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Ordinance 2011-36 ..-- /~ ,,' i\)0. ~:':j ...... 'i0' , .,,\ "" \ ., ,'!'-... e'... ,/, 1 \ f".. , ,f ORDINANCE NO. 2011 - ~ 'i::!?/, ,rl ''-1/9 ,f:.~N ORDINANCE OF THE BOARD OF COUNTY COMMI~SIONERS 1," ~'. r , :' '~,<'OF COLLIER COUNTY, FLORIDA, AMENDING ORDINAN'CE 94-12, <' AS AMENDED, BY AMENDING, SECTION TWO, DEFINITIONS;-, SECTION FOUR, EXEMPTIONS AND EXCLUSIONS FROM' '. CERTIFICA TE REQUIREMENT; SECTION FIVE, PROCEDURE FOR OBTAINING CERTIFICATE; SECTION SEVEN, REQUIREMENT FOR BOARD APPROVAL IN GRANTING CERTIFICATE; SECTION NINE, RIGHTS AND DUTIES GRANTED BY CERTIFICATE; SECTION ELEVEN, EMERGENCY PROVISIONS; SECTION TWEL VE, CLASSIFICATIONS OF CERTIFICATES; SECTION FIFTEEN, GENERAL OPERATING REGULATIONS; SECTION TWENTY, CONDUCT OF DRIVERS AND ATTENDANTS; SECTION TWENTY-ONE: PASSENGERS; SECTION TWENTY-TWO, OBEDIENCE TO TRAFFIC LAWS, ORDINANCES AND REGULATIONS; PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR INCLUSION IN THE CODE OF LAWS AND ORDINANCES; AND PROVIDING FOR AN EFFECTIVE DATE. '~ WHEREAS, Collier County Ordinance No. 2004-12, as amended, is codified as Article III of Chapter 50 of the Code of Laws and Ordinances of Collier County, and originally enacted through its predecessor Ordinance No. 81-75; and WHEREAS, Collier County desires to make available to its citizens safe, professional emergency health care transportation and non-transportation services for emergency pre-hospital responses and the transfer of patients between and among local hospital facilities; and WHEREAS, Collier County desires to facilitate the provision of such services and has the necessary equipment, training, expertise, professional certifications and licenses to do so; and WHEREAS, this amendment creates a Class 3 Non-Transport ALS certificate classification that will result in a benefit to Collier County by reducing response times for certain transports and providing for the availability of more transport vehicles. NOW THEREFORE: BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA: Words underlined added and words strl:lek throl:lgh are deleted. Pagelofl2 SECTION ONE: Amendments to Section Two of Ordinance No. 04-12, as amended. Section Two of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION TWO: DEFINITIONS. A. Advanced Life Support (ALS) shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code, Section ME and the Collier County Medical Director's protocol. B. Administrator shall mean the County Manager or his designee. C. Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land, or water transportation of persons, who are sick, injured, or otherwise helpless. D. Board shall mean the Collier County Board of County Commissioners. E. Certificate means a certificate of public convenience and necessity as authorized in Section 401.25 (2)( d), Florida Statutes. F. Emergency Call shall mean the transit of an ambulance under conditions which warrants travel with flashing lights and siren operating. G. Operator shall mean any person, organization or governmental entity providing ambulance or ALS services. H. Patient shall mean an individual who is ill, sick, injured, wounded, or otherwise incapacitated or helpless. I. Routine Call or Routine Transfer shall mean the transportation of a patient under non-emergency call conditions. 1. Rescue Service (Non-ALS) shall mean first response treatment of patients but does not include Advanced Life Support (ALS) or transport. SECTION TWO: Amendments to Section Four of Ordinance No. 04-12, as amended. Section Four of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION FOUR: EXEMPTIONS AND EXCLUSIONS FROM CERTIFICATE REQUIREMENT. Certificates shall not be required for: Words underlined added and words struek threl:lgh are deleted. Page 2 of 12 A. Rescue Services (Non-ALS). B. The use of a non-ambulance for any transport of a patient pursuant to the Good Samaritan Act, Section 768.13, Florida Statu!es. C. Vehicles rendering ambulance-type services when requested to do so by the Board of County Commissioners or County Manager in the event of a major catastrophe or other such emergency which requires more ambulances thant are available in the county. D. Ambulances based outside the county which pick up a patient in the county and transport him out of the county, or which pick up a patient out of the county and transport him into the county. E. Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services en route are not covered by this exemption. SECTION THREE: Amendments to Section Five of Ordinance No. 04-12, as amended. Section Five of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION FIVE: PROCEDURE FOR OBTAINING CERTIFICATE. An applicant for a certificate shall obtain forms from the department to be completed and returned to the Diyision provide the Administrator with the following information in order for a request for a certificate to be considered. Each applieation request shall contain: A. The name, age, and address of the owner of the ambulance or ALS provider Operator, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more that 25% of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. ***** SECTION FOUR: Amendments to Section Seven of Ordinance No. 04-12, as amended. Section Seven of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION SEVEN: REQUIREMENT FOR BOARD APPROV AL IN GRANTING CERTIFICATE. Words underlined added and words struek through are deleted. Page J of 12 The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: A. That there is a public necessity for the service. In making such determination, the Board of County Commission shall consider, as a minimum, the following factors: (1) The extent to which the proposed service is needed to improve the overall Emergeney Medieal Services emergency medical services (EMS) capabilities of the County. (2) The effect of the proposed service on existing services with respect to quality of service and cost of service. * * * * * SECTION FIVE: Amendments to Section Nine of Ordinance No. 04-12, as amended. Section Nine of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION NINE: RIGHTS AND DUTIES GRANTED BY CERTIFICATE. The certificate granted by the Board shall be valid for one calendar year and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, a new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate. Acceptance of the certificate by the applicant shall obligate the applicant to: A. Service the entire zone granted to the applicant. B. Provide coverage to adjoining zones, if available. when requested to do so by Emergency Control emergency dispatch for emergency calls when the certificate holder for that zone is unable to respond. C. Keep posted at his place of business a copy of the fee schedule, which must be filed with the Administrator (If applicable). D. Operate in accordance with the rules and regulations adopted pursuant to this Ordinance and any applicable County Ordinances, and Chapter 40 I Florida Statutes, and any administrative regulations adopted pursuant thereto. Words underlined added and words struek through are deleted. Page 4 of 12 E. Employ at all times sufficient personnel experienced in operation and management of emergency medical services to ensure proper and efficient operation. SECTION SIX: Amendments to Section Eleven of Ordinance No. 04-12, as amended. Section Eleven of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION ELEVEN: EMERGENCY PROVISIONS. The Board may modify, suspend or revoke a certificate in the interest of the public health, safety and welfare, only at public hearing and after reasonable notice has been given to the certificate holder affected. However, if a situation exists which poses a serious threat that ambulance or rescue service the Operator will not be available to any certain area of Collier County, the Administrator shall have such temporary emergency powers as are necessary to provide that service. These temporary powers are intended to provide interim protection until such time as the Board meets to resolve the emergency. SECTION SEVEN: Amendments to Section Twelve of Ordinance No. 04-12, as amended. Section Twelve of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION TWEL VE: CLASSIFICATIONS OF CERTIFICATES. There shall be three twe ill ~ classifications of service in Collier County, as follows: A. Class 1: Collier County EMS ALS Transport: ALS Rescue: An EMS provider Operator with the capability of rendering on the scene prehospital ALS services with transport capability and who mayor may not elect to transport patients based on medical necessity. An EMS pro':ider Operator rendering this level of service for a governmental entity shall be deemed to be operating under the Class I - ALS rescue certificate of public convenience and necessity held by the governmental entity. An EMS pro...ider Operator holding a Class 1 - ALS rescue certificate may provide post-hospital interfacility medical transfer services and routine ALS and BLS calls within the County. A certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. B. Class 2: Collier County Hospitals: I. ALS Transfer: An EMS provider Operator who renders ALS interfacility medical transfer services. An EMS pro':ider Operator who is awarded a Class 2 - ALS transfer certificate and does not possess a Class 1 - ALS rescue certificate shall not respond to an emergency call and provide ALS rescue services unless called upon by the appropriate Class I - ALS rescue provider Operator to provide Words underlined added and words struek through are deleted. Page 5 of 12 emergency backup service. In these instances, it shall be deemed to be operating under the Class 1 - ALS rescue certificate of the governmental entity requesting such emergency backup service. 2. Class 2 - ALS transfer certificate holders may provide post-hospital interfacility medical transfer services and routine ALS and BLS calls within the County but only to hospitals owned by the certificate holder, however, the Class 2 certificate holder may provide out-of-County transports. Unless an EMS provider possesses a Class 1 - ALS Rescue certificate issued by the County, a certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. 3. Class-2 transfer certificate holders shall contract with the Class 1 rescue certificate holder's Medical Director the County for the performance of services set forth in Florida Statutes, Section 401.265 and Chapter 64J-1.004(4)(a). Florida Administrative Code. and as specifically set forth herein as follows: a. He shall supervise and accept direct responsibility f{)r the medical performance of the paramedies and Emergency Medical Technicians (hereinafter EMTs). b. He shall develop medically correct standing orders or protocols relating to life support system procedures '.vIleR communication cannot be established \vith a supervising physician or v/hen any delay in patient care would potentially threaten the life or health of the patient. c. He shall issue standing orders and protoeols to ensure that the Class 2 transfer certificate holder transports each of its patients to facilities that offer a type and level of care appropriate to the patient's medical condition. d. He or his appointee shall provide continuous 21 hour per day, 7 day per week medieal direction which shall include, in addition to the development of protocols and standing orders, directiofl to the Class 2 transf~r certificate holder's personnel as to the availability of "off line" service to resolve problems, system conflicts, and provide services in an emergency as that term is defined by section 252.31(3), FIBri61a St61tulcs. e. He shall establish a quality assurance eommittee to provide for quality assurance re...iew of all EMTs and paramedics operating under his superVISIOn. f. He shall audit the performaflce of system persolHlel by use of a quality assurance program that includes but is not limited to a prompt revievi of patieflt care records, direet observation, and comparison of performaflee standards for drugs, eqHipment, system protocols afld procedures. He shall be responsible f{)f participatiflg ifl quality assuranee programs deyeloped by the Class 2 transfer certificate holder. g. He shall ensure and certify that security procedures of the Class 2 transfer certifieate holder for medications, flHids and controlled substances are in compliance \\'ith chapters 101, 199 and 893, F!(J}Aida S:61:utes, and ehapter IOD 15 oftne Florida Administratiye Code. Words underlined added and words struck threugh are deleted. Page 6 of 12 h. He shall create, authorize and ensure adherence to, detailed y:ritten operating proeedures regarding all aspects of the hafldling of medications, fluids and cOfltrolled substances by the EMS persoflflel and comply with all requirements of chapters 101, 199 and 893, FJerioo Statbltcs. i. He shall notify the Florida Department of Health, (hereinafter the "Departmeflt") in writing .....hen the use of telemetry is not necessary. j. He shall flotify the departmeflt in \witing of each substitution of equipment or medication. k. He shall assume direct responsibility for the use by an EMT of an automatic or semi automatic defibrillator; the performance of esophageal intubation by an EMT; and on routine interfaeility transports, the monitoriflg and maintenance of non medicated I.V.s by an EMT. He shall ensure that the EMT is trained to perform these procedures; shall establish written protoeols for the perf{)rmance of these procedures; and sball pro':ide written evidence to the Florida Department of Health documenting compliance with the pro':isions of this paragraph. I. He shall ensure that all EMTs and paramedics are trained in the use of the trauma scorecard metbodologies as provided in seetiofls ME 2.017 of the F..\.C., for adult trauma patients and 61E 2.0175, F..\.C., for pediatric trauma patients. m. He shall participate as a cre\vmember on an EMS vehicle f{)r a minimum of 10 hours per year and complete a minimum of 10 hours per year of continuing medical education related to pre hospital care or teaching or a combination of both. n. He shall ensure that all of the Class 2 transfer certifieate holder's EMTs and paramedics haye all proper certifications and recei':e all training necessary to maintain their certifieation. C. Class 3: ALS Non-Transport: 1. ALS Non-Transport: An EMS Operator who renders Advanced Life Support pre-hospital services without transport capability. 2. Class 3 certificate holders work in concert with applicable Class 1 providers to assure adequate and timely response to prehospital incidents with the intent to either reduce applicable response times or otherwise augment the level of services as requested by the associated Class 1 Operator. Unless an EMS Operator possesses a Class I - ALS Rescue certificate issued by the County. a certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. 3. Class-3 certificate holders shall contract with the County for a negotiated amount per year for administrative services offered by the Office of the Medical Director for the creation and update of medical protocol: and other general support as requested by the Class-3 certificate holder. The Office of the Medical Director shall not be considered the medical director for a Class-3 Operator for purposes of this Ordinance or Florida Statutes unless the Class-3 Operator separately contracts with the County in order for the Words underlined added and words str~ek through are deleted. Page 7 of 12 County's Medical Director to serve as its medical director for the performance of services set forth in Section 401.265. Florida Statutes. and Chapter 64J-2.004( 4)(a), Florida Administrative Code. 4. The medical director for the Class-3 certificate holder shall work cooperatively with the County's Office of the Medical Director to ensure continuity of care. The medical director for the Class-3 certificate holder shall not delegate or relinquish any responsibilities identified in Section 401.265, Florida Statutes, and associated Florida Administrative Code rules. SECTION EIGHT: Amendments to Section Fifteen of Ordinance No. 04-12, as amended. Section Fifteen of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION FIFTEEN: GENERAL OPERATING REGULATIONS. All certificate holders, operators, and drivers shall comply with all state statutes and administrative regulations as following regulations: A. Twenty-four Hour Service. Every certificate holder shall be required to operate sufficient ambulances, or relevant apparatus. as stated on the certificate of operation vehicle permit issued by the State Department of Health, Bureau of Emergency Medical Services and determined by the Board permit issued by the Board, on immediate call at all times. B. Prompt Service Required. Every call for ambulance service shall be answered promptly. Patients shall be appropriately assessed, treated, packaged, loaded and transported by an Operator that is licensed to transport without being subject to unreasonable delays. All calls for emergency assistance requiring over twenty (20) minutes from time of notification to arrival on scene shall be reported to the Administrator with complete documentation of the circumstances, which delayed the response. Those instances where more than three (3) minutes elapse between receipt of an emergency call and dispatch of an emergency vehicle ambulance shall also be reported to the Administrator with documentation of circumstances. C. Bed Linens. Every Operator transporting patients shall provide clean Gleaft and sanitary bed linens shall be pro':ided for each patient carried ami which shall be changed as soon as practicable after the discharge of the patient. D. Daily Log. Every eOperator transporting patients shall maintain in a daily log upon which shall be recorded the place or origin, time of call, time of dispatch, time of arrival at scene, time left for hospital, time of arrival at hospital, and charges for each trip made and such other operating and patient information as may be required by Ordinance. Every eOperator shall retain and preserve all daily logs for at least two (2) years, and such logs shall be available for inspection by the Administrator. Words underlined added and words strl:lek through are deleted. Page 8 of 12 E. Communications. Each ambulance emergency vehicle shall maintain two-way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by Ordinance or state law. F. Vehicles and Equipment. Each Operator's vehicle~ shall be equipped with the proper medical and emergency equipment as required by the iointly agreed to by the medical director of each licensed provider and the laws of the State of Florida and shall be subjeeted to inspectiofl from time to time to insure compliaflce 'Nith the laws of Florida and this Ordinance. G. Certification. ill In addition to the State of Florida Department of Health, Bureau of Emergency Medical Services requirements for certification, each Collier County EMS paramedic, Class-2 Operator's paramedic. and Class-3 Operator that has separately entered into a contract with the County in order for the County's Medical Director to serve as its medical director for the performance of services set forth in Section 401.265. Florida Statutes. and Chapter 64J- 2.004(4)(a). Florida Administrative Code. must be certified by the County Medical Director. Each Collier County EMS paramedic and Class-2 Operator paramedic must work with a Collier County EMS ambulance for a sufficient length of time pursuant to paragraph H. for the County's arne\:llance service Mmedical DElirector to properly judge the paramedic's fti.s capability. At minimum, the paramedic must 'NOrl, in that capacity not less than one full month's work shift alumally. Salaries of other than Collier County EMS paramedics will be paid by the agency seeking the Medical Director Certification. (ii). The Medical Director of a Class-3 Operator or a Class-l Operator. excluding Collier County EMS. shall certify its paramedics pursuant to Section 401.265. Florida Statutes. and Chapter 64J-2.004(4)(a). Florida Administrative Code. (iii). A Class-3 Operator that has separately entered into a contract with the County in order for the County's Medical Director to serve as its medical director for the performance of services set forth in Section 401.265. Florida Statutes. and Chapter 64J-2.004(4)(a). Florida Administrative Code. shall be certified pursuant to the terms of such contract. H. Ride Time Requirement. Each paramedic employed by Collier County EMS. a Class-l Operator or a Class-2 Operator must work. at a minimum. with a Class-l Operator's ambulance not less than one full month's work shift annually. Each paramedic employed by a Class-3 Operator that has its own medical director must accompany a patient on the Collier County EMS ALS transport from scene to hospital when the paramedic for such Class-3 Operator initiates ALS services on a patient prior to Collier County EMS transport arrival or if the patient's condition requires that additional level of expertise. Each paramedic employed by a Class-3 Operator that has separately entered into a contract with the County in order for the County's Medical Director to serve as its medical director for the performance Words underlined added and words stTUel( thr8ugh are deleted. Page 9 of 12 of services set forth in Section 401.265, Florida Statutes. and Chapter 64J- 2.004(4)(a). Florida Administrative Code, shall either work with a Collier County EMS ambulance not less than one full month's work shift annually or must accompany a patient on the Collier County EMS ALS transport from scene to hospital when the paramedic for such Class-3 Operator initiates ALS services on a patient prior to a Collier County EMS transport arrival or if the patient's condition requires that additional level of expertise. as provided for in its contract with the County. H;J", Application. Each ambulance or ALS service shall be subject to those rules and regulation as promulgated by Ordinances of the Board for the purpose of carrying out this ordinance. SECTION NINE: Amendments to Section Twenty of Ordinance No. 04-12, as amended. Section Twenty of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION TWENTY: CONDUCT OF DRIVERS AND ATTENDANTS. All drivers, EMT's and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this Ordinance and no driver, EMT or paramedic registered hereunder shall: * * * * * I. Operate or ride in aft vehicle ambulance without using seatbelts. (Personnel attending patients are exempt). SECTION TEN: Amendments to Section Twenty-One of Ordinance No. 04-12, as amended. Section Twenty-One of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION TWENTY-ONE: PASSENGERS. No person shall be aboard ambulances when engaged in emergency or routine medieal ~routine calls except the following: A. Driver, attendants and fire or law enforcement personnel; B. Patients; C. Not more than one relati'.'e or close frief}d of the patient, or if the situation warrants, the paramedic if} charge may authorize more than Ofle passenger. Relatives or close friends of the patient when authorized bv an EMS Battalion Words underlined added and words stmek through are deleted. Page 10 of 12 Chief or position of a higher rank. These requests will only be granted under exceptional circumstances; D. Physicians and nurses; E. Personnel in an observing capacity that are being trained for ambulance or ALS servlce7;-or F. Operator's supervisory personnel. SECTION ELEVEN: Amendments to Section Twenty-Two of Ordinance No. 04-12, as amended. Section Twenty-Two of Ordinance No. 04-12, as amended, is hereby amended as follows: SECTION TWENTY-TWO: OBEDIENCE TO TRAFFIC LAWS, ORDINANCES OR REGULA nONS. A. Under the provisions of Florida State law. +!he driver of an ambulance or ALS vehicle when responding to an emergency call or while transporting a patient may exercise the following privileges when such driver has reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges: * * * * * SECTION TWELVE: Conflict and Severability. In the event this Ordinance should ever conflict with any other Ordinance of Collier County or other applicable law, the more restrictive shall apply. If any phrase or portion of this Ordinance is held invalid or unconstitutional by any court of competent jurisdiction, such portion shall be deemed a separate, distinct, and independent provisions and such holding shall not affect the validity of the remaining portions. SECTION THIRTEEN: Inclusion in the Code of Laws and Ordinances. The provisions of this Ordinance shall be made a part of the Code of Laws and Ordinances of Collier County, Florida. The sections of the Ordinance may be renumbered or re- Words underlined added and words stnlek threugh are deleted. Page II ofl2 lettered and internal cross-references amended throughout to accomplish such, and the word "ordinance" may be changed to "section," "article," or any other appropriate word. SECTION FOURTEEN: Effective Date. This Ordinance shall be considered adopted upon the date written below and subject to filing with the Florida Department of State. PASSED AND DULY ADOPTED by a vote of majority of the Board of County Commissioners of Collier County, Florida, this ~ day of Oc:1:i36eJ ,2011. ~ , -~ ,,?'~;~Jj;,. 0' '~ ~ ' ATTEST:'" ",...Ir~ . \. . . _,-11 DWIGHT E. i'.R'0.~, CLERK ~: /j'~..:'i I /?-~~n :~ - r ~ ~~~~ ;, ;;;:'.: r ..........'.jJ. Deputy Clerk t'~ ~~ ~~/.lt .,._:,~ ~. :..,', -~- 'J , _tt4t1't, "~$ ~Q 'h~ tH'd~ ~ 'HMAttirt Qillj, ApproVea as to form al'!d legal sufficiency: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: '1uJ-W. ~ FRED W. COYLE, CHAI AN ~~~~ Jenm r B. WhIte Assistant County Attorney This ordinance filed with the SiC~ry of Stat~fs Office tl'1l'j ay of _> Oc"r- - I c:S€)1 { and acknowledgement t{~thot ~;;ng ~;;edth;S.~ day ~"" Words underlined added and words struek thrl:lugh are deleted. Page 12 of 12 STATE OF FLORIDA) COUNTY OF COLLIER) I, DWIGHT E. BROCK, Clerk of Courts in and for the Twentieth Judicial Circuit, Collier County, Florida, do hereby certify that the foregoing is a true and correct copy of: ORDINANCE 2011-36 Which was adopted by the Board of County Commissioners on the 11th day of October, 2011, during Regular Session. WITNESS my hand and the official seal of the Board of County Commissioners of Collier County, Florida, this 17th day of October, 2011. DWIGHT E. BROCK Clerk of Courts and Clerk Ex-officio to Board ot County commissionerp.,,'.:,!~;:'.'>}... ~ i? " i~U';:'l.} ..... '''':l ~-A '...... .' - "--J ~ . ----~. ,'..'/ By: Teresa Polaski," ,jn'_J~'.':::'ll'(/' .. , TfI <J!'''~ Deputy Clerk .', ' '