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EMA Agenda 12/14/202215.A.3 COLLIER COUNTY EMERGENCY MEDICAL AUTHORITY (EMA) AGENDA December 14, 2022— Wednesday 9:30ann 3299 Tamiami Trail, Bldg F 5th Floor IT Training Room 1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE 2. AGENDA AND MINUTES a. Approval of Today's Agenda b. Approval of the November 9, 2022, Meeting Minutes 3. OLD BUSINESS a. Performance Measures Update 4. NEW BUSINESS a. North Collier COPCN Renewal Application b. Care Med COPCN Renewal Application c. Year End Letter to BCC 5. FIRE SERVICE DISCUSSION 6. STAFF REPORTS 7. PUBLIC COMMENT 8. BOARD MEMBER DISCUSSION 9. NEXT MEETING DATE a. January 11, 2023 10. ADJOURNMENT Packet Pg. 292 15.A.3 COLLIER COUNTY FIRE & EMS CHIEFS' ASSOCIATION, INC. 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I I �'Cov ltry 4iE1• j � tDUr i1f i i .F!sth aAr 1t C-OiAtiv-f Cte„ Moorings Gplf� Wild s1 11:-i :•ILL z I 'f i U� k Nnpisa Beach Golf G::ib th swe. N P {� G Packet Pg. 315 15.A.3 alt & Gauntry j !' C�+urrtry Club_ G. N x Club N O N East Naples ' L m Davis Blvd -- —. _. Davls.ftYJ E t2-0'. _ I rji rJ D WWW YF-dt er' Galt Club 3: The Glo-dasOLI I i3f Gull � CilutnwiiLU I � Adklna:� ,fe__ -.,Ir'rf ,wrk :. II SiUilf@Idr�#� - II N Ljt Re l til Park 7harifasIra* Rani[: frak fiamrnork.R. i C ill+t4CU!i �q+" rJ Lely Q Packet Pg. 316 15.A.3 Celand Carnestown Ochopee, Everglades City Fakahatcheo Cho%Pskoo Ten Thousand cur�.�, I sra�7as Tan Thoasand Islands Key (Iffflll; i!fjn Crass a� �a Y v m d L E d u 0 c (1) m u Q Packet Pg. 317 15.A.3 s ----H � apa VYe4ds-WAg- -�_-- -,---_---BpKyraod-ih'ag—_:_ -. Aw BW___liIh Tmlistwand Wal -- Y-- I I 9cuWas.Wag 9�-- _:-HbirirrPn-nods-t5fs j i—_iSthAvsSWL--i5th Av +W n. Blvd 3_—t�k�msta Blvd_ Srean -BlvdiIt i0h Ca) fiW Ttbtii p SIN ' {- r,.. 1 lift Avg SW Vsr� �v* #I I I ,, �, I ,;j III I ii I - � I, '. I � •-. _C�Pas ait.L.n- �Ilil it IAck ,.4 Golden Gate)_-..- -=�.�_l �� -..:,. .. � f � � I•Fr IL _ il_ _ ]G go J • i I I I f 2 __ _ �I I it I I'2� llli—ll �3rdArcBw -l� - t � - ilt 0 E _ iC{ s.3 ilj IS (t mom Packet Pg. 318 15.A.3 Lake TraflRord InifltoknIoe- Rd 4 Q- u trn`m�kal Regional Mporl Immakai Gui"y R*Aid 844 Bd6 8 Hecker Y j y Ave Marla n �i C Rom Packet Pg. 319 15.A.3 Isles Capri ISIOS of Gapn cwwmw 4a . 11"Way { Bch Gatf Smokehouse= g say 'rMarco Island rt� rg , s tzkurf �. �p�`,� i I San M *ron Rd i r Char'1 Q Packet Pg. 3 0771 15.A.3 -4 r+4+r.reo anita Bhores ' z Springs Sonlia Beach Rd 99 Ene Club 3'a � ya, F, _ sp7R19h walig MorlilorTa I - — — - N j O Club at IWIY psrk:Ou'! os+all Wext onit '. Ciub a C-Ounlry Cwb r 4� I e Vrd+t,4 A•vl'^1. 3s.y r1 I' 777 6 r "JO sit '. � C�ffuli C440k � eauP Strnnl 4unGY Cit+l = _ « fmrotlil Golf W O D. Ewa- Ewa-C.Q �It �►� 2 Country t7111l1 'a ar Gild Cattier Q04f Palm River Naples Park Itnmsakalee Rd- _.. _ — Imm of liutw PI r s a O < E ;, m {` ( RA Csrtctr t:�r r try t: •. ' ApanMh.brka LA tcu { I Goff Out 'i fl RB�iUII .i' fl•'i � Y�ik A� ri illit 1VVr K tl Twuwn PyCali i � r i a[w-a�y Oaks OrrClu i Cluk ✓+� �' _ �1a_z � ' k�4 1 � I' ,tIIt ftearh Rd - — e sa e Chefty wo" DI 71b A �'! d silohorywoadof —•itM� 5 la owl" mad as !td 10 Pelican BOy + R# to" ok SO Ac eMr u .Wood > o .14WtliM r+ d Vine ards Y tom! Q North 'Naples I: t>,.naa►.ad�� ' 1 i _�rrrl m a Ir 4, 90111194I40*•ta --- _ a4- I i : � tiettMttra(�II i.a �( � t sd+•a Pima Ri� 9 -.- - Packet Pg. 321 15.A.3 November 21, 2022 HAND DELIVERED Amy Patterson, County Manager Collier County 3299 Tamiami Trail East Naples, Florida 34112 Re: Certificate of Public Convenience and Necessity (COPCN) Renewal Application Dear Ms. Patterson: Pursuant to Collier County Ordinance 81-75, please consider this correspondence as the District's application to renew its Class 3 Advanced Life Support (ALS) non -transport Certificate of Public request Convenience and Necessity (COPCN). Enclosed please find a check in the amount of $250.00 towards the renewal fee, the names of the District's Board of Fire Commissioners, (Attachment "A"), a list of the District's Apparatuses (Attachment "B"), and references (Attachment "C"). The District has continued to provide high quality ALS Non -Transport services. The District also continues to participate in the Collier County Non -Transport Quality Assurance Committee, the Collier County Fire/EMS Chiefs Protocol Sub -Committee, and communication with Dr. Tober and Dr. Lee. I hereby respectfully request the approval of the District's application to renew its COPCN. If you have any questions reference this matter, please feel free to contact my office at your convenience, �Sincerely, Eloy Ricardo Fire Chief cc: Dan E. Summers, Director, Bureau of Emergency Services Tabatha Butcher, Chief, Emergency Medical Services Enclosure NORTH COLLIER FIRE CONTROL AND RESCUE DISTRICT 1885 Veterans Park Drive Naples, FL 34109 . (239) 597-3222 . northcollierflre.com FIRE CHIEF ELOY RICARDO BOARD OF FIRE COMMISSIONERS M. James Burke . Christopher Crossan .James A. Calamari . Norman E. Feder . J. Christopher Lombardo Packet Pg. 322 15.A.3 i 1. M. James Burke 1885 Veterans Park Drive Naples, Florida 34109 2. James Calamari 1885 Veterans Park Drive Naples, Florida 34109 3. Christopher Crossan 1885 Veterans Park Drive Naples, Florida 34120 4. Norman E. Feder 1885 Veterans Park Drive Naples, Florida 34109 5. J. Christopher Lombardo 1885 Veterans Park Drive Naples, Florida 34109 Attachment "A" Packet Pg. 323 15.A.3 District Vehicles 2010 ierceQuantum 4PICUOIE3AA010553 2002 Pierce uantum 4PICT02SO2AO02256 12004 ierce uantum P1CT02S93A003679 ord F450 IFDAF56P95ED24543 F13 ord F350 1FT8W3BT6CEC56211 ierce EL P1CJOIA8EA014108 Pierce RMPEL 4P1CJOIA8EA014125 2006 Pierce Quantum 4P 1 CUOI S36A006032 2005 Pierce Contender 4PICCOlM65AO04732 2016 Pierce Pumper 4PIBAAFF7GA015968 2013 Ford F550 IFDOX5HTXDEA80905 2015 Ford F550 IFDOX5HT2FEB71542 2006 SUTPHEN S2 1S9A1BLD261003097 016 Pierce Quantum 4P1BAAFF5HAO17350 2016 Pierce QuantumY 4PIBAAFF9HAOI7349 2017 Pierce IMPEL 4PIBAAFF7RAOI87379 2017 Pierce VELOCITY 4PIBCAGFXRA017417 2017 Pierce LOCITY 4PIBCAGFlJA019828 2005 _ Intemational MEDTEC IHTMNAAM67H460580 2017 Ford -450 1FDUF4GTXHDA02636 2017 Ford -450 1FDUF4GT4HEC04205 2017 Ford -450 1FDUF4GT1HDA02637 1998 Pierce Quantum 4PICT02SSWA000816 1998 Pierce Quantum 4PICT02SIWA000604 1998 Pierce Quantum 4PICT02S4WA000600 2013 Ford IF250 1FT7W2B69DEA80904 2021 Braun mbulance 1FDUF4GTS MG78994 Attachment "B" E w ti v N as a� �a 0 a as E 0 u as 0 c w E M u Q Packet Pg. 324 REFERENCES 1. Michael Reagen 10391 Regent Circle Naples, Florida 34109 2. Ramon Chao 164 Flame Vine Drive Naples, Florida 34110 3. Reg Buxton 1885 Veterans Park Drive Naples, Florida 34109 Attachment "C" Packet Pg. 325 NORTH COLLIER FIRE CONTROL DISTRICT 15.A.3 7 3 9 P 1-1 CLR CO BRD COMM Collier Co. Board of Co. Commi 00000000000057084 11/16/2022 00000000000103072 COPCN 2023 11/16/2022 $250.00 $250.00 $0,00 $0.00 NORTH COLLIER FIRE CONTROL DISTRICT 1885 VETERANS PARK DRIVE NAPLES, FL 34109 PAY Two Hundred Fifty Dollars and 00 Cents TO THE ORDER OF Collier Co. Board of Co. Commi PO BOX 413016 Naples F1 34101-3016 $250.00 $250.00 $0.00 $0.00 FIRST HORIZON 26-2/840 DATE 11/16/2022 W/%I'�� $250A $250.0 s 7398 a AMOUNT $250.00 W AUTHORIZED SIGNATURE y �a v r0 7 3 98 WO 40840000264 200 L00 5 4 3 4v a L E d U 0 E m U Q Packet Pg. 326 15.A.3 RECENED Nov 1 5 2022 Collier County Care Med CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY APPLICATION FOR COLLIER COUNTY BLS RENEWAL 2023-2024 FISCAL YEAR NOVEMBER 9, 2022 CARE MED TRANSPORTATION, LLC 704 Goodlette-Frank Rd, Suite 240, Naples, FL 34102 w a� �a U a L E d U 0 E m U Q Packet Pg. 327 15.A.3 44;p Care Med T r a n s p o r t a t i oil Non -Emergency BLS Interfacility Transfer Ambulance Services 704 Goodlette-Frank Rd, Suite 240 Naples, FL 34102 Office: (239) 599-5606 Fax: (239) 599-5607 ATTACHMENTS: Page 1: Introduction Page 2: Officers Page 3: Territory to Be served and BLS Service License Page 4: Ambulance List PAge 5: Office Location Page 6:Training and Experience Page 7: 3 Letters of Support from Community Page 8: Fee Schedule and Balance Sheet Page 9: Certificate of Insurance Page 10: Letter from CEO Page 11: Check for COPCN Renewal Packet Pg. 328771 15.A.3 INTRODUCTION Care Med is excited to apply for the renewal of its 3rd BLS COPCN for non -emergency interfacility transport which expires on February 24, 2022. Care Med would also like to take this opportunity to introduce its upcoming new application for the ALS COPCN for non -emergency interfacility transports in a separate application, which will be submitted to Director Summers. Care Med continues to provide safe, reliable, and efficient BLS non -emergency interfacility transport services to the Collier County community. Care Med has been licensed to provide Basic Life Support non -emergency interfacility ambulance services in Collier County by the Florida Department of Health since March 2020. Care Med received its first BLS Certificate of Public Convenience and Necessity from the Collier County Board of Commissioners in February 2020, since then Care Med has been readily available to serve the Collier County community. Care Med was founded in March 2014 as a regular wheelchair and stretcher van, which grew to become the 3rd ambulance company in Collier county to serve and provide a much needed service with much integrity and compassion. Care Med complies 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 the need for our services as an ambulance company in Collier county. 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 (Attachment A). Page 1 Packet Pg. 329 15.A.3 OFFICERS Nerlyne Saintyl Agenor, RN, 44 Owner-Founder/CEO 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Jean Marie Saintyl, CPA, 43 Owner -CFO 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Dr. Vladimir J Mathieu, MD, 53 Medical Director 704 Goodlette Frank Road Ste 240, Naples, FL 34102 Page 2 Packet Pg. 330 15.A.3 TERRITORY DESIRED TO SERVE Collier County, Florida E W Page 3 Packet Pg. 331 (ZZOZ 4jti� aagwooaa-Al!joy;my leolpaW A3ua6aaua3 : VLVVZ) 06e)13ed aaquaaoaa :;uewt43e;}d ui _0 J J LLI O i.f. O O �ZL) 0Ww ON 4Z� raw �WW U. Q w m N W J W W N a a W LL J N W U 0 H �1 z W cr M • . N M M d d Y U R d 15.A.3 AMBULANCES AND OTHER VEHICLES AVAILABLE Care Med Transportation has a total of 3 BLS State licensed vehicles. Attachment 8: Permit Number Type Year Make Model Vin 006460 BLS 2021 Dodge Ram Promaster 2500 3C6LRVDG6ME540223 BLS 2010 Ford E450 006054 1FDXE4FP6ADA09870 To be replaced 006053 BLS 2007 Ford E450 1FDXE45P37DA69129 To be replaced Page 4 Packet Pg. 333 15.A.3 OFFICE LOCATION Care Med Transportation currently operates at: 704 Goodlette-Frank Rd, Suite 240 Naples, FL 34102 Page 5 Packet Pg. 334 15.A.3 TRAINING & EXPERIENCES Care Med transportation believes that staff development is key to developing the knowledge, skills, and competencies of our staff. Our team of professionals stays abreast of new techniques, protocols, and policies. We have implemented several courses; BLS/CPR course, Emergency Vehicle Operator Course, Infection Control, etc. Care Med ensures that all EMTs and Paramedics stay up to date with their continuing education requirements and uses the Department of Health board -approved Continuing Education courses for its team. Page 6 Packet Pg. 335 15.A.3 COLLIER COUNTY REFERENCES Three (3) Collier County Residents to act as references: Margaret Rozman 121 Sabal Lake Drive, Naples, FL 34104 23 years in Collier County Tara Calderon 710 20th St SE, Naples, FL 34117 53 years in Collier County Pat Wille 151 Fox Glen Drive, Naples, FL 34104 22 years in Collier County Letters of recommendation attached: Page 7 Packet Pg. 336 15.A.3 Margaret Choban-Rozman (spouse of Edward Roman). Residing in Collier county for over 20 years. Current address: 121 Sabal Lake Dr, Naples FL 34114 Phone number:(239) 216-0597 October 23, 2022 To: The Collier County EMA Board Re: Care Med Transportation My husband was 81, on oxygen, bedbound and a dialysis patient. That's how I was introduced to Care Med. I personally used their services from May 2021 to February 2022 for my husband who needed transportation. They were a great support for both my husband and myself. I just wanted to take the time to let you know how wonderful their staff members are, and how they took great care of my husband while transporting him while he was sick during the year 2021 and January and February of 2022 until he passed away. They transported him from ManorCare at Lely Palms to Physicians Regional Medical Center and the Dialysis Center as well as from our home to both facilities as well. Everyone was very capable and respectful but I would especially like to point out Evelyn, Nerlyne and James as the best. I would be happy to recommend Care Med Transportation to Collier County or anyone else who needs transportation medical services. Please let me know if I can do anything else for you. Sincerely, Margaret Choban-Rozman (spouse of Edward Rozman Packet Pg. 337 15.A.3 Tara Calderon (former patient transported by Care Med Ambulance) Residing in Collier county for over 53 years. Current address: 710 20th St SE, Naples, FL 34117 Phone number: (239) 825 9846 November 3, 2022 To: The Collier County EMA Board Re: Care Med Transportation My name is Tara Calderon, I have lived in Collier county for over 53 years. Due to my medical condition, I am in need to be transported as needed to or from the hospital with extra crew members for safety issues. I am pleased with the care that I have received from Care Med each time during transport. Case managers at NCH use Care Med as the "go to company" to use whenever I am there, since the first time they have used Care Med. It is with pleasure that I recommend Care Med as an ambulance company in Collier county. They have transported me twice, and so far I must say that their staff were both kind, courteous and professional. They make sure that I feel safe and secure as they monitor me during transport. They are very efficient. My safety was a priority for them. I love to have Care Med as a much needed service in the community. Respectfully yours, � I11 'j, Tara Calderon Former patient transported by Care Med Packet Pg. 338 15.A.3 Collier County Care Med Referral Name: ID,7,+ W. I1-e Phone: Address: �S 1 �U� % icn C)r GtV�2�e 3N lob How long have you lived in Collier County? ZZ `I Would you recommend our services to another patient/ family member? (circle one) YES NO Please explain why or why not? 2C Jy� aid ��me� t,.ler-c p, � ten . ::LbtLti, c.� lAn d -ice vie +rv-)--5:iz ie iq� c co- N LA 4 What can we improve on to make our patient transport's care better? n 0 ±D �s , Please circle a title if applicable: MD, DO, PA, NP, RN, Social Worker, Discharge Planner, etc. Signature: �,� ( Qy i ^�� Date: Packet Pg. 339 15.A.3 FEE SCHEDULE Attachment C: Codes Services Rate A0428 Basic Life Support Base Rate $395 A0425 Per Loaded Mile $7.5 E0431/A0422 Oxygen $50 E w Page 8 Packet Pg. 340 Care Med Transportation LLC Balance Sheet As of October 20, 2022 ASSETS Current Assets Bank Accounts Bank of America Checking - 4566 Bank of America Checking - 6906 Total Bank Accounts Accounts Receivable Accounts Receivable (AIR) 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 Other Current Liabilities Total Other Current Liabilities Total Current Liabilities Long -Term Liabilities Notes Payable Notes Payable - Ally Bank 2019 Dodge Caravan Notes Payable - EIDL Notes Payable - Stryker Total Notes Payable Total Long -Term Liabilities Total Liabilities Equity Owner's Investment Retained Earnings Net Income Total Equity Total 7,865.00 N 255.00 t $ 8,120.00 L d E 151,957.00 V $ 151,957.00 d $ 160,077.00 O 156, 236.74 3 $ 156,236.74 Q 57,937.35 c2 $ 57,937.35 O $ 214,174.09 $ 374,251.09 v C O tSl O E W ti N 31,987.00 O $ 31,987.00 v cv 10,352.09 d $ 10,352.09 L $ 42,339.09 c) a> 0 20,657.00 a> 313, 900.00 28,090.00 R $ 362,647.00 Q $ 362,647.00 $ 404,986.09 192,732.00 -68,776.00 -154,691.00 $ 30,735.00 Packet Pg. 341 15.A.3 TOTAL LIABILITIES AND EQUITY 374,251.09 ti r N i� Y V m d L 0 E 0 u 0 0 0 0 E m u a Packet Pg. 342 15.A.3 Care Med BLS Certificates Of Liability Insurance Attachment D: Workers Comp General Liability Vehicles Page 9 Packet Pg. 343 15.A.3 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 11/15l2022 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 INSURER(S), AUTHORIZED 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Acentric Insurance - Ft. Myers 11215 Metro Parkway Building1 Suite 4 Fort Myrs FL 33966 CONTACT Certificate Team- Fort Myers PHONE A/c No. Ext , 239-939-1010 a No . 239-939-7172 'E-MAILDDRESS: COifm acentria.com _ INSURER(S) AFFORDING COVERAGE NAICB INSURERA: Western World Insurance Company IN6UgERa: Michigan Commorcial Insurance Mutual 13196 _ 10998 - ----_ License : L100460 INSURED 6AREMED-02 Care Mad Transportation LLC INSURER C : 704 Goodlette Frank Road Suite 240 Naples FL 34102 INSURER D: INSURER E : INSURER F : -- '-- "— - r%=V101VIV 114uraCCK: 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 ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MMIDDY EFF MM/DD FY LIMITS A X I COMMERCIAL GENERAL LIABILITY NPP8793200 3/1612022 CLAIMS -MADE OCCUR 3/16/2023 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence S 100,000 _ MED EXP (Any one person) $5,000 -- - PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- F-1 GENERAL AGGREGATE S 2,000,000 JECT LOC PRODUCTS •COMP/OP AGG I S OTHER: S — - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea accident S BODILY INJURY (Per person) S OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident S I Is M UBRELLA LIAR OCCUR I EXCESS LIAB EACH OCCURRENCE S CLAIMS -MADE AGGREGATE $ DIED RETENTIONS � B WORKERS COMPENSATION Y WC10000178132022A 10/18/2022 AND EMPLOYERS' LIABILITY S 10/18/2023 X Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A STATUTE ERH E.L EACH (Mandatory in NH) ACCIDENT $1,000,000 If yes, describe under E.L. DISEASE - EA EMPLOYEE S 1,000,000 DESCRIPTION OF OPERATIONS below I Professional Liability E.L. DISEASE -POLICY LIMIT S 1,000,000 Aggregate 11000,000 Deductible 250 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached H is more Sexual Abuse is not excluded. space required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Emergency Medical Services ACCORDANCE WITH THE POLICY PROVISIONS. 8075 Lely Cultural Parkway Suite 445 Naples FL 34113 AUTHORIZED REPRESENTATIVE cz y ACORD 25 (2016/03) The ACORD name and logo are registered Marks of ACORD ACORD CORPORATION. All rights reserved. Q Packet Pg. 344 15.A.3 DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCEFii 11 / 1112022 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 INSURER(S), AUTHORIZED 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Acentria Insurance - Ft. Myers PHONE Certificate Team- Fort Myers FAX 11215 Metro Parkway c xi 239-939-1010 A/c No:239-939-7172 Building 1 Suite 4 ADDRESS: coifm@acentria.com Fort Myers FL 33966 INSURERS AFFORDING COVERAGE _ NAIC# License#, L1nn4B0 INSURER A: Western World Insurance COmDanv 13196 INSURED Care Med Transportation LLC 704 Goodlette Frank Road Suite 240 Naples FL 34102 CAREMED-02 INSURER D : COVERAGES CERTIFICATE NUMBER: 145625623 REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DUn EFF MM/DDI EXP LIMITS A X COMMERCIAL GENERAL LIABILITY -RENTED-- CLAIMS-MADE OCCUR NPP8793200 3/16/2022 3/16/2023 I I EACH OCCURRENCE $1,000,000 DAMAGE TO PREMISES(Ea occuRe^cej_ $100,000 GENT X MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- LOC OTHER: GENERALAGGREGATE $2,000,000 PRODUCTS-COMPlOPAGG _ $ $ - --- AUTOMOBILE LIABILITY ANY AUTO OWNED _ SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY i COMBINED SINGLE LIMIT Ea accident $ ' ____. _-_..__......._._... $ $ $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPE ) AGE Par accident) UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ $ $ _ AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) Ifes, describe under y'�. DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER _ $ -- $ ----- - $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Professional Liability Aggregate Deductible 1,000,000 250 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Care Med Transportation 704 Goodlette Frank Rd Ste 240 Naples FL 34102 ACORD 25 (2016/03) ♦.MIY t,LLLP1 I IVIY 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 v mots-LUI0 AL;URU GURPURATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r+ Q Packet Pg. 345 15.A.3 ,a� ©® CERTIFICATE OF LIABILITY INSURANCE o09/14/20 2YI 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT -NAME: Rich Mathews Rich Mathews State FarmPHONE - — — -- — — FAX_— -- --- - .lALG, No.Ext)• 239-992-9896 __— _ i _ 1(A/cNop 239-992-2957 StafeFarm 9510 Corkscrew Palms Cir, #4 E-MAIL ADDRESS_nc_h a_richarmathewsagency.com _ Estero, FL 33928 _I1,19URERSSLAFFORD ING COVERAGE NAIC # --- -- ---. —_ _r__ _ INSURER A :State Farm Mutual Automobile Insurance Company INSURED a NTed Transportation — --- -- — — — — -- -- " "-- INSURER B : 8891 BRIGHTON LN STE 129 — - - - — ---- — - INSURER C BONITA SPGS, FL 341357526 INSURERo: INSURER E —�� COVERAGFS rCOTlrirrATr •nuaoen. nGvlJiUly lvUMOCR: 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 DE5CRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE AD L�$U�R� WVD POLICY NUMBER —? POLICY EFF POLICY EXP '.. MMIDO MMIDD Y LIMITS LIABILITY -GENERAL ! �I EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY _ — DA—rluiGE TO -RENTED- --- : -- ---- - — - -- ----- PREMISES(Eeoccurrence) S l CLAIMS -MADE OCCUR I MED EXP (Any one person) S_ PERSONAL 8 ADV INJURY �S - — GENERAL AGGREGATE $_,- GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS -COMP/OP AGG S POLICY . PRO• I LOG I I 1 ---- A AUTOMOBILE LIABILITY _-_ Y Y J02 8936-C25.59 09-25-2022 03.25-2023 COMBINED SINGLELIA I Ea accident S 1.000,000 X ANY AUTO SCHEX G90 9342-F16-59 I 06.16-2022 12-16-2022 BODILY INJURY (Per person)ALL s BODILY INJURY (Per acridenl) - AUTOS AUTODULED %� AUTOS ED G16 6319 E03-59H 111-03.2022 05-03-2023 S _- -- ---- -- — HIRED AVTOS _X� ,PROPERTY DAMAGE (Per _accident - - UMBRELLA LIAR OCCUR ❑I _ EXCESS LIAB CLAIMS -MADE - -- I ! : EACH OCCURRENCE s S AGGREGATE -- DED RETENTION s— $ --- - — - - - WORKERS COMPENSATION ANY LIABILITY Y YIN WC STATU- OTH-I �. _I T-HY-LIMITS ' ER ROPRIEERS' ANY PROPRIBFR EXARTNER/EXFCUTNF OFFICE/MEMBER EXCLUDED'+ ❑ I N I A ❑ E,L. EACH ACCIDENT E.L. DISEASE - CA EMPLOYEE (Mandatory in NH) I If yes, doscrtbe under - s _ -- E.L. DISEASE - POLICY LIMIT S I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarka Schedule, if more space is required) J02 6936-C25-59 (2010 Ford E-450) G9r1 A349-FIR-50 (9M7 Ford E-460) G16 6319-E03-59H (2021 Ram Promaster) rro7lrlrArr unl n VAIVt:.rLL.A I IUN Care Med Transportation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 704 Goodlette Rd Suite 240 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Naples, FL 34102 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRGSEWYATIVE `—� ©r1988-2010 ACORD CORPO TION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 Q Packet Pg. 346 15.A.3 Nerlyne Saintyl-Agenor 704 Goodlette-Frank Road Suite #240 Naples, FI 34102 (239) 599-5606 November 09, 2022 To: Director Summers & The Collier County EMA Board Re: Care Med Transportation Dear Director Summers & EMA Board Members, It is a privilege to apply for the renewal of Care Med's 3rd BLS COPN. With GOD'S Grace, Care Med is committed to serving our community in partnership with the Collier county EMS department irrespective of all the challenges Care Med has faced, including those ahead . Once again on behalf of Care Med, I thank you for the opportunity to serve the community we live in and love. Please receive the application for the renewal of our BLS COPCN, Care Med Transportation 704 Goodlette-Frank Road Suite #240 Naples, FL 34102 Phone: (239) 599-5606 Fax: (239) 599-5607 Page 10 Packet Pg. 347 Af U...j u n b t STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY.ASSURANCE DATE LICENSE NO. CONTROL NO. 06/05/2021 RN 9340654 3263995 THE REGISTERED NURSE NAMED BELOW HAS MET ALL REQUIREMENTS OF THE LAWS AND RULES OF THE STATE OF FLORIDA Expiration Date: APRIL 30, 2023 NERLYNE SAINTYL-AGENOR. 15275 COLLIER BLVD APT 201.356 NAPLES, FL - 34119 EXPIRATION DATE: APRIL 30, 2023 QUALIFICATION(S): -Single-state License `—) I Z t. 0 W Q Z Nm Q W U z z J � ( Q �62U O.W p OO� o W LLWo 0 $ z a O p — cc <(L> u~oo i iE 15.A.3 r ....tv. N LL O o J Q Q W LL �o r N m o d� W a� LL ao O N W W U 6 xZ) 3o oz J Q W V J � N z N Q O V) N W m� o g w � w z z Your license number is RN 9340654. Please use it in all correspondence with your board/council. Each licensee is solely responsible for notifying the Department in writing of the licensee's current mailing address and practice location address. If you have not received your renewal notice 90 days prior to the expiration date shown on this license, please visit www.FLHealthSource.gov and click "Renew A License" to renew online. The Medical Quality Assurance Online Services Portal gives you the ability to manage your license to perform address updates, name changes, request duplicate licenses and much more. It's simple. Log onto your MQA Online Services account today at http://flhealthsource.gov/. Select the "Account Login" button to access your account. For changes to your name, address or to request duplicate licenses, choose your selection from the dropdown list under "Manage My License". Your profession will open for renewal 90 days prior to your expiration date. When the renewal cycle opens for your profession, the "Renew My License" header will automatically display on your license Dashboard. IMPORTANT ANNOUNCEMENTS ARE YOU RENEWAL READY? The Department of Health will now review your continuing education records at the time of license renewal. To learn more, please visit www.FLHealthSource.gov/AYRR GROUNDS FOR DISCIPLINE You should be familiar with the Grounds for Discipline found in Section 456.072(1), Florida Statutes, and in the practice act for the profession in which you are licensed. Florida Statutes can be accessed at www.leg.state.fl.us/Statutes aO `a-10' N�Ilaw Packet Pg. 348