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Backup Documents 04/08/2025 Item #16F 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 1 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 5Akifil 4. BCC Office Board of County Commissioners a S L it5/5/ q/3 5. Minutes and Records Clerk of Courts Office r 1 dnif;e PRIMARY CONTACT INFORMATION '1a 5 ' ` 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 Cherie DuBock/EMS Phone Number 239-252-3756 Contact/ Department Agenda Date Item was 04/08/2025 Agenda Item Number 16.F.1 Approved by the BCC Type of Document COPCN CERTIFICATE&PERMIT Number of Original 2 Attached Documents Attached PO number or account PLEASE EMAIL TO number if document is BRUCE.GASTINEAU@ to be recorded COLLIERCOUNTYFL.GOV 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? CD 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 signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 117 4. All handwritten strike-through and revisions have been initialed by the County Attorney's 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. lW7 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. 1 01, 7. In most cases(some contracts are an exception),the original document and this routing slip 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 41112s and all changes made N/A is not during the meeting have been incorporated in the attached document. The County 14�f�,,t�j an option for Attorney's Office has reviewed the changes,if applicable. ����!! this line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the sAkifito an option for Chairman's signature. this line. 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 16F 1 �•. n > co ?CD I ^� , OfT y, cn cn CT'� o. r © ' 0" ° C ', o j CD o ccD o CD ()ICJ o' 0 c < co amo • B a '" o' c° •c cr w o" AD n g". < • CD CD P AT CD C oo 1-3 -co c/o v w " O o aCD �a ° 5• LA na n crQ a - aoAym 0 ° . r B D � D H c" � p O y oo co 0 5' A co a AD 0 a. `D C -. cro 5 C" 4 -o C w a cD o a, ,-< AD CD cn o n < o a. � 0 ' p- n 0 i-+ 5 0 z n CD crn coo M iG o on a• ccoo O rm 05. < ° • 0 = oo - < o CD co sa. V' o 5 a: n 0 co O ,G a. 0 )- CA rn rn n m c •�' S . N 0 =R E o- t� 0 w cD C w a G a. w a 'd � -]] K. �' ° w n .. CD c.nw 70 O • 0" . b ,) co 0 d 0 a. p n O ar c a' ;; n P. Y O aCD .4 0 " ;° w ►'' • yi P' CD - c<v '» 0 co CD N O AD O n ? 0- ,-.. 0 co ten, N AD 00 O 0 N in' n co 'O — C7 m aIzo a '' 5 QC/' y z ° o n P 0 rrnn a. ,-. N c $ , s 4 a P q R. 16F 1 COLLIER COUNTY FLORIDA Renewal of Class "2" COPCN Name of Service: Medtrek Medical Transport, Inc. Name of Owners: Jalix Georges. Principle Address of Service: 3892 Prospect Ave, Ste 2,Naples Fl 34104 Business Telephone: (239)-228-7900 Description of Service: Inter-facility and out of county transport for Collier County Number of Ambulances: 7 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 8+ik day of April , 2025. Effective Date: April 5, 2025 Expiration Date: April 5, 2026 ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kin -1, Clerk COLLIE COUNTY, FLORIDA TA. • 4f :f ...,4040A.04-- est as to Chalrr►en's,Dep t C l'k Burt . Saunders, Chairman • signature:..* I. _ -. Appro - : 0t .1 d legality: ii ' ILA Jeffrey i . lat ow, County Attorney [24-EMS-01229/1887108/1] 16F 1 Appendix A Medtrek Medical Transport, Inc LIST OF AMBULANCES LIST OF ACTIVE AMBULANCES Unit# Name Relationship Profession License Effective Date MT-5 1FOBW2CG3PKB90091 PERMIT VEHICLE PERMIT(ALS) 264114 11/•1/2024 MT-5 1FDBW2CG3PK890091 PERMIT VEHICLE PERMITS (BLS) 7572 11/4/2024 MT-1 1GB3G2CGT8FI16GSG2 PERMIT VEHICLE PERMIT(ALS) 25070 5/10/2023 MT-1 1GB3G2CGT8F11GG562 PERMIT VEHICLE PERMITS (BLS) 7014 7/27/2023 MT•4 1GB3GRCL1G1133054 PERMIT VEHICLE PERMIT(ALS) 25066 S/10/2023 MT•4 1GB3GRCL1G1133054 PERMIT VEHICLE PERMITS (BLS) 7010 7/27/2023 MT-3 1GBKG3164911 10442 PERMIT VEHICLE PERMIT(ALS) 25068 S/10/2023 MT-3 1GBKG316491110442 PERMIT VEHICLE PERMITS (BLS) 7012 7/27/2023 MT-7 1FDBW2CGXPKB236 8 PERMIT VEHICLE PERMIT(ALS) Pending MT-7 1FDBW2CGXPKB23&18 PERMIT VEHICLE PERMITS IBLSI Pendin UST OF BACKUP AMBULANCE PENDING ARRIVAL OF REPLAMENT UNITS Unit# Name Relationship Profession License [Ifective Dale MT-2 1GB3CZCGSFF6G'IGOO PERMIT VEHICLE PERMIT(ALS) 25069 5/10/2023 MT-2 1GB3CZCGSFFGG'IGOO PERMIT VEHICLE PERMITS (BLS) 7013 7/27/2023 MT-G 1GB6GSCLIE1193119 PERMIT VEHICLE PERMIT(ALS) 25067 S/10/2023 MT 1GB6GSCLIE1193119 PERMIT VEHICLE PERMITS (BI.SI 7011 7/27/2023