Backup Documents 09/24/2024 Item #16F 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 6
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. (Enter your Dept here)
3. County Attorney Office County Attorney Office JAK/mb 10/1/24
4. BCC Office Board of County CH by MB 10/1/24
Commissioners [s]
5. Minutes and Records Clerk of Court's Office
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 missing information.
Name of Primary Staff Madison Bird Phone Number 2939
Contact/Department
Agenda Date Item was 9/24/24 Agenda Item Number 16F6
Approved by the BCC
Type of Document(s) COPCN Certificate&Class"2"Renewal Number of Original 2
Attached Documents Attached
PO number or account Please email Cherie Dubock copies of
number if document is certified documents
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 signature?(stamped unless otherwise stated) MB
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 MB
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 MB
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 MB
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 MB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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_9/24/24 and all changes made JAK/mb
during the meeting have been incorporated in the attached document. The County
Attorney Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the JAK/mb
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
1 6 F 6
a , ? ‘E. �' u
9 o � JU-o c o
E z o O
o U z L �o o
n
Q. N Trno Cfli < ' C N
0 ` '`° ca, 20 ' N o
I en U 7 2 2 O N
N
s a) s v v O O N N
`� U 'C N U -] N i
ca
u` o a)
3 o = c u c � ' 00, c c
>. Z 0 o a0i • U ° Z ii O
c
U >V> a y elf) V O iL) et
v o y
O
R U � _, Do
• 0 o
C N• fdrV .< 4 U
f C a -0 e- 'C .0 UO ‘'4,50
i � y
Z T C L en U U tr. L2A y Ct al
`/J U 66) y .L E v of 0 1--
Z Z Z 0 c a v 0 o
x W L.
o ' = E _ > 0
4. H
E4 > z o c y .3• u E
Q Z - - e
U O 0 o •H o -O L o 3 >
y A
►• U N P. C i; V F-- ` u O
w U < -0 .5 •" z > -o
G F •
0 'J t g u U C H )
AZ U ay
. o 8 N wO co
F. F °� 1) O Z E L o
I. 1 Q A o Z -v U 0) U 2
o +-,
C C V R E w f co N0 QI C'
Qt:d f"' 8 H E p o C N 1UT
W C .D y CA 0 0 d I L'
LI co
> m
0 NO U O 0 .. E E .
O '"' N a
•0 .L .0 a .0 in U gN.
on
f 4ti .
N
JET1 C
< < Q r, 1 ° y, `° +
W W W, j� . F- - : ` .<W Ls: rs: ' a c
3 3 3 ¢ � ¢ 1 g u
i
16F6
COLLIER COUNTY FLORIDA
Renewal of Class "2" COPCN
•
Name of Service: Ambitrans Medical Transport, Inc.
Name of Owner: Michael and Lorraine Grant
Principle Address of Service: 4351 Pinnacle Street, Charlotte Harbor, FL 33980
Business Telephone: (941) 743-3665
Description of Service: Inter-facility and out of county transport for Collier County
Number of Ambulances: 38 Ground Units available.
See attachment"A"for description of vehicles.
This permit, as provided by Ordinance No. 24-25, as amended, shall allow the above
named Ambulance Service to operate inter-facility 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 4-1 day of 5 the - , 2024.
Effective Date: October 22, 2024
Expiration Date; , October 22, 2025
•
ATTEST:. - BOARD OF COUNTY COMMISSIONERS
Crystal-K. ,.n :`Clerk COLLIER . U TY, F RIDA
Attest as ••air i P play Clerk Chris H h irman
sigria-ttrre pn.ly
Approve to'fo'nand legality:
Jeff Klatzli ', u1 y Attorney
•
I2J-WS-OI229/1887108/1J
16F6
Unit Number Unit Type VIN License Plate FL ALS Permit FL BLS Permit
266 BLS 1FDSS3ES7BDB27804 MIP 802 17026 5213
327 BLS 3C6LRV0G0ME507993 MIU 00U 23949 6456
328 BLS 3C6MRVJG4MES45168 MIU O1U 23949 6456
329 BLS 3C6LRVDG3PE535792 MIX 49T 25912 7348
330 BLS 3C6LRVDGOPE583413 MIX 50T 25913 7349
359 BLS 1FDSS3ES6ADA31208 MIN 36Q 20880 4678
364 BLS 1FDSS3ES7BDB27799 MIU 97T 20883 4777
365 BLS IFDSS3ES1BDB27801 MIU 95T 17027 5212
372 BLS 1FDSS3ESSCDA18372 MIU 66Y 20886 4954
374 BLS 1FDSS3ESODDA41561 MIU 71Y 20886 4954
379 BLS 1FDSS3ES8DDB02266 MIU 72Y 20889 4776
381 BLS 1FDSS3E59EDA22265 MIL 19V 20890 4823
606 ALS 1FDXE4FS6C0A90604 MIP 59X 25631 7214
609 BLS 1FDWE3FS4ADA62447 MIP 61X 20891 5119
615 BLS 1FDWE3FS8BDA01958 MIP 66X 21048 5368
617 ALS 1FDXE4FS2EDA55898 MIP 7IZ 22002 5693
618 ALS 1FDXE4FSOGDC00665 MIP 74Z 22759 6007
619 ALS 1FDXE4FS2GDC00666 MIP 75Z 22760 6008
620 BLS 1FDXE4FS8GDC04320 MIS 37N 25632 7215
621 ALS 1FDXE4FSXGDC04321 MIS 38N 23010 6113
622 ALS 1FDXE4FS5EDA77930 MIU 96T 23534 6312
623 ALS 1FDWE3FSXDDA264Z7 MIP 79Z 23547 6317
625 ALS IFDXE4FS2EOA12033 MIU 98T 23547 6317
626 ALS IFDXE4FN3NDC07228 MIU 99T 23948 6455
629 ALS 1FDWE3FS1JDC23238 MIU 04U 24293 6672
630 ALS IFDXE4FSXDDA11436 MIU 69Y 24722 6856
632 BLS 1FDWE3FS5CDB314S5 MIU 70Y 24896 6909
636 ALS 1FDXE4FS8HDC51865 MIP 58F 25232 7015
637 NICU 1FDXE4FS5HDC56358 MIP 59F 25233 7016
638 CCT IFDWE3FNXPDD07139 MIU 76U 25448 7136
639 ALS 1FDWE3FN9PDD07133 MIU 77U 25447 7135
640 ALS 1FDXE4FS9JDC07783 MIU 74Y 25523 7166
641 ALS IFDXE4FS6HDC51864 MIN26Q 0025780 007291
642 ALS 1FOXE4FS2JDC21654 MIN27Q 0025779 007290
643 BLS 1FDXE4FS9EDA55896 MIX 47T 25914 7350
644 ALS 1FDXE4FS9KDC09597 MIX 48T 25915 7351
712 BLS 1FDWE3FS5ADA20885 MIP 63X 24646 6828
731 BLS 1FDXE4FS2DDA11415 MIU 68Y 24721 6857