Backup Documents 03/26/2024 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
1 6 F 7
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 Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office `/2 2/�it
4. BCC Office Board of County ���5 / l
Commissioners 3 oZ>/o?
5. Minutes and Records Clerk of Court's Office WA/
2141
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 X3622
Contact/Department
Agenda Date Item was March 26,2024 ✓ Agenda Item Number c
Approved by the BCC 16 I 7
Type of Document(s) Certificate and Permit Number of Original 2
Attached Documents Attached
PO number or account J�
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)? N/A
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 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 NA
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 March 26,2024 and all changes made KH
during the meeting have been incorporated in the attached document. The County
Attorney Office has reviewed the changes,if applicable. ;°'s lin.'
9. Initials of attorney verifying that the attached document is the version approved by the JAK ,, is
BCC,all changes directed by the BCC have been made,and the document is ready for the /
Chairman's signature.
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
16F 7
COLLIER COUNTY FLORIDA
Permit for Class "2" COPCN
Name of Service: MedTrek Medical Transport, Inc.
Name of Owner: Jalix Georges
850 29th Street SW
Naples, Fl 34117
Principle Address of Service: 3892 Prospect Ave, Ste 2,Naples, Fl 34116
Business Telephone: 239-228-7900
Description of Service: Intrafacility and out of county transport for Collier County
Number of Ambulances: 5 Ground Units available.
See Appendix "B" for description of vehicles.
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Ambulance Service to operate intrafacility 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.
Issued and approved this LL4 day of fl W)Q . 2024.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER COUNTY, FLORIDA
est as to Chairman s ..
,�epuhy-Cl Chris Hall, hairman
signature only
rlppr ve‘ a• 0 orrn and legality:
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Jc]7r itzko«
Coun ALE(Inc)
[24-EMG-00515/1849704/1]
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