Backup Documents 04/14/2026 Item #16F 1ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 F I
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 sienature. draw a line through routing lines # 1 thrnngh 0 emmlete the rherlrlict and f nuard to the Art.,... nFFi..o
Route to Addressees (List in routing order)
Office
Initials
Date
1.
2. (Enter your Dept here)
Collier County EMS
J
3. County Attorney Office
County Attorney Office
4. BCC Office
Board of County
Commissioners
j
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 additinnal nr miccing information
Name of Primary Staff
Bruce Gastineau
Phone Number
239-252-3740
Contact / Department
Agenda Date Item was
4/14/2026
Agenda Item Number
16. F.1.
Approved by the BCC
Type of Document(s)
COPCN Certificate and COPCN Permit for
Number of Original
4
Attached
Medtrek
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 signature? (stamped unless otherwise stated)
BG
2.
Does the document need to be sent to another agency for additional signatures? If yes,
NA
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
BG
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
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
si nature 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
certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
8.
The document was approved by the BCC on and all changes made during
N/A is not
the meeting have been incorporated in the attached document. The County Attorney
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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
N/A is not
BCC, all changes directed by the BCC have been made, and the document is ready for the/
an option for
Chairman's signature.
l
this line.
l: 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
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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 Count
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 14 t day of �; , 2026.
Effective Date: April 5, 2026
Expiration Date: April 5, 2027
Ar�102'���ti5't0
1, Clerk
uty Clerk
legality:
, County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER C TY, FLORIDA
/ r
Dan owal, Chairm
[24-EMS-01229/1887108/1]
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