Backup Documents 12/08/2015 Item #16E 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO E4
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THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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 , (Z 11 13 j15
4. BCC Office Board of CountyW�7
Commissioners
5. Minutes and Records Clerk of Court's Office '2���
i :3 I1
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 Artie Bay, 'ye Svs, Phone Number 253-3740
Contact/ Department
Agenda Date Item was 12/8/15 Agenda Item Number -+6± -
Approved by the BCC \ x/
Type of Document COPCN Certificate and Permit Number of Original 2
Attached Documents Attached
PO number or account
number if document is ,""cL,
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. / 3 (Initial) Applicable)
1. Does the document require the chairman's original signatu ?"S4- r•v p v
2. Does the document need to be sent to another agency for a 'oval signatures?-kf 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 -1C1.8
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N ,
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. Jl f l
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 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 12/8/15 (enter date)and all
. changes made during the meeting have been incorporated in the attached document.
The County Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made, and the document is ready fo e
Chairman's signature.
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
16E4
MEMORANDUM
Date: December 11, 2015
To: Artie Bay, Accounting Supervisor
Emergency Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Certificate of Public Convenience and Necessity for an
Advanced Life Support Transport Permit and Certificate
Attached you'll find the original certificate and permit referenced above, (Item #16E4)
approved by the Board of County Commissioners on Tuesday, December 8, 2015.
A copy of both documents will be held on file in the Minutes & Records Department
for the Board's Official Record.
If you have any questions please call me at 252-8406.
Thank you
Attachment
16 E 4
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16 E4
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2016
Name of Service: Collier County Emergency Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway,Naples,Florida 34113
Business Telephone: (239)252-3740
Emergency Telephone: 9-1-1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty: 26 ground units(ambulances)
Number of Ambulances on 12 hour duty: 1 ground unit(as needed during season taken from reserve fleet).
Number of reserve Ambulances: 19
Number of non-transport ALS vehicles 11
Number of Medivac helicopter: 1
See attachment"A"for description of vehicles.
This permit, as provided in Ordinance 04-12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the
expiration date 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
applicable to the provision of Emergency Medical Services.
Issued and approved this day ofJCQm-0t Com-(,2015.
ATTEST: BOARD OF COUNTY COMMISSSIONERS
Dwight E.Brock,eLERK COLD COUNTY,FLORIDA
74P'Attest as to t . Clerk Tim Nance, Chairman
A Ft'�a Q 'yy'rm I Item# 1 E Lt
p$ g 6 &legality:
Agenda ,a 1,17
Date
Assist ounty AttorX7 c
Date 1a —G
Recd --►------
1Depu ���
16 E 4
ATTACHMENT A
Permit# ALS Year Make Model VIN
1 1453 AT 1999 EUROCOPTER EC135 N911CK
2 16170 T 2010 FORD F550 1FDAF5GR1AEB39235
3 16166 T 2010 FORD F550 1FDAF5GR7AEB25355
4 16168 T 2010 FORD F550 1FDAF5GR8AEB39233
5 16167 T 2010 FORD F550 1FDAF5GR9AEB25356
6 16169 T 2010 FORD F550 1FDAF5GRXAEB39234
7 18087 T 2013 FORD F550 1FDUF5GTODEA35168
8 18868 T 2015 FORD F550 1FDUF5GTOFEA64026
9 17257 T 2012 FORD F550 1FDUF5GT10EB23693
10 18089 T 2013 FORD F550 1FDUF5GT2DEA35169
11 18869 T 2015 FORD F550 1FDUF5GT2FEA64027
12 17258 T 2012 FORD F550 1FDUF5GT3CEB23694
13 19045 T 2015 Ford F550 1FDUF5GT4FEC82390
14 19046 T 2015 Ford F550 1FDUF5GT6FEC82391
15 18088 T 2013 FORD F550 1FDUF5GT7DEA35166
16 18866 T 2015 FORD F550 1FDUF5GT7FEA64024
17 17255 T 2012 FORD F550 1FDUF5GT8CEB23691
18 18870 T 2015 FORD F550 1FDUF5GT8FEA98764
19 19044 T 2015 Ford F550 1FDUF5GT8FEC82389
20 19047 T 2015 Ford F550 1FDUF5GT8FEC82392
21 18090 T 2013 FORD F550 1FDUF5GT9DEA35167
22 18867 T 2015 FORD F550 1FDUF5GT9FEA64025
23 17256 T 2012 FORD F550 1FDUF5GTXCEB23692
24 19048 T 2015 Ford F550 1FDUF5GTXFEC82393
25 13313 T 2005 INTERNATIONAL 4300 1 HTMNAAM85H689274
26 13312 T 2003 INTERNATIONAL 4400 1HTMRAAMX3H573348
27 15463 T 2003 STERLING ACETERA 2FZAAHBW43AK59622
28 12440 T 2004 STERLING ACETERA 2FZACFCS14AM52869
29 14123 T 2007 STERLING ACETERA 2FZACFCS17AY33965
30 12445 T 2004 STERLING ACETERA 2FZACFCS24AM52864
31 19305 T 2004 STERLING ACETERA 2FZACFCS44AM52865
32 14125 T 2007 STERLING ACETERA 2FZACFCS47AY33961
33 14121 T 2007 STERLING ACETERA 2FZACFCS67AY33962
34 12442 T 2004 STERLING ACETERA 2FZACFCS84AM52867
35 14124 T 2007 STERLING ACETERA 2FZACFCS87AY33963
36 12441 T 2004 STERLING ACETERA 2FZACFCSX4AM52868
37 14637 T 2008 STERLING ACETERA 2FZACFDJO8AZ51755
38 14629 T 2008 STERLING ACETERA 2FZACFDJ18AZ51747
39 14632 T 2008 STERLING ACETERA 2FZACFDJ18AZ51750
40 14630 T 2008 STERLING ACETERA 2FZACFDJ28AZ51748
41 14633 T 2008 STERLING ACETERA 2FZACFDJ38AZ51751
42 18881 T 2008 STERLING ACETERA 2FZACFDJ58AZ51749
43 14634 T 2008 STERLING ACETERA 2FZACFDJ58AZ51752
44 14635 T 2008 STERLING ACETERA 2FZACFDJ78AZ51753
45 14636 T 2008 STERLING ACETERA 2FZACFDJ98AZ51754
46 18871 T 2015 FORD F650 3FRMF6GZ1 FV675309
47 19304 2015 Ford EXPLORER 1FM5K8AR2FGC26953
48 19303 2015 Ford EXPLORER 1FM5K8AR0FGC26952
49 18248 2013 FORD EXPLORER 1FM5K8AR6DGC15886
50 16567 2010 FORD EXPLORER 1 FMEU7D83AUA65806
51 16566 2010 FORD EXPLORER 1FMEU7D85AUA42785
52 17877 2010 FORD EXPLORER 1FMEU7D85AUA65807
53 17878 2006 FORD EXPEDITION 1FMPU16546LA60376
54 17879 2003 FORD Crown Victoria 2FAFP71W23X186492
55 17880 2004 FORD Crown Victoria 2FAFP71WX4X124758
56 17881 2007 FORD Crown Victoria 2FAHP71W07X126287
57 17882 2007 FORD Crown Victoria 2FAHP71W27X126288
TOTAL BLS ALS(Transport) ALS(Non Transport AIR
57 0 45 11 1