Backup Documents 01/24/2023 Item #16F 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP j 6 F 3
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.
2.
3. County Attorney Office County Attorney Office
JAK/fit, I/2.143
4. BCC Office Board of County
Commissioners IL by fi 3
5. Minutes and Records Clerk of Court's Office
1 VA.) 1125 lo:37om1
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 Kathy Heinrichsberg Phone Number 252-3622
Contact/ Department
Agenda Date Item was January'L4,2023 Agenda Item Number Minute Traq Item
Approved by the BCC 24218 IC. F.3
Type of Document Certificate and 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? KH
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAK
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 NA
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 NA
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 1/24/23 and all changes made during the KH N/A is not
meeting have been incorporated in the attached document. The County Attorney's 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.
Please return to Kathy Heinrichsberg after BMR Recording
l: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
16F3
COLLIER COUNTY FLORIDA
Class "2" COPCN
BLS Transfer
Name of Service: Care Med Transportation, LLC.
Name of Owner: Nerlyne Saintyl-Agenor
Principle Address of Service: 704 Goodlette Frank Road
Ste 240
Naples, FL 341102
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 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.
Issued and approved this 24th day of January 2023
ATTEST: K BOARD OF COUNTY COMMISSIONERS
CRYSTAL K.KINZEI; COLLIER COUNTY, FLORIDA
CLERK
(----2, ______
Deputy Clerk , ttest as to Chairman's Rick LoCastro, Chairman
signature only.
Appri ve s fo■.q and legality:
1
Jeffre I, . .tzkow, County Attorney
[I9-EMG-00436/15 10051/1]
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