part 1 1 EMS Pediatric Respiratory Emergencies: Upper Airway for the Paramedic (Advanced) 1 EMS Pediatric Assessment Part 2 1 EMS Spinal Cord Injuries 2 EMS Therapeutic Communications 2 EMS Femur Fractures 1 EMS Introduction to Hazardous Materials 2 EMS Grey Area Calls 1 EMS Special Challenges in Patient Assessment 2 EMS Introduction to Hazardous Materials 2 EMS Asthma Advanced 1 EMS Narcotics Overdose for the Paramedic (Advanced) 1 EMS Communication and Documentation 1 EMS Rapid Secondary Assessment 1 EMS Pain Management 1 EMS Pediatric Fluid and Airways (Advanced) 1 EMS Asthma Part 2 1 EMS Confined-Space Awareness 1 EMS Head & Facial Injuries Advanced 1 EMS Sudden Infant Death Syndrome (SIDS) 1 EMS Sports Medicine for EMS 1 EMS Understanding the Basics of ECGs 1 EMS Cervical Spine Injuries Part 1 (Advanced) 1 EMS Poisons and Toxins Part 1 1 EMS Protecting Yourself from Influenza 1 EMS Poisons and Toxins Part 2 1 EMS Environmental Emergencies Advanced 1 GN- Dr. Tober COVID-19 Asthma-COPD-Acute Decompensated Heart Failure (CHF) Discussion 0.5 EMS Advanced Airways: Intubation and Beyond (2 hours) 2 EMS Operating an AED 1 EMS HIV/AIDS Awareness 2 EMS Ecstasy Abuse Management 1 EMS CNS Injuries Advanced 1 EMS Intro to Arrhythmias: Tachy-arrhythmias and Fibrillation 1 EMS Suctioning the Patient Airway 1 EMS Clinical Decision-Making 1 GN- Dr. Tober COVID-19 Asthma-COPD-Acute Decompensated Heart Failure (CHF) Discussion 0.5 EMS Disease Conditions of Chronic Alcoholism (Advanced) 1 EMS H1N1 (Swine Flu) 1 EMS Managing Cardiac Arrest: During and After Resuscitation 2 EMS Kinematics of Trauma 1 EMS Emergency Responder Rehabilitation for the EMT 1 ACLS - Advance Cardiac Life Support 1 EMS H1N1 (Swine Flu) 1 EMS Musculoskeletal Injuries Basic 1 16.E.6.a Packet Pg. 1633 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 19 | Page GN- Dr. Lee COVID-19 Sepsis and Septic Shock Protocol 0.5 BLS HCP CPR 1 28 EMS Dementia (Advanced) 1 EMS Dementia: Overview, Assessment, and Care 1 EMS Health & Wellness 1 EMS Injuries and Infections of the Eye 1 EMS Complementary and Alternative Medicine (Basic) 1 Disease Conditions of Chronic Alcoholism (Advanced) 1 GN- Dr. Lee COVID-19 Sepsis and Septic Shock Protocol 0.5 36 16.E.6.a Packet Pg. 1634 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 20 | Page Paramedic Hours EMT Hours May 2020 EMS Special Challenges in Patient Assessment 2 EMS Rapid Secondary Assessment 1 EMS Ecstasy Abuse Management (Advanced) 1 EMS Death and Dying (Advanced) 1 EMS Communication and Documentation 1 EMS Medication Errors 1 EMS Environmental Emergencies Basic 1 EMS Fetal Trauma from Motor Vehicle Collisions (ALS) 1 EMS Dementia: Overview, Assessment, and Care 1 EMS Calcium Channel Blocker Overdose 1 EMS Emergency Care for Lightning Strike Victims (Advanced) 1 EMS Neonatology Advanced 2 EMS Emergency Response to Terrorism (MOD #1) 1 EMS Child Abuse: An EMS Professionals Role & Responsibilities 1 EMS Over the Counter Drug Overdoses (Advanced) 1 EMS Pediatric Burns Advanced 1 EMS Functional Approach to Physical Fitness for Emergency Responders 1 EMS Heat Illness and Emergencies 1 EMS Hematology 1 EMS Hazard Communication 1 EMS Kinematics of Trauma 1 EMS Poisons and Toxins Part 2 1 EMS Obstetrical Emergencies Basic 1 12 EMS Unstable Pelvic Fractures 1 EMS Workplace Stress 1 EMS Patient Assessment Basic 1 EMS Suctioning the Patient Airway 1 17 16.E.6.a Packet Pg. 1635 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 21 | Page Paramedic Hours EMT Hours Jun-20 EMS Musculoskeletal Injuries Basic 1 EMS Medical, Ethical, and Legal Issues 1 EMS Pediatric Cardiac Emergencies (Advanced) 1 EMS Respiratory System A&P Review 1 EMS Injuries and Infections of the Eye 1 EMS Traumatic Injury During Pregnancy 1 BLS HCP CPR 1 EMS Geriatric Emergencies Basic 1 EMS Musculoskeletal Injuries Advanced 1 EMS Functional Approach to Physical Fitness for Emergency Responders 1 EMS Shock and Shock Management 1 EMS Obstetrical Emergencies Basic 1 EMS Endocrine System Emergencies Advanced 2 EMS Respiratory Emergencies Basic 1 EMS Understanding and Restraining Patients with Excited Delirium 1 7 EMS Slips, Trips and Falls 1 EMS Thoracic Emergencies Basic 1 11 Jul-20 EMS Complete Resuscitation: Integrating Post-Care Advanced 2 EMS Thoracic Emergencies Basic 1 EMS Common Infectious Pathogens 1 EMS Understanding the Basics of ECGs 1 EMS Ethics for the EMS Provider (BLS) 1 EMS Burn Management Advanced 2 EMS Calcium Channel Blocker Overdose 1 EMS Geriatric Assessment Challenges 1 EMS Child Abuse: EMS Roles & Responsibilities 1 EMS Tracheostomies Advanced 2 EMS MRSA Infections 1 EMS Assessment, Treatment and Transport of Morbidly Obese Patients (Advanced) 1 EMS Fetal Trauma from Motor Vehicle Collisions (ALS) 1 EMS Shock and Shock Management 1 8 9 16.E.6.a Packet Pg. 1636 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 22 | Page Paramedic Hours EMT Hours Aug-20 EMS Myths and Realities of Drug Seeking Behavior (Advanced) 1 EMS Grey Area Calls 1 EMS Orotracheal Intubation 1 EMS Managing Multiple Casualty Incidents 1 EMS Weapons of Mass Destruction - An Intro to WMD Agents 1 EMS Blind Nasotracheal Intubation 1 EMS Emergency Response to Terrorism (MOD #2) 1 EMS Emergency Care for Lightning Strike Victims (Advanced) 1 EMS HIPAA Awareness 1 EMS Emergency Responder Rehabilitation for the Paramedic (Advanced) 1 5 EMS Non-Traumatic Abdominal Injuries 1 EMS MRSA Infections 1 EMS Ecstasy Abuse Management (Advanced) 1 EMS Hypothermia Assessment and Treatment (Advanced) 1 EMS Non-Traumatic Chest Pain 1 10 Sep-20 EMS Detailed Physical Exam 1 EMS Disease Conditions of Chronic Alcoholism (Advanced) 1 General Medical Training 2 1 3 16.E.6.a Packet Pg. 1637 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 23 | Page Paramedic Hours EMT Hours Oct-20 EMS Medical, Ethical, and Legal Issues 1 GN- EMS Level B Instructor Course 15 16 Nov-20 EMS Functional Communication for EMS Providers 2 GN - Air Ambulance Landing Zone and Safety 1.5 2 EMS Functional Communication for EMS Providers 2 3.5 Dec-20 EMS Emergency Care for Electrical Burns 1 1 16.E.6.a Packet Pg. 1638 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 24 | Page Jan-21 2021 January MD In-service Training COVID-19 Vaccine 1 2021 January MD In-service Training COVID-19 Vaccine 1 EMS Fundamentals of 12 Lead ECG Operation and Interpretation 1 1 EMS Intraosseous Infusion Advanced 1 3 Feb- 21 EMS Non-Traumatic Abdominal Injuries 1 EMS HIPAA Awareness 1 1 1 Mar- 21 Apr- 21 May- 21 GN- NAEMT- Tactical Emergency Casualty Care 16 16 Jun-21 EMS Dementia (Advanced) 1 1 Jul-21 GN - Binder Lift 0.5 GN - Binder Lift 0.5 GN- Manual Auscultation of Blood Pressure 0.5 GN- Manual Auscultation of Blood Pressure 0.5 1 1 Aug- 21 GN- Introduction to Clinical Priorities 1 GN- Introduction to Clinical Priorities 1 GN- Zoll Online X-Series Refresher 2021 1 GN- Zoll Online X-Series Refresher 2021 1 16.E.6.a Packet Pg. 1639 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 25 | Page General Medical Training 1.5 2 3.5 Sep- 21 EMS Child Abuse: An EMS Professionals Role & Responsibilities (Advanced) 1 1 Oct- 21 EMS Protecting Yourself from Influenza 1 1 Nov- 21 ALS Engine Academy - Respiratory 6 EMS Traumatic Head and Brain Injuries Advanced 2 ALS Engine Academy - Cardiology 6 EMS Pharmacology Basic 1 ALS Engine Academy - Environmental 6 ALS Engine Academy - Respiratory 6 18 ALS Engine Academy - Cardiology 6 ALS Engine Academy - Environmental 6 21 Dec- 21 ALS Engine Academy - General Medical 6 ALS Engine Academy - General Medical 6 ALS Engine Academy - Obstetrics / Gynecological 6 ALS Engine Academy - Obstetrics / Gynecological 6 ALS Engine Academy - Pediatrics 6 ALS Engine Academy - Pediatrics 6 ALS Engine Academy - Trauma 6 ALS Engine Academy - Trauma 6 EMS Emergency Care for Electrical Burns 1 EMS Capnography 1 25 EMS Pediatric Respiratory Emergencies: Upper Airway for the Paramedic (Advanced) 1 26 16.E.6.a Packet Pg. 1640 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 26 | Page Exhibit 4 Financial Data 16.E.6.a Packet Pg. 1641 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 27 | Page LOANS AND LEASES LOANS AND LEASES OPERATIONS FY - 21-22 IMPACT FY - 21-22 VENDOR PRINCIPAL INTEREST VENDOR PRINCIPAL INTEREST Bancorp -4 of 5 trucks 225,125.00 33,539.00 Bancorp -1 of 5 trucks 56,281.00 8,385.00 Iberiabank - HQ & Sta 73 307,966.00 40,396.00 Iberiabank - HQ & Sta 73 307,966.00 40,396.00 Station 70 4,200.00 0.00 Station 70 12,596.00 0.00 Bancorp -1 E-One Typhon 57,129.00 7,048.00 White Lake 362,000.00 79,512.00 Leasing 2 Inc. 234,430.00 64,569.00 Leasing 2 Inc. (1 of 5) #74 58,608.00 16,142.00 TOTAL 828,850.00 145,552.00 TOTAL 797,451.00 144,435.00 Principal Interest Total 293,038.00 80,711.00 GF 234,430.40 64,568.80 Impact 58,607.60 16,142.20 Note: Leasing 2, Inc., is a capital lease of 5 Trucks - 1 of these trucks uses Impact Fees (station #74). 16.E.6.a Packet Pg. 1642 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 28 | Page EXHIBITE PAYMENT SCHEDULE LESSEE: LEASE AMOUNT: COMMENCEMENT DATE: INTEREST RATE: Greater Naples Fire Rescue District S2,659,385.00 5/1512021 2.79% PAYMENT PURCHASE NO. DATE PAYMENT INTEREST PRINCIPAL 1 6/1512022 $373,749.62 $80,711.47 $293,038.15 $2,432,789.98 2 6/1512023 $373,749.62 $65,978.01 $307,771.61 $2,110,527.20 3 6/1512024 $373,749.62 $57,396.78 $316,352.84 $1,780,949.05 4 6/1512025 $373,749.62 $48,576.29 $325,173.33 $1,443,889.48 5 6/1512026 $373,749.62 $39,509.88 $334,239.74 $1,099,178.65 6 6/1512027 $1,113,000.00 $30,190.67 $1,082,809.33 $0.00 Grand Totals $2,981,748.10 $322,363.10 $2,659,385.00 LESSEE: By: Title: Fire Chief 16.E.6.a Packet Pg. 1643 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District 29 | Page Balance Sheet As of 12/31/2021 Greater Naples Fire Rescue District (GNF) Assets CASH IN BANK 10100-001-0000-004 HEALTH FUND (GNFRD) $ 47,684.42 10100-001-0001-002 OPERATIONS GENERAL FUND $ 28,828,393.07 10100-001-0003-003 PAYROLL CASH IN BANK $ 100,231.76 10100-001-0015-000 DEBT SERVICE RESERVE FUND $ 723,668.16 10100-001-0200-000 FIRST FLORIDA INTEGRITY BANK $ 2,106,205.41 Total CASH IN BANK: $ 31,806,182.82 CASH ON HAND 10200-001-0001-000 CASH ON HAND Total CASH ON HAND: $ 50.00 $ 50.00 $ 91,987.71 PREPAID Total DUE FROM OTHER FUNDS: $ 434,553.98 15500-001-0001-000 PREPAID INSURANCE $ 310,607.39 Total PREPAID: $ 310,607.39 Total Assets: $ 32,643,381.90 Liabilities VOUCHER PAYABLE 20100-001-0000-002 AFLAC - PRE TAX $ 10,889.21 20100-001-0000-003 AFLAC - POST TAX $ 5,119.41 20100-001-0000-006 EE CONTRIB TO DEF COMP - NW (457) $ 125.00 20100-001-0000-007 EE CONTRIB TO DEF COMP FL (457) $-250.00 20100-001-0000-009 EE ELECTIVE LIFE INS - STANDARD INS $-3,248.27 20100-001-0000-010 EE CONTRIBUTION TO FRS $-3.64 20100-001-0000-012 EE CONTRIB TO 175 RETIREMENT $ 35.26 20100-001-0000-013 FSA CONTRIBUTION $ 7,926.80 20100-001-0000-014 GARNISHMENT $ 544.46 20100-001-0000-017 EMPLOYEE LIABILITY TO DISTRICT $ 8,530.35 20100-001-0000-019 DISTRICT 457 NW MATCH $ 275.00 20100-001-0000-022 FSA Contributions from Prior Year $ 25,954.44 20100-001-0000-025 DISTRICT 457 FL MATCH $ 100.00 20100-001-0100-010 FRS ADJUSTMENT 2016-2020 $-1,907.27 20100-001-0100-012 175 ADJUSTMENT 2016 $-118.65 20100-001-0101-012 175 ADJUSTMENT 2017 $-154.16 20100-001-0102-012 175 ADJUSTMENT 2018 $-177.27 20100-001-0103-012 175 ADJUSTMENT 2019 $-172.45 20100-001-0104-012 175 ADJUSTMENT 2020 $-89.28 Total VOUCHER PAYABLE: $ 53,378.94 ACCRUED TAXES PAYABLE 21700-001-0000-001 PAYROLL W/H TAXES $-562.86 21700-001-0000-002 FICA TAXES $-293.41 Run Date: 1/31/2022 1:56:34PM Page: 1 G/L Date: 1/31/2022 ACCOUNTS RECEIVABLE 11500-001-0001-000 COLLIER COUNTY RECEIVABLE $ 18,974.67 11500-001-0003-000 EMPLOYEE RECEIVABLE $ 8,430.81 11500-001-0005-000 FEMA/GRANT RECEIVABLE $ 14,981.75 11500-001-0007-000 MISCELLANEOUS RECEIVABLE $ 49,440.48 11500-001-0011-000 RETURNED CHECKS $ 160.00 Total ACCOUNTS RECEIVABLE: DUE FROM OTHER FUNDS 13200-900-0001-001 DUE FROM MM63 FOR SET UP $ 175,000.00 13300-001-0000-001 DUE FROM M63 $ 259,553.98 16.E.6.a Packet Pg. 1644 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 30 | Page Balance Sheet As of 12/31/2021 Greater Naples Fire Rescue District (GNF) ACCRUED TAXES PAYABLE (Continued) 21700-001-0000-003 EMPLOYER SOCIAL SECURITY TAXES Total ACCRUED TAXES PAYABLE: $-293.42 $-1,149.69 OTHER CURRENT LIABILITIES 22900-001-0001-000 GRIT BANKRUPTCY DISBURSEMENT $ 11,229.65 Total OTHER CURRENT LIABILITIES: $ 11,229.65 Total Liabilities: $ 63,458.90 Equity PREPAID EXPENSES 27300-000-0000-001 PREPAID EXPENSES $ 603,223.61 Total PREPAID EXPENSES: $ 603,223.61 FUND BALANCE 28100-001-0000-000 FUND BALANCE - RESTRICTED $ 696,723.00 28400-001-0000-000 FUND BALANCE - UNASSIGNED $ 8,200,865.84 28400-001-0000-002 Retained Earnings-Current Year $ 20,878,240.49 28400-001-0000-002 FUND BALANCE CURRENT YEAR $ 2,200,870.06 Total FUND BALANCE: $ 31,976,699.39 Total Equity: $ 32,579,923.00 Total Liabilities & Equity: $ 32,643,381.90 Run Date: 1/31/2022 1:56:35PM Page: 2 G/L Date: 1/31/2022 16.E.6.a Packet Pg. 1645 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 31 | Page Balance Sheet As of 12/31/2021 GREATER NAPLES FIRE RESCUE DISTRICT (M63) Assets 10100-00000-0001-0001 STATION 63 GENERAL FUND $ 144,540.24 -002 11500-00000-0107-0000 STATE OF FLORIDA RECEIVABLE $ 387,228.42 -001 Total Assets: $ 531,768.66 Liabilities DUE TO OTHER FUNDS 20700-00000-0001-0000 DUE TO GREATER NAPLES FIRE RES DIST $ 259,553.98 -001 20700-00000-0001-0000 DUE TO GNFRD-LOAN TO SET UP CHECKING $ 175,000.00 -002 Total DUE TO OTHER FUNDS: $ 434,553.98 UNAVAILABLE REVENUE 20999-00000-0001-0000 UNAVAILABLE REVENUE MM63 $ 164,246.00 -000 Total UNAVAILABLE REVENUE: $ 164,246.00 Total Liabilities: $ 598,799.98 Equity 28400-00000-0001-0000 FUND BALANCE - UNASSIGNED--CURRENT YEAR $-72,311.47 -002 28400-00000-0001-0000 Retained Earnings-Current Year $ 5,280.15 -002 Total Equity: $-67,031.32 Total Liabilities & Equity: $ 531,768.66 Run Date: 1/31/2022 2:07:30PM Page: 1 G/L Date: 1/31/2022 16.E.6.a Packet Pg. 1646 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 32 | Page Balance Sheet As of 12/31/2021 Greater Naples Fire Rescue District (IMP) Assets 10100-301-0000-001 IMPACT FEES (IBERAIBANK) $ 7,664,222.51 Total Assets: $ 7,664,222.51 Equity 28100-301-0000-001 FUND BALANCE - IMPACT FEES PRIOR YEAR RESTRICTED $ 7,274,053.43 28100-301-0000-002 Retained Earnings-Current Year $ 24,284.90 28100-301-0000-002 FUND BALANCE IMPACT FEES CURRRENT YEAR $ 365,884.18 Total Equity: $ 7,664,222.51 Total Liabilities & Equity: $ 7,664,222.51 Run Date: 1/31/2022 2:02:51PM Page: 1 G/L Date: 1/31/2022 16.E.6.a Packet Pg. 1647 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 33 | Page Balance Sheet As of 12/31/2021 GNFRD Hydrant Fund (HYD) Assets 10100-101-0000-001 HYDRANT OPERATING ACCOUNT $ 618,412.88 Total Assets: $ 618,412.88 Equity 28200-101-0000-001 FUND BALANCE - HYDRANT ASSIGNED (PRIOR YTD) $ 594,690.13 28200-101-0000-003 Retained Earnings-Current Year $-238.75 28200-101-0000-003 FUND BALANCE-CURRENT YEAR $ 23,961.50 Total Equity: $ 618,412.88 Total Liabilities & Equity: $ 618,412.88 Run Date: 1/31/2022 2:04:21PM Page: 1 G/L Date: 1/31/2022 16.E.6.a Packet Pg. 1648 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 34 | Page Exhibit 5 Value Added through Data Analysis (January 2015- January 2021) 16.E.6.a Packet Pg. 1649 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 35 | Page All ALS Resources Travel Time- Time Enroute to Time Arrive on Scene Zone Under 4 Under 5 Under 6 Under 7 Under 8 Under 9 Under 10Under 11 Under 12 Over 12 1 45 66 78 86 91 93 95 96 97 3 2 40 61 77 86 91 94 95 96 96 4 20 33 56 74 84 91 94 96 96 97 3 21 38 55 71 83 90 94 96 96 97 3 22 34 60 81 91 96 97 98 98 98 2 23 22 37 52 66 77 85 91 94 96 4 24 22 45 66 81 88 93 96 97 98 2 25 20 35 51 66 78 87 91 94 95 5 40 35 57 76 89 95 98 99 99 99 1 42 31 49 67 82 89 94 96 98 98 2 43 17 38 62 79 89 94 97 98 99 1 44 38 59 77 89 95 97 99 99 99 1 45 48 65 78 88 94 97 98 99 99 1 46 40 58 75 86 93 96 98 99 99 1 48 16 36 63 80 89 93 96 98 99 1 50 55 71 82 89 93 95 96 96 97 3 70 29 50 67 79 86 91 94 95 96 4 73 16 36 58 73 84 90 94 97 98 2 75 23 43 62 77 86 92 94 95 96 4 76 21 38 57 75 85 92 95 97 98 2 90 37 48 58 71 82 90 95 97 98 2 10 20 34 46 57 68 76 84 89 93 7 30 37 56 70 80 87 90 93 94 95 5 31 29 49 65 74 82 86 89 91 92 8 32 11 21 33 45 55 63 69 73 79 21 60 24 33 39 44 50 55 60 66 69 31 71 16 27 37 47 56 64 71 78 84 16 Criteria - Within Date Range- 01012015-01012021 Emergency Calls Only. As defined and adopted from the consultant study. Fastest Arriving Unit Only. Responses from other arriving units are not considered. Must have an Enroute and Arrival Timestamp. Interval is the difference of Enroute to Arrival times by the second. 16.E.6.a Packet Pg. 1650 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 36 | Page All ALS Resources (GPS)Travel Time- Time Enroute to Time Arrive on Scene Zone Under 4 Under 5 Under 6 Under 7 Under 8 Under 9 Under 10Under 11 Under 12 Over 12 1 44 66 79 86 91 94 95 96 97 3 2 40 60 76 86 91 94 95 96 96 4 20 31 54 72 83 90 93 95 96 96 4 21 38 54 71 83 91 94 95 96 96 4 22 32 59 80 91 95 97 98 98 98 2 23 29 48 66 80 89 93 96 98 98 2 24 20 42 64 79 88 93 96 97 97 3 25 19 39 56 72 83 91 94 96 97 3 40 33 55 74 88 95 97 98 99 99 1 42 30 47 65 80 88 94 96 97 98 2 43 17 38 62 79 89 95 97 98 99 1 44 38 57 76 88 94 97 99 99 99 1 45 48 65 78 88 94 97 98 99 99 1 46 41 60 77 89 94 97 98 99 99 1 48 16 35 62 79 88 93 96 98 99 1 50 55 71 82 89 93 95 96 96 97 3 70 28 49 67 78 86 91 93 95 95 5 73 19 41 66 80 89 94 96 97 98 2 75 21 40 60 76 86 91 94 95 96 4 76 22 40 60 76 86 92 95 97 98 2 90 37 48 58 71 82 90 95 97 98 2 10 19 31 43 54 64 74 82 87 92 8 23 5 11 20 35 51 67 78 87 91 9 25 23 29 39 55 68 78 85 88 90 10 30 35 54 68 78 85 89 92 94 95 5 31 25 46 62 73 80 85 88 90 92 8 32 10 18 31 43 54 61 68 72 77 23 60 26 34 40 45 50 55 59 64 68 32 70 16 31 48 65 76 84 89 92 93 7 71 16 26 36 46 55 62 70 77 83 17 73 9 23 45 64 76 85 92 96 98 2 Criteria - Within Date Range- 01012015-01012021 Emergency Calls Only. As defined and adopted from the consultant study. Fastest Arriving Unit Only. Responses from other arriving units are not considered. Must have an Enroute and Arrival Timestamp. Interval is the difference of Enroute to Arrival times by the second. 16.E.6.a Packet Pg. 1651 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 37 | Page All EMS Resources (GPS)Travel Time- Time Enroute to Time Arrive on Scene Zone Under 4 Under 5 Under 6 Under 7 Under 8 Under 9 Under 10Under 11 Under 12 Over 12 1 44 66 79 86 91 94 95 96 97 3 2 39 60 76 85 91 94 95 96 96 4 20 31 54 72 83 90 93 95 96 96 4 21 37 54 71 83 90 94 95 96 96 4 22 26 51 73 86 92 94 95 96 96 4 23 29 48 66 80 89 93 96 98 98 2 24 17 36 58 73 83 90 94 95 96 4 25 19 39 56 72 83 91 94 96 97 3 40 21 41 61 78 88 93 95 96 97 3 42 20 34 50 66 77 83 88 91 93 7 43 10 25 45 62 74 83 88 92 94 6 44 24 41 58 73 83 90 93 95 95 5 45 13 22 38 60 78 88 92 95 96 4 46 30 47 64 77 86 91 94 95 96 4 48 10 25 49 67 77 83 89 92 94 6 50 42 60 74 82 88 90 92 94 94 6 70 28 49 67 78 86 91 93 95 95 5 73 17 37 60 74 85 90 94 95 96 4 75 21 40 61 76 86 92 94 95 96 4 76 22 40 58 75 85 91 94 96 97 3 90 25 37 46 58 69 79 86 92 94 6 10 13 23 33 43 54 64 74 81 87 13 23 5 11 20 35 51 67 78 86 91 9 25 22 29 39 55 68 79 85 88 90 10 30 35 54 68 78 85 89 92 94 95 5 31 25 46 63 73 81 85 89 90 92 8 32 10 19 32 43 54 61 68 72 77 23 60 26 34 40 45 50 55 60 65 68 32 70 16 30 48 65 76 84 89 91 93 7 71 16 26 36 46 55 62 69 77 83 17 73 8 20 42 60 73 83 90 94 96 4 Criteria - Within Date Range- 01012015-01012021 Emergency Calls Only. As defined and adopted from the consultant study. Fastest Arriving Unit Only. Responses from other arriving units are not considered. Must have an Enroute and Arrival Timestamp. Interval is the difference of Enroute to Arrival times by the second. 16.E.6.a Packet Pg. 1652 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 38 | Page References 1. Florida Department of Health Emergency Medical Services State Plan 2016-2021: https://www.floridahealth.gov/licensing-and-regulation/ems-system/ems-state-plan.html 2. Kimmel, K., and Persse, D., (2015). Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model. Health Care Current Reviews: 3(1). doi:http://dx.doi.org/10.4172/2375- 4273.1000138. 3. Salonish, M.J., and Allen, S.D., (2.21.2018). EMS Key Performance Indicators: What to Measure & Why. JEMS 911. 4. Williams, D.M., (2006, September). The Myth of the Perfect Model. EMSWORLD. 16.E.6.a Packet Pg. 1653 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 39 | Page Appendix “We have initiated our preliminary review of your COPCN Application for Class 3 Non-Transport and respectfully we are requesting clarification on the following,” (Dan Summers’ March 3, 2022, E-mail): 1. Medical Direction and Medical Director: Please provide more information and confirmation of who is providing your EMS medical program delivery and confirmation of who will be providing your direct physician medical director ALS engagement. We would appreciate a resume or CV of those individuals leading your program and confirmation of a contractual or employment arrangement. Answer: The Medical Director and Medical Direction is provided through the Office of Collier County Medical Director - Dr. Bob Tober. Effective April 26, 2021, GNFRD acquired the services of Dr. James Augustine to serve as Associate Medical Director – see attached contract, service scope, and CV. Dr. Augustine works under the Medical Direction command of Dr. Tober to assist GNFRD with implementation of protocols, standards, training, quality improvement, certification/re-certification standards, and planning for employee health and welfare. 2. Quality Assurance: Please detail on how and who will be responsible for your quality assurance efforts and how these efforts will work in conjunction with Collier County EMS. Your application references the purchase of new software for similar efforts. Please explain how that software will be available or interoperable with Collier County EMS and its Training Division. Answer: GNFRD - comprehensive Continuous Quality Improvement (CQI) program consists of the Associate Medical Director (Dr. James Augustine), Division Chief of EMS, Captain of Training, Lt. of Training. The goals include working with the county EMS providers and the county Medical Director to assure quality care is provided to all patients in accordance with Collier County Emergency Medical Services Protocols; ensures review of medical incident reports are performed for quality assurance and accuracy. The new software (Image Trend) allows GNFRD to customize its QA criteria, while allowing the County EMS training division full access and ability to review and provide input as needed. 3. Response times and dynamic modeling: Your application references EMS resources meeting an 8-minute response time, followed by plans to align your resources to 12 minutes. Please clarify the standard that Greater Naples will be implementing, versus the modeling exercise you are proposing. Answer: As EMS and Fire units are combined in the data sets on pages 35-37, GNFRD intends to continue meeting and further enhancing the ZONE response times as depicted in the 3 tables. As more GNFRD personnel/paramedics and ALS squads are placed into our rural zones, the goal is to have the “Time En Route to Time Arrive on Scene” zone fractiles increase into the 90% range; hence, decreasing response times as more units are strategically and properly placed in the EMS ALS system. 4. Previous Interlocal Agreement: Our ordinance requires the applicant to demonstrate the need for a certificate. Collier County EMS operating under State guidance enjoyed an interlocal agreement with Greater Naples for ALS services for many years. The agreement was terminated by Greater Naples. Please explain what the need is for a COPCN when a previous interlocal agreement was working successfully for many years. 16.E.6.a Packet Pg. 1654 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 40 | Page Answer: There is a need since the District is currently not providing ALS services and the current Board is electing not to provide the services until such time that it has its own COPCN. Section 191.008(1), F.S., authorizes the District to provide EMS services pursuant to chapter 401, F.S., and any COPCN issued thereunder. The District is not authorized to provide services without a COPCN. Under Section 163.01, F.S., local governments are authorized to enter into ILAs when they have like authority. Once the District receives its COPCN, it has stated that it will execute an ILA with the County. This approach is similar to the approach taken with North Collier Fire Control and Rescue District since 2016 and the approach currently being discussed between the County and City of Naples. Answer: Moreover, the longitudinal data provided (pages 35-37) supports the “need” argument as the data set(s) encompass not only EMS in-service units, but respective ALS fire department apparatus responding to EMS service calls. In essence, the fire departments properly augment the entire county-wide EMS response system, and removing the ALS fire response units from said data sets decrease Advanced Life Support delivery times. 5. Protocols: Please clarify or provide your ALS protocols or web link as we deem it relevant to ensure that your ALS protocols align with the Collier County EMS Medical Directors approved protocols. Answer: GNFRD has the 225-page Collier County EMS & Fire Department 2020-2022 Common Medical Protocol document posted on the District’s website under the Admin. Docs Tab which requires a password to access. In lieu of the link, attached is the actual document in pdf. format. 6. ALS Manning: Your application infers that all stations and all state-authorized vehicles will have ALS coverage. Please describe your level of ALS coverage for all zones and all apparatus listed. Will all of your ALS services be activated on the same day or will your services be gradually implemented? Are any “downing” of units anticipated due to staffing levels. Answer: The table on page 10 (Exhibit 2 GNFRD Apparatus Availability) depicts the current ALS/BLS apparatus status (e.g., Engine 20 that resides in Zone 20 is currently a BLS apparatus, and Engine 22 that resides in Zone 22 is a full-time, 24/7/365 ALS response engine). Prior to the ALS agreement being terminated by GNFRD, the District operated its ALS/BLS units as shown in Exhibit 2 – this was agreed upon between CC EMS and GNFRD based on overall county ALS service needs. In essence, on “day one” we are proposing to staff additional apparatus (e.g., E60 and E71) with Paramedics (see table below); hence, moving to an entire apparatus/district-wide ALS response posture remains a gradual implementation (depending on the FY 2021 SAFER grant submission, the staffing may occur sooner rather than later). Apparatus ALS Service “Day One” ZONE Engine 20 NO - BLS 20 Ladder 21 Paramedic dependent (ALS-2) 21 Squad 21 Paramedic dependent (ALS-2) 21 Engine 22 YES – ALS-1 (24/7/365) 22 Engine 23 YES – ALS-1 (24/7/365) 23 Engine 24 NO – BLS 24 Engine 25 Paramedic dependent (ALS-2) 25 Squad 70 Paramedic dependent (ALS-2) 70 Engine 60 YES – ALS-1 (24/7/365) 60:Enhancement to prior staffing 16.E.6.a Packet Pg. 1655 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 41 | Page Apparatus ALS Service “Day One” ZONE Engine 61 YES – ALS-1 (24/7/365) 61 Engine 63 YES - ALS – CCEMS Paramedic 63 Engine 70 Paramedic dependent (ALS-2) 70 Engine 71 YES- ALS-1 (24/7/365) 71: Enhancement to prior staffing Ladder 72 Paramedic dependent (ALS-2) 72 Engine 73 YES – ALS-1 (24/7/365) 73 Engine 75 NO – BLS 75 Squad 76 YES - ALS-1 (24/7/365) 76 Engine 90 YES - ALS-1 (24/7/365) 90 Engine 74 (future) YES – ALS -1 (24/7/365) 74:Enhancement to prior staffing Note: Engines 60, 71, and 74 are proposed to have full-time ALS staffing. 7. COPCN Application: On page 5 please remove the ages from the Board of Fire Commissioners roster and send us a replacement page. The ages noted in the ordinance are a scrivener’s error. a. Answer: Done - ages are deleted from page 5. 8. COPCN Application: On page 10, please provide the full vehicle identification number and verify your intentions to make all the listed vehicles and apparatus ALS. You may present this page in landscape format as needed. Please clarify what is referenced as ALS 1, ALS2, and “State” in the vehicle roster. Answer: ALS 1 – operational and staffed as an ALS unit 24/7/365 (includes calling in a paramedic on OT) ALS – 2 – operational and staffed with a paramedic as staffing allows (no OT as of today) State – This pertains to Rescue 63 which is licensed through CCEMS with a staff member from CCEMS providing the ALS (paramedic staffing). Answer: Exhibit 2 on page 10 is properly adjusted with a smaller font to accommodate the full VIN. Answer: As stated in item #6 – GNFRD intends to make all listed vehicles and apparatus ALS, and this happens in concert with continuing dialogue between GNFRD /CC EMS. 9. COPCN Application: On page 11 you provided a list of topics for Paramedic and EMT training. Please describe how the training is being delivered, the participation rate, and the minimum contact hours required by your organization. Answer: The training outline and topics provided with the application took place during the time the ILA was effective. A new plan for the next 2 years (see attached 2023-2024 pdf file) provides the delivery of training in the following ways: 1. Self-study via Target solutions platform; 2. Hands on training to coincide with CC EMS Medical Directors; 3. In-service and GNFRD monthly protocol topic as identified by the District’s Associate Medical Director; 4. Hands on training with the Associate Medical Director conducting in-service/face-to-face quarterly sessions. Answer: The state of Florida requires all certified EMT’s and Paramedics to complete 30 hours of CEU’s in a 2-year renewal cycle, 28 general- and 2 pediatric-related. GNFRD requires a 50-hour minimum in the same recertification period. 16.E.6.a Packet Pg. 1656 Attachment: GNFRD COPCN Application Revised 7 13 Revised (002) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1657 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1658 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1659 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1660 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1661 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1662 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.b Packet Pg. 1663 Attachment: GNF Partially Executed ILA (003) (23454 : Greater Naples Fire District CoPCN) 16.E.6.c Packet Pg. 1664 Attachment: Greater Naples Fire Rescue District COPCN Certificate CAO approved (23454 : Greater Naples Fire District CoPCN) 16.E.6.d Packet Pg. 1665 Attachment: Permit Class 3 COCPN (23454 : Greater Naples Fire District CoPCN) 16.E.6.e Packet Pg. 1666 Attachment: VIN List (23454 : Greater Naples Fire District CoPCN)