The URL can be used to link to this page

Backup Documents 09/09/2014 Item #16E10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE Ft ' Print on pink paper. Attach to original document. The completed routing slip and original documents are to I o-nr he u - ,.. (?fticc at the time the item is placed on the agenda. All completed routing slips and original documents must be reeds ed in the(ouah tto •■ ( 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. KH 9/5/14 3. County Attorney Office County Attorney Office Zc ,<•-•\� C) ' J,4. BCC Office Board of County Commissioners V / 1.7.\\* 5. Minutes and Records Clerk of Court's Office -170(\ q((2_114 3`.02em 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 Phone Number 252-3600 Contact/ Department Dan Summers/Kathy einrichsberg Agenda Date Item was September 9,2014 Agenda Item Number 16E10 Approved by the BCC ` Type of Document Number of Original 2 e.acSr, ) Attached Ambitrans Certificate and Permit Documents Attached PO number or account N/A number if document is V‘,/0.. 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 original signature? KH V 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A N/A L 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 KH 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's N/A NA V. 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 KH 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 KH signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip s kr hould 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 9/9/14(enter date)and all changes made N/A is not during the meeting have been incorporated in the attached document. The County 5 an option fia 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 R W 03? /A is not BCC,all changes directed by the BCC have been made,and the document is ready for a option for Chairman's signature. d is 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 1oE1U MEMORANDUM Date: September 15, 2014 To: Kathy Heinrichsberg, Executive Secretary Bureau of Emergency Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Annual Certificate of Public Convenience and Necessity (COPCN) to provide Class 2 inter-facility transport ambulance service for a period of 1-year Contractor: Ambitrans Medical Transport, Inc. Attached is a copy of the Annual CPN and Permit referenced above, (Item #16E10) approved by the Board of County Commissioners on Tuesday, September 9, 2014. The original will be held in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment 16E10 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: 20 Ground Units available. See attachment "A" for description of vehicles. This permit, as provided by Ordinance No. 2004-12, 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. Issued and approved this `11-\-t day of Se.NAexrk\oc_> - , 2014 J?^ ATTEST ^; BOARD OF CO. TY COMMISSIONERS DWIGHT E: BRA, K; CLERK COLL , CO. i TY, FLORIDA �'. M lerk Tom Henning, Chai _ •• hest aeito signtre"only. Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney 9/9/2014 16.E.10. Ambitrans Medical Transport 16E 10 Vehicle Listing Vehicle Identification State Number (VIN) ALS or BLS Vehicle Permit # 1FDSS3ES4DDB02264 Vehicle Permit (ALS) 18015 1FDSS3ES8DDB02266 Vehicle Permits (BLS) 4776 1FDSS3ES7DDB06017 Vehicle Permit (ALS) 18017 1FDSS3ES3CDA18371 Vehicle Permit (ALS) 17149 1FDSS3ES5CDA18372 Vehicle Permit (ALS) 17150 1FDSS3ES9EDA22265 Vehicle Permit (ALS) 18211 1FDSS3ES5ADA25626 Vehicle Permits (BLS) 4677 1FDSS3ES4BDA26137 Vehicle Permits (BLS) 4775 1FDSS3ES6BDA26138 Vehicle Permits (BLS) 4475 1FDSS3ES3BDA26145 Vehicle Permits (BLS) 4355 1FDSS3ES7BDB27799 Vehicle Permits (BLS) 4777 1FDSS3ES1BDB27801 Vehicle Permit (ALS) 17027 1FDSS3ES7BDB27804 Vehicle Permit (ALS) 17026 1FDSS3ES6ADA31208 Vehicle Permits (BLS) 4678 1FDWE3FSXADA32546 Vehicle Permit (ALS) 18487 1FDWE3FS1ADA32547 Vehicle Permit (ALS) 18534 1FDXE45F2YHB54092 Vehicle Permits (BLS) 4228 1 FDSS3ES6BDB36820 Vehicle Permit (ALS) 17356 1FDSS3ESODDA41561 Vehicle Permit (ALS) 17867 1FDWE35F92HA44797 Vehicle Permits (BLS) 4133 1FDXE45F73HB48975 Vehicle Permits (BLS) 4470 1FDSS34P09DA59420 Vehicle Permits (BLS) 4615 1FDSS34P78DA64922 Vehicle Permits (BLS) 4476 1FDWE3FS7ADA69148 Vehicle Permit (ALS) 18535 1FDWE3FS5ADA69150 Vehicle Permit (ALS) 18536 1FDXE4FS9EDA75257 Vehicle Permit (ALS) 18361 Attachment"A" Packet Page -2381- . ... ...._.... ............ . .��1�v 1r v :; =0i�1rr r�%/% , QQ1rlr rlllji .\I r{r{r///• b 0 r/r/%%%',;( 74stf"), \- , ,,„,_.1„, ,, Nt.\ "(ty .' '-z'iail,"‘te---7 .' 141‘\14eAr .eir...*.ti , rvw-y. mp- \----=4 '--:=----- -. ".-i-',..2 _..--1F-- - --,_ --',-ET: f --_;-'1- _.'* --_,-- el'il 40) -3 tA rL g � o % •• a a a 0 rn rn SP / •' ..-Lg t_. - -- 7 ),„;,... . n �Nlr�r'y a< •• QQ 6 r... > .1• _ N. • 1 _ =. CD 0 O~ CD O0 o (gyp /�,'. CD is co -- g CD .� `G w O N CD A= ;r• CD kA �" w o p co N cr a, ," •' CD rn w x m "' N F, o• m 0. z :� ..:-.*a / co c c N < a , ,, ` j•' D, 0 f <D cD p m H '7 y e 0. � o n � o' � co o b � cA CD CD 0 :/ 0 �' p ,• � 0 o1'''l to -,, d �-3 ("1 CG • °• u coo o. •• w o 7� '�1 Z ii cD 0 -. .0 1).� o qo O ('� cD : 5 � o : �, � o � n (� ri�yy-> _-- .',',.>,' o Cr N r. C7 N c• �D Lz C1 G �, coo rn C�7 N y.n ` .p ..O a) cD 0 z N O v, O" • O n Z CA . U A � � R co ,� � � �• W-e � day O +rte %• Htit -I -• b to `i Z ti til 4 oo 1 c. ?; a C / r "ms N i v "C ;vwX,o m cD co B p < O 1 - .4„Y 0:7 3 07, . . , ' b,\ J /4"1-0 � �i/ � � ' l .0 I/ \� ' it \� 'II �,..