Backup Documents 09/27/2022 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP I tiE*
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
** ROUTING SLIP**
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office i01'D'T
4. BCC Office Board of County
Commissioners (i p1 AA(/O f"s� Ib/7/Z 2
5. Minutes and Records Clerk of Court's Office `oj� �� /
existi-t,
PRIMARY CONTACT INFORMATION �L
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Kathy Heinrichsberg Phone Number 252-3622
Contact/Department
Agenda Date Item was September 27,2022 Agenda Item Number 16E5
Approved by the BCC
Type of Document(s) Certificate, Permit Number of Original 2
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature(instead of stamp)? KH
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legality. (All documents to be signed by KH
the Chairman, with the exception of most letters,must be reviewed and signed by the
Office of the County Attorney.)
4. All handwritten strike-through and revisions have been initialed by the County Attorney KH
Office and all other parties except the BCC Chairman and the Clerk to the Board.
5. The Chairman's signature line date has been entered as the date of BCC approval of the KH
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's KH
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KH
should be provided to the County Attorney Office at the time the item is uploaded to the
agenda. Some documents are time sensitive and require forwarding to Tallahassee within a
certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/27/22 and all changes made during the KH N/A is not
meeting have been incorporated in the attached document. The County Attorney an option for
Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the JAK N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05; 11/30/12;4/22/16;9/10/21
E
MEMORANDUM
Date: October 7, 2022
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Arm Jennejohn, Deputy Clerk
Minutes & Records Department
Re: CPOCN's: Ambitrans & Greater Naples Fire Rescue District
and Interlocal Agreement between the District and the County
Attached are original copies of the documents referenced above (Item #16E5 &
16E6), and a copy of the (unrecorded) Interlocal Agreement (Item #16E6) also
referenced above, approved by the Board of County Commissioners on
September 27, 2022.
Copies of the COPCN's will be held in the Minutes and Records Department for
the Board's Official Record. The Interlocal Agreement will be sent for recording
and a copy will be sent to you after is it is recorded.
If you have any questions, please call me at 252-8406.
Thank you.
Attachments
1 6 E 5
• COLLIER COUNTY FLORIDA
Renewal of Class "2" COPCN
Name of Service: Ambitrans Medical Transport, Inc.
Name of Owner: Michael and Lorraine Grant
Principle Address of Service: 4351 Pinnacle Street, Charlotte Harbor, FL 33980
Business Telephone: (941) 629-1009
Description of Service: Inter-facility and out-of-county transport for Collier County
Number of Ambulances: (31) Thirty-One (ALS ONLY)
See attachment "A" for description of vehicles.
This permit, as provided by Ordinance No. 2004-1 2, as amended, shall allow the above
named Ambulance Service to operate inter-facility and out of county transports for a fee
or charge for the following area(s): Collier County for one year from the date executed
hereon, except that this permit may be revoked by the Board of County Commissioners
of Collier County at any time the service named herein shall fail to comply with any
local, state or federal laws or regulation application to the provisions of Emergency
Medical Services.
el Issued and approved this ..,/ day of stets nber , 2022
ATTEST: .. BOARD OF UNTY COMMISSIONERS
CRYSTAL K.-KINZEL COLLIER TY,Pb(Z,RIDA
CLERK r ` ,
642 i
,�
't, p "714 ler Willi4tm L. McDaniel, Jr., Chairman
Ap v1 As torm and legality:
hit bk ''. - 7 alitAa3Z-C.
Assistant County Attorney
16
Ambulance# Vin Eff. Date ALS Permit BLS Permit
265 1 FDSS3ES 1 BDB27801 12/8/2011 17027 5212
266 1 FDSS3ES7BDB27804 12/8/2011 17026 5213
695 1 FDWE3FS6BDA87027 3/10/2015 20896 4821
601 1FDXE4FS2BDB29932 1/19/2016 19699 5220
606 1 FDXE4FS6CDA90604 7/5/2016 19956 5225
607 1FDXE4FS8BDB35783 7/5/2016 19957 5226
615 1FDWE3FS8BDA01958 10/25/2017 21048 5368
616 1 FDXE4FS0EDA55897 12/19/2018 22001 5692
617 1FDXE4FS2EDA55898 12/19/2018 22002 5693
618 1FDXE4FSOGDC00665 2/5/2020 22759 6007
619 1FDXE4FS2GDC00666 2/5/2020 22760 6008
620 1FDXE4FS8GDC04320 6/29/2020 23009 6112
621 1 FDXE4FSXGDC04321 6/29/2020 23010 6113
623 1FDWE3FSXDDA26427 2/18/2021 23547 6317
624 1 FDXE4FS5DDA34901 2/18/2021 23548 6318
625 1 FDXE4FS2EDA12033 6/15/2021 23784 6385
626 1 FDXE4FN3NDC07228 9/13/2021 23948 6455
327 306LRV0G0ME507993 9/13/2021 23949 6456
328 3C6MRVJG4ME545168 9/13/2021 23950 6457
359 1FDSS3ES6ADA31208 2/15/2010 20880 4678
364 1 FDSS3ES7BDB27799 12/8/2011 20883 4777
371 1FDSS3ES3CDA18371 3/29/2012 20885 4832
372 1FDSS3ES5CDA18372 3/29/2012 20886 4954
374 1FDSS3ESODDA41561 4/10/2013 20888 4956
379 1 FDSS3ES8DDB02266 7/23/2013 20889 4776
381 1FDSS3ES9EDA22265 3/10/2015 20890 4823
709 1FDWE3FS4ADA62447 3/8/2017 20891 5119
712 1 FDWE3FS5ADA20885 3/8/2017 20892 5120
714 1 FDWE3FS7ADA20886 3/8/2017 20893 5121
722 1FDXE4FS5EDA77930 2/15/2021 23534 6312
729 1FDWE3FS1JDC23238 3/16/2022 24293 6672
Exhibit"A"
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