Backup Documents 10/28/2025 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE F 7
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) DC County EMS C f/j (0131
3. County Attorney Office County Attorney Office A I (l 3
ftfC
4. BCC Office Board of County
Commissioners
5. Minutes and Records Clerk of Court's Office _, ., C t ' r,
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 Bruce Gastineau CCEMS Phone Number 239-252-3740
Contact/Department
Agenda Date Item was 10/28/25 Agenda Item Number 16.F.7
Approved by the BCC
Type of Document(s) Ambitrans COPCN Certificate and Permit Number of Original 2
Attached Documents Attached
PO number or account Please email to bruce.gastineau@collier.gov
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 signature?(stamped unless otherwise stated) BG
2. Does the document need to be sent to another agency for additional signatures? If yes,
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. NA
3. Original document has been signed/initialed for legality. (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.)
4. All handwritten strike-through and revisions have been initialed by the County Attorney
Office and all other parties except the BCC Chairman and the Clerk to the Board. 1564
5. The Chairman's signature line date has been entered as the date of BCC approval of the ielb
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
signature and initials are required.
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 uploaded to the
agenda. Some documents are time sensitive and require forwarding to Tallahassee within a /��A
certain time frame or the BCC's actions are nullified. Be aware of your deadlines! /V
8. The document was approved by the BCC on 10/28/2025 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County Attorney L an option for
Office has reviewed the changes,if applicable. 9i 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 ph 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;2.24.05;11/30/12;4/22/16;9/10/21
16F7
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16F7
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: Intrafacility and out of county transport for Collier County
Number of Ambulances: 41 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 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.
f1
Issued and approved this 2 6 day of do 10 ber , 2025.
Effective Date: October 22, 2025
Expiration Date: October 22, 2026
ATTEST:,,;, BOARD OF COUNTY COMMISSIONERS
Mery'Sfal K. K hzel,CLERK COLLIER CO NTY, FLORIDA
- 7).,„.,, s5i. .. e,41e406100--
;. � tIlia gldGi'airman s Burt!, Saunders, Chairman
signature only
Apprdv6i ` • 4: . i egality:
ilk
Jeffrey A is lat.. ow, County Attorney