Backup Documents 04/25/2023 Item #16F 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 F
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office
64403
4. BCC Office Board of County
Commissioners /Vj/5/ Y� /z 3
5. Minutes and Records Clerk of Court's Office ( 4.76,1,3 P:P
ant
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 April 25,2023 Agenda Item Number
Approved by the BCC 16F1
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? NA
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 KH
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
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 4/25/23and 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 RTT N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the c.) an option for
Chairman's signature. /` this line.
Please route to BMR and return to Kathy Heinrichsberg
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
16 F I
COLLIER COUNTY FLORIDA
Class "1" and Class "2"COPCN
ALS Transfer Services
Effective Date: April 28,2023
Expiration Date: April 28,2024
Name of Service: Seminole Tribe Fire Rescue Department
Name of Owner: Seminole Tribe Fire Rescue Department
Principle Address of Service: 6300 Stirling Road
Hollywood, FL 33024
Business Telephone: (954) 966-6300
Description of Service: ALS Transport/ALS Rescue and Intra-facility out of county
transport for Collier County
Number of Ambulances: See application for description of 6 vehicles
See Application for description of vehicles.
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Ambulance Service to operate intra-facility and out of county transports for a fee or
charge for the following area(s): Collier County, 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 2s44 day of April , 2023
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER TY, FLORIDA
r A2
l_ . :i; ` D eput' Clerk Rick LoCastro, Chairman
((Attest ast0 Ch rtnan S
,.r(,lior ':6nh.
Ap oveci a& kec
rm and legality:
�I Jt
Ronald Tomasko
Assistant County Attorney
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