Backup Documents 12/13/2022 Item #16E 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 13 E 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.County Attorney Office County Attorney Office
YAk/, 12/I3/2Z
2. BCC Office Board of County
Commissioners /. 1 I 43/ZZ
3. Minutes and Records Clerk of Court's Office111/1
l R
4. Tabatha Butcher EMS
5.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Cherie DuBock Phone Number 239-252-3756
Contact/ Department
Agenda Date Item was 12/13/2022 Agenda Item Number 23951
Approved by the BCC 16, E.S
Type of Document COPCN permit and certificate 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? CD
2. Does the document need to be sent to another agency for additional signatures? If yes, CD
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be CD
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's CD
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 CD
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 CD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CD
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 12/13/2022(enter date)and all changes CD N/A is not
made during the meeting have been incorporated in the attached document. The an option for.
County Attorney's Office has reviewed the changes,if applicable, this line.
9. Initials of attorney verifying that the attached document is the version approved by the 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,Revised 2.24.05;Revised 11/30/12
16E5
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2023
Name of Service: Collier County Emergency Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway,Naples, Florida 34113
Business Telephone: (239)252-3740
Emergency Telephone: 9-1-1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24-hour duty: 26 ground units(ambulances)
Number of Ambulances on 12-hour duty: 2 ground units(as needed during season taken from reserve fleet).
Number of reserve Ambulances: 16
Number of non-transport ALS vehicles 13
Number of Medivac helicopter: 2
See attachment"A" for description of vehicles.
This permit, as provided in Ordinance 04-12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the
expiration date hereon, except that this permit may be revoked by the Board of County Commissioners of Collier
County at any time the service named herein shall fail to comply with any local, state or federal laws or regulation
applicable to the provision of Emergency Medical Services.
Issued and approved this I3 day of Detemjv , 2022.
ATTEST: BOARD O. `i NT :► MISS ONERS
Crystal K. Kinzel,CLERK C L I ' . ► Y, FLOR • lip!,
I I- Aar-
,._
., ds to C airman's , Deputy Clerk Willem L. McDaniel,Jr.,Chairman
Signath(�'�pOf)F; ,-:o_r orm & legality:
All t 1
Jeffrey . .tz• , County Attorney
[22-EMS-01 1 39/1 7 53943/1]
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