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Agenda 05/09/2017 Item #16E 505/09/2017 EXECUTIVE SUMMARY Recommendation to approve a Certificate of Public Convenience and Necessity for a Class 1 and Class 2 Advanced Life Service (ALS) Rescue and intra-facility ambulance transport for the Seminole Tribe of Florida Fire Rescue within the boundary of the Seminole Tribe in Immokalee. OBJECTIVE: To proceed in the best interest of the public health, safety and welfare by granting a Certificate of Public Convenience and Necessity (COPCN), Class 1 Advanced Life Support (ALS) Transport, and a Class 2 Advanced Life Support (ALS) intra-facility ambulance transport certificate(s) to the Seminole Tribe of Florida Fire Rescue Department. The Seminole Tribe Fire Rescue Department operates exclusively for and on the Seminole Reservation in Immokalee. These certificates are subject to certain conditions noted below. CONSIDERATIONS: On March 17, 2017, the Collier County's Bureau of Emergency Services received an application from the Seminole Tribe of Florida for a Certificate of Public Convenience and Necessity (COPCN) for a Class 1 ALS Transport and Class 2 ALS Transfers. A COPCN may be approved routinely by the Board as provided by Section 50 of the Collier County Code of Laws and Ordinances governing medical transportation services. The Board’s Emergency Medical Authority has reviewed the application and voted on April 12, 2017, in the affirmative to recommend granting both the Class 1 and Class 2 certificates for a period of one (1) year following the approval of the Board. The Seminole Tribe of Florida and its Fire Rescue Department operate numerous fire rescue and ambulance services acrosss the State within the boundaries of various reservations in a highly cooperative manner with other local county governments and EMS operations. It is the opinion and findings of the Bureau of Emergency Services that this Class 1 and Class 2 certificate be granted. The Seminole Fire Rescue Department will be operating and providing services exclusively to the geographical boundaries of the Reservation. Collier County EMS and the Semiole Fire Rescue Department may bring forth Memorandums of Understanding to provide for rare situations where concurrent calls for service at, near, or within the geographical boundaries of both providers occurs and providing mutual emergency medical services assistance is in the best interest of patient care. Each agency will work under its respective emergency medical services protocol, dispatch system, billing, and medical direction. Calls for service on the Seminole Reservation in Immokalee for emergency services is broadly estimated to be approximately 50 calls for service annually as this first year of service begins operations. Seminole Tribe of Florida Fire Rescue Department employees are dually Paramedic, E.M.T., and certified fire rescue personnel licensed by the State of Florida. The Department’s Medical Director has adopted the Greater Broward Emergency Medical Directors Association (GBEMDA) Regional Medical Protocols, which are in compliance with the State of Florida’s standards for medical oversight. The Department’s Medical Director is Wayne Lee, MD. Conditions of the Certificates are as follows: 1. For the issuance of a Class 2 ALS intra-facility transport certificate limits transports to tribal members only as requested by the Seminole Fire Rescue Department application. 2. Staff is recommending the initial COPCN application to expire on May 1st 2018. 3. Seminole Tribe of Florida COPCN shall be required to be renewed annually. Its renewal application is to be received by the County no later than 90 days prior to its expiration. 4. Seminole Tribe of Florida COPCN will be required to work cooperatively with Collier 16.E.5 Packet Pg. 719 05/09/2017 County EMS, Bureau of Emergency Services, Collier County Sheriff's 911 dispatch personnel, local licensed facilities and other responders to ensure that their entry into local and regional ambulance transportation is properly coordinated and services are appropriately represented. Collier County EMS shall be allowed to conduct any reasonable inspections or site visits and receive in a timely manner any statistical call volume information needed to evaluate services, monitor complaints and address any quality of care issues. FISCAL IMPACT: This redistribution of emergency and non -emergency transports on the Seminole Reservation in Immokalee by authorizing the Seminole Fire and Rescue Department to receive a Class 1 and Class 2 certificate is expected to be minimal. There is no increase to the Collier County EMS budget for granting this Class 1 and Class 2 COPCN if approved. The Board shall also recognize and accept the $250 application fee within Fund 490. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from this action. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board action. - JAB Additionally, regarding the consideration of this item, Ordinance No. 04-12, Section 7 states: “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 Commissions shall consider, as a minimum, the following factors: (1) The extent to which the proposed service is needed to improve the overall 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. (3) The effect of the proposed service on the overall cost of EMS service in the County. (4) The effect of the proposed service on existing hospitals and other health care facilities. (5) The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. (6) That the applicant has sufficient knowledge and experience to properly operate the proposed service. B. That, if applicable, there is an adequate revenue base for the proposed service. C. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area.” Ordinance No. 04-12, Section 8 provides: “In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only.” 16.E.5 Packet Pg. 720 05/09/2017 RECOMMENDATION: 1. To accept the findings of the Board’s Emergency Medical Authority. 2. To accept the findings of the Director of the Bureau of Emergency Services. 3. To approve the Certificate of Public Convenience and Necessity for the Seminole Tribe of Florida and, up to (2) two ALS ambulances, (1) one ALS Fire Engine GPM Pumper, and (1) one ALS Fire/EMS Supervisory Vehicle. 4. To authorize the Chairman to execute the Permit and Certificate. 5. To approve a Budget Amendment to recognize and appropriate the $250 application fee. Prepared by: Dan E. Summers, Director, Bureau of Emergency Services ATTACHMENT(S) 1. Initial Application for Seminole Tribe CoPCN (PDF) 2. Seminole Tribe 2017 Stamped Permit (PDF) 3. Seminole Tribe 2017 Stamped Certificate (PDF) 4. Seminole VIN List (DOCX) 16.E.5 Packet Pg. 721 05/09/2017 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.5 Doc ID: 3086 Item Summary: Recommendation to approve a Certificate of Public Convenience and Necessity for a Class 1 and Class 2 Advanced Life Service (ALS) Rescue and intra-facility ambulance transport for the Seminole Tribe of Florida Fire Rescue within the boundary of the Seminole Tribe in Immokalee. Meeting Date: 05/09/2017 Prepared by: Title: Executive Secretary – Emergency Management Name: Kathy Heinrichsberg 04/19/2017 4:57 PM Submitted by: Title: Division Director - Bureau of Emer Svc – Emergency Management Name: Daniel Summers 04/19/2017 4:57 PM Approved By: Review: Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 04/24/2017 10:14 AM Emergency Medical Services Tabatha Butcher Additional Reviewer Completed 04/24/2017 1:18 PM Emergency Management Daniel Summers Additional Reviewer Completed 04/25/2017 3:44 PM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 04/25/2017 4:39 PM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 04/27/2017 10:33 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 04/27/2017 10:51 AM Office of Management and Budget Laura Wells Additional Reviewer Completed 04/27/2017 11:03 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 04/27/2017 1:49 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 04/30/2017 9:24 AM Board of County Commissioners MaryJo Brock Meeting Pending 05/09/2017 9:00 AM 16.E.5 Packet Pg. 722 SEMINOLE TRIBE OF FLOR!DA Fire Rescue DepartmentDonald DiPetrillo Flre Chiel/Ditcctor Telephone Ofi; 954-966-6300 exl. I1611 Fax: 863-983-8045 WEBSITE www.semtribe.com March 1", 2017 eresening Life ani lPropoty' Dan E. Summers, CEM, FPEM, Director Collier County Bureau of Emergency Services Emergency Services Center, Suite 445 8075 Lely Cultural Parkway Naples, Florida 341 l3 Re: Certificate of Public Convenience and Necessity (COPCN) Application - Seminole Tribe of Florida Class I - ALS Transport & Class 2 - ALS Transfer Dear Mr. Summers, In accordance with Collier County Ordinance No. 04-12, Chapter 50, Article III, Sections l-25 please find attached the Cenirtcarc of Public Convenience and Necessiry (COPCN) Application, for the Seminole Tribe of Florida Fire Rescue Department, to provide Basic/Advanced Life Suppon Emergency Medical Services, Class-l Transport and Class-2 Transfer services to the Seminole Indian Immokalee Reservation, located in Collier County, Florida. In addition, the department plans to enter into a mutual-aid agreement with the Collier County Emergency Medical Services (EMS) Division to provide lifesaving assistance where warranted. Your assistance with this matter is greatly appreciated. Should you have questions please contact me at your earliest convenience at (954) 966-6300 x1l6l I office. Respectfully, //-.4(% Donald DiPetrillo, Fire Chief/Director Attachments cc: file Original to County Manager's Office Seminole Tribe Fire Flescue Administrative Otlices 3105 North State Road 7 HollFvood, FL 33021 fribal Olficets: Marcellus W. Osceola, Jr. Chairman Milchell Ctpress Vice Chairman Lavonne M. Roae Secretary Peter A, Hahn frcasurfr RECEIYED MAR i 7 2017 EMERGENCY MANAGEMENT 16.E.5.a Packet Pg. 723 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue Ord. No. 04-12, $ 4; Ord. No.05-16, $ 4; Ord. No. 201l-36, $ 2 Sec. 50-55. - Procedure for obtaining ce(ificate COPCN Application Collier County (l) The name, age, and address of the owner of the umbulance or ALS Operutor, or if the owner is a corporatiotr, then of the directors of the corporution and of all the stockholders holding more than 259o of the outstanding shares. For governmental units, this information shall be supplied for ntembers of the governing body. . SEEATTACHMENT#I Marcellus W. Osceola, Jr., Chairman Age/DOB: 44 ylo,lJ6ll8l1972 Mitchell Cypress, Vice Chairman Age/DOB: 69 ylo,MlOZl1947 Cicero Osceola, Councilman Age/DOB: 48 ylo, 0913011968 Andrew J. Bowers, Jr. Councilman Age/DOB: 7O ylo, llll0l1946 ChristopherOsceola,Councilman Age/DOB:47ylo,Oll2Oll97O c/o Seminole Tribe of Florida 6300 Stirling Road Hollywood, FL 33024 Telephone: (954) 966-6300 (2) The bounduries of the territort desired to be serrcd. . SEEATTACHMENT#2 The geographical boundaries of the territory served will encompass the entire Seminole Tribe of Florida Immokalee Reservation as noted in Attachment #2. Occasionally mutual aid requests by Collier County and/or other Public Safety Agencies may necessitate responses outside the geographical boundaries of the reservation. In such cases, STFR will promptly notify the appropriate licensed EMS provider via the Seminole Police/Fire Rescue Communications Dispatch Center, or authorized interagency mutual aid radio communications channels of all such incidents. (-1) The nrunber and brief dest'ription of the antbulances or otlrcr vehicles the applicant n,ill have available. . Two (2) Medical Rescue Units (Ambulances) - Rescue 38 - Class l&2 ALS Transport and Inter-Facility (FL-ALS Permit # 19849) - Rescue 238 Class l&2 ALS Transpon and Inter-Facility (FL-ALS Permit # 14456) o One (l) Fire Engine 1250 GPM Pumper - Engine 38: Class 3 ALS Non-Transport (FL-ALS Permit #15633) . One (l) Fire/EMS Supervisory Vehicle - Battalion 38: Supervisor, Exempt [Rescue Services (Non-ALS)w/ Paramedic)] Note: Only pcrmanently assigned vehiclcs listed ahove. STFR has additional spare Fire/EMS vehicles used for lemporary maintcnance. back-fill or special events permittcd in accordance with Florida Statutes 401 and FDOH Rcgulations 6.1-E. Page I of 4 16.E.5.a Packet Pg. 724 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue (4) The uddress of the intended heodquarters und any substdtions. COPCN Application Collier County Fire Rescue Headquarters: - Seminole Tribe of Florida Fire Rescue Department 30280 Josie Billie Highway Clewiston. FL 33440 Fire Rescue Substations: - Fire Station #38 I I l0 South I st Street Immokalee. FL 34142 - Fire Station #2 30280 Josie Billie Highway Clewiston, FL 33440 Fire Station #7 660 East Hamey Pond Road Okeechobee. FL 34974 Fire Station # 108 3l 05 State Road 7 Hollywood. FL 33021 (Executive Admin. Offices) (s)The training and experience of the applicant. Experience - The Seminole Tribe of Florida Fire Rescue (STFR) Department was established in 2003 and has provided single-tier, Advanced Life Support Emergency Medical Services (ALS/EMS) since 2005 at all eight Tribal reservations and non-trust lands state wide directly or indirectly via contractual relationships. STFR employs over 130 dual certified fire and rescue personnel licensed through the State of Florida. The department directly serves 4,000 tribal members and over 22 million visitors annually at its public venues and attractions. Annually STFR and its contractual partners respond to over 12,000 requests for 9-l-l emergency and non- emergency fire rescue services. The Seminole Tribes Fire Rescue Depanment manages or provides Fire/EMS services in multiple statewide locations including Broward, Dade, Hendry, Okeechobee, Saint Lucie, Polk and Hillsborough Counties. The department is highly recognized by the State of Florida DOH/EMS Bureau and receives outstanding ratings on all annual EMS in-service inspections. It is 1007o complaint on annual data reports to DOH/EMS, NFIRS and FFIRS incident data collection systems sent directly to federal, state and local agencies. As the primary base of operations for the Tribe is in Hollywood, Florida; the Broward County Office of Medical Examiner/Trauma Services continually reviews the department's operations and receives excellent ratings among all local EMS providers. STFR routinely participates in county, state and regional associations or activities for fire rescue and emergency medical services in each community served. STFR's Executive/Management team averages 34+ years' experience in fire and emergency medical services: and field operations personnel average 9+ years of experience. Several staff members have been recognized by the state or other EMS organizations and awarded such distinctions as; "Firefighter/Paramedic of the Year", and "Paramedic Instructor of the Year". Page 2 of 4 16.E.5.a Packet Pg. 725 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue (5) Continued COPCN Application Collier County A'I'TACHMEN'I'#3 Training- All Seminole Tribe of Florida Fire Rescue (STFR) employees are dual-certified fire and rescue personnel licensed by the State of Florida. The depanment provides vigorous six (6) week multi-disciplinary Fire/EMS orientation training program for all new employees. An additional ( l2) month probationary "in-service" skills sign-off program is mandated for successful completion by all new employees. Every two years all personnel must successfully complete a continuing education medical training matrix including but not limited to the State of Florida EMS mandatory thirty (32) contact hours to include ACLS, Protocols and "hands on" lab skills testing, etc. The department's Medical Director has adopted the Greater Broward Emergency Medical Directors Association (GBEMDA) Regional Medical Protocols, which are in compliance with the State of Florida's standards for medical oversight. The Tribes Medical Director Wayne Lee, MD is a certified Ernergency Medical physician with more than 40 years' experience as a local and statewide leader in the field of medicine. In addition during 2016, the department delivered 187 life safety classes (CPR/AED/Fire Extinguisher training) to 3,157 Tribal Gaming employees; and Crowd Manager Classes to 480 employees. In addition STFR provided 269 Youth Safety, Senior Safety and Fire Drill presentations to 7,039 Tribal children, seniors and employees and also 3l CPR /AED classes to 370 Tribal members and employees. This pro-active life safety training reached over I1,000 people in 480 presentations totalingT ,771 staff hours. The rumres and addresses of three Collier Countl' residents who u'ill uct as rekretrces for the applirunt. Tina Marie Osceola,5920 Westport Lane, Maples, FL 341 16, Ph. (239) 298-3279 O.B. Osceola, Sr., 5870 Westpon Lane, Naples, FL 341 16, Ph. (239) 455-2171 Michael D. Murphy, 1280 San Marco Rd., Marco Island, FL 34145, Ph. (239) 393-0099 (7)A schedule of rates w'hich the sert'ice intends to charge. Class I - ALSiIf LS Emergency Transports Only ** The Seminole Tribe of Florida contracts with ADPl-Intermedix, 500 NW 165 St., Ste. 102. Miami, FL 33169, (30-5) 945-2280 for all EMS patient transportation billing/collections services. All non-emergency Class 2 - EMS lnterfacility Transports are strictly for the private use of Seminole Tribal mernbers and billed directly to Medicare eligible patients only. (6) **Mileage Rate = $15.O0/mile Page 3 of 4 Call Level Rate BLS s660.00 ALSI $800.00 ALS2 $ 1,000.00 16.E.5.a Packet Pg. 726 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue (8) Such other perlinent information as the administrator may require. COPCN Application Collier County o ATTACHMENT#4 Florida Depanment of Health Bureau of Emergency Medical Oversight Advanced Life Support License #2603 o ATTACHMENT#5 Cenificate of General Liability Insurance (STOF) o ATTACHMENT#6 Hany W. Lee, M.D. - Medical Director License o ATTACHMENT#7 Florida State Fire Marshal - Ce(ificate of Appreciation 2015 o ATTACHMENT#E Certificate of General Liability Insurance (Medical Director) (9) An uppliuttion or renewol fee of $250.00. (Exceptiur Collier County EMS). o ATTACHMENT#9 Payment to Collier County enclosed with application - Check # 7MEl5 (10) Financial data includirtg assets and liabilities of the operator. A sr:hedule of all debts encunrbering an! equipment shall be irrcluded. o ATTACHMENT#10 Seminole Tribe of Florida Fire Rescue Department FY' l7 Annual Budget Mission Statement: "To protect and enhance the quality of life of the Seminole Tribe of Florida communities, through a comprehensive program of services committed toward education, prevention and control of fire, rescue, medical emergencies, life safety, forestry and all hazard responses." Motto:.LOVE ALL, SERVE ALL" Laa pkon Aa nookaa- c he k, laapkon Em pac lrc k Values: We e.ypect to make a clifference in the quali* of hfe to the Seminole Tribe and guests- To this end, we focus our resources for the most enduring benefit.. Improve the quality of life safety through education and code enforcement to prevent fires, reduce injuries and other harmful events.o Deliver responsive and caring emergency services.. Protect life and property from fire, hazards, injuries and illness.o Mitigate emergencies and disasters, both man-made and natural.o Enhance customer and communitv relations. Page 4 of 4 16.E.5.a Packet Pg. 727 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Collier County COPCN Application 2017 ATTACHMENTS: 16.E.5.a Packet Pg. 728 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue ATTACHMENT #1 COPCN Application Collier County l/islory Gwemnqt Tanbm EnlaV661 Sqnin&lrihne Enffyruf Go\emment Government Trihal Council Introduction TodaYs covemment Tribal Council Board of Directors Tribal Court Emplotm€nt I rlfrllf l.itchcll Cylrr?'t Vrcc Charrman cLri. orc6l. Hollyvrood councilman ^ IlE l{$tutlri$ r \,.ndor,lpplicatiot > schdJl FiLld 'l.iFr Sitc lofo , Sitc Map > Purcha!€ Ord€r'ltrms aod Cordltiolr. &tfirrd, 680l) Srirlint Rlnd llolh&rod. 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Patient History from an Alert and Oriented Patient 2. Comprehensive Normal Adult Physical Assessment Techniques 3. Comprehensive Normal Pediatric Physical Assessment Techniques 4. Airway, Oxygenation, and Ventilation 5. DirectOrotracheal lntubationAdult 5. Direct Orotracheal lntubation Pediatric 7. Nasotracheal lntubation Adult 8. Supraglottic Airway Device Adult (LMA) 9. Needle cricothyrotomy 10. Surgical Cricothyrotomy 11. CPAP 12. Trauma Adult Physical Assessment 13. Pleural Decompression 14. spinal lmmobilization Adult (Supine Patient) 15. Spinal lmmobilization Adult (Seated Patient) 17. Traction Splinting 18. Hemorrhage Control 19. Medical and Cardiac Physical Assessment 20. lntravenous Therapy 21. lntraosseous Therapy 22. lntravenous / lntraosseous Bolus Medication Administration 23. lntramuscular Administration 24. lntranasal Medication Administration 25. lnhaled Medication Administration 26. Glucometer 27. l2-lead ECG 28. Synchronized Cardioversion 29. Defibrillation 30. Transcutaneous Pacing 31. Normal oelivery with Newborn Care 32. Abnormal Delivery with Newborn Care NT SKIttS tAB - STA 8. lntraosseousTherapy 9. lntravenous / lntraosseous Bolus Medication Administration 10. 12-lead ECG 11. Synchronized Cardioversion 12. Defibrillation 13. Transcutaneous Pacing 1. Direct Orotracheal lntubation Adult 2. Direct Orotracheal lntubation Pediatric 3. Supraglottic Airway Device Adult (tMA) 4. NeedleCricothyrotomy 5. SurgicalCricothyrotomy 6. CPAP 7. PleuralDecompression 16.E.5.a Packet Pg. 738 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue STATION SKILLS tAB COPCN Applicaiion Collier County License f: ATTACHMENT #3 SEMINOLE TRIBE FIRE RESCUE DEPARTMENT TRAINING DIVISION NAME:YEAR:EMT OR PARAMEDIC ID tr: skiI Date lnitials tD t Date lnitials tDf Date lnitials ID fl 1. Direct Orotracheal lntubation Adult 2. Direct Orotracheal lntubation Pediatric 3. Supraglottic Airway Device Adult (LMA) 4. NeedleCricothyrotomy 5. Surgicalcricothyrotomy 6. CPAP 7. PleuralDecompression 8. lntraosseousTherapy 9. lntravenous / lntraosseous Bolus Medication Administration 10. 12-lead EcG 11. Synchronized Cardioversion 12. Defibrillation 13. Transcutaneous Pacing District Chief Name: District Chief Signature: 16.E.5.a Packet Pg. 739 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue COPCN Applicaiaon Collier CountyATTACHMENT #3 SEMINOLE TRIBE FIRE RESCUE DEPARTMENT TRAINING DIVISION NAME: DEPARTMENT SKILLS LAB EMT OR PARAMEDIC ID #:YEAR;License f: skill Date lnitials tDr 1. Direct Orotracheal lntubation Adult 2. Direct Orotracheal lntubation Pediatric 3. Supraglottic Airway Device Adult (LMA) 4. Needle Cricothyrotomy 5. Surgical Cricothyrotomy 6. CPAP 7. PleuralDecompression 8. lntraosseousTherapy 9. lntravenous / lntraosseous Bolus Medication Administration 10. 12-lead ECG 11. Synchronized Cardioversion 12. Defibrillation 13. Transcutaneous Pacing 14. Patient History from an Alert and Oriented Patient 15. Comprehensive Normal Adult Physical Assessment Techniques 16. Comprehensive Normal Pediatric Physical Assessment Techniques 17. Airway, Oxygenation, and Ventilation 18. Nasotracheal lntubation Adult 19. Supraglottic Airway Device Adult (LMA) 20. Trauma Adult Physica I Assessment 21. Spinal lmmobilization Adult (Supine Patient) 22. Spinal lmmobilization Adult (Seated Patient) 23. Joint Splinting 24. Traction Splinting 25. Hemorrhage Control 25. Medical and Cardiac Physical Assessment 27. lntravenous Therapy 28. lntramuscular Administration 29. lntranasal Medication Administration 30. lnhaled Medication Administration 31. Glucometer 32. Normal Delivery with Newborn Care 33. Abnormal Delivery with Newborn Care Proctor Name:Signature: 16.E.5.a Packet Pg. 740 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) r o E o5 ! A D F Ilola.tl sll ol a IL' 33Blo ..,r H a{l.f,| \o \l5l E o(Ld6 3oo --o 3g QCE.CgU 9.q N='tr .ooa do Eg Ed6 ;-ar: a. =E u,d3 1 HE r- i=, 7.'= !io I =s= >.tfE tr -E .= .9 q,EE; Ell rE ij 1 JE --:tB e-r -lv,= i'..:: i6= r-,ti :Ed 1 e^.E € tCl-LilEEO C'(J=* too=bE:'' vrEBt= >2E-th9 1ro o5 4ce 6--i 9? cro.Y aea z-st fr.EO F:+ a =a)0, EfI'o=(,E()8E^z_Ed ol J E. zo F.pr, 'LlJb9!-,zi&i Zs ,l F] la Td q) €a{o I I I I I IFI-l(,-l oEl*:ltll .i rOur 41F -t9 ElJdfr trsee 3?IJF r.J bHF 3._)5 eLC' (,, ofi=H d =lH= hlbEft IIesg aftEX I6u-i 6OZfE IJJ d,D @ aa .9 CDro O)(t o d,o ll- IIo IJJF o Fz Lr.l I(-) FF q g z()(Ioo p 9 9o, EO 16.E.5.a Packet Pg. 741 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) CERTIFICATE OF LIABILITY INSURANCE of 21 09 /29 /20L6 rHE CERTIFICATE IS ISSUEOAS A MATTER OF INFORUATION ONLYANO CONFERS NO RIGHIS UPOt{ IHE CERTIFICATE HOLOER. THIS CERNFICATE DOES NOT AFFIR]XATIVELY OR NEGATIVELY AMEXD, EXTENO OR ALTERTHE COVERAGE AFFORDEO BY THE POLICIES BELOW. TH|S CERTTFTCATE OF TNSURANCE OOES NOI CO STTYUTE A CO YRACT BETWEEN THE TSSUTNG TNSURER(S), AUTHORTZED REPRESENTATME OR PRODUCER, ANDTHE CERTIFICATE HOLOER. ImPORTANTT Itth. c.d,lc.lr hold.r l..n AODITIONAL lt{SUREO, th. pollcy(Lt)murt bc rndo.lrd. IISUBROGATION lS WAMD,3ubl.c-i to tha tarma and cordruorlt ol thc pollcy, ccrtaln pollcl6 may rrqulrr an andortrmont A 3tatanant on thla cortlflcalr do6 not co.rfaa rlghta to tho cartfirata holdar ln lbu of tuch andoGainairqa). rt1lt. ot t.r.., Iac. c/o 25 c.atury Blvd- P.o, lor 305191x.rbYl11., lll 3?230-5131 ffi,,,, rzz-grs-zrza li# *." eee-rez-zrze i;g+''.. cartl.llcrt..rv,.l11. - ca INSURER(S)AFFORDNG COVERAGE TNSUREiA Bud.o! I!.ur.!c. Cqr.ry 2505a-00r 8abo1. lrtb. ot tlorld.Iarur.nc. t t1.L L.o.gc!t D.9t. 5300 tt1!lt!g td lolryrood, ll 33021 rNsuRER I t.tlEgtoa IErut.lc. cq,&y 19at7 - 001 TNSURERC ll.r Yolt Irr1[. f o.n.r.l Iarunac. caD.15 608 - 000 INSURERO NSURERE Seminole Tribe of Florida Fire Rescue ,eiopif ,tFFt?.F COPCN Application Collier CountyATTACHMENT #5 Coll:{96?995 rpl:20837'15 ccrt:2180{58{ OleEt-2014 THIS IS TO CERTIFY T}iAT I1IE POUCIES OF IT{SURA'{CE USIEO BELOW ttAVE BEEfl ISSUED TO TTIE ITISUREO MAIED ABOVE FOR IHE POIICY PERIOD INUCATED NOTWIIHSTANDIXG ANY REOUIREA4E'{T, IERM OR COTiOMO'{ OF ARY CONTRACT OR OIHER OOCUME,{T U'I}l RESPECT TO W{CH IHIS CERNFrcATE MAY BE ISSU€O OR MAY PERTAIN THE IIISURA'{CE AFFORDED 8Y I}IE POI.ICIES OESCRIBEO HEREIT{ IS SUBJECT TO AI.L THE IERI.IS, EXCLUSIOiISAXDCOIIOmO SOFSUCHPOLICIES LllrlTS SHO!t/ll MAY HAVE SEEI REOUCED 8Y PArD CIAIMS A __l cLAr.s-rr^ELII ocq.n NAro0058-15 Lo /7/20L6 lo./ L,/ 2071 €AC}I OCCURRENC€10.000.000 mgoffi{$Estg-,300.000 MED F,XP (Arry d!. ,16)s,000 PERSoiUT T A.,1/ INJ(FY 10 .000, 000 AOGREGATE LITIT APFiJES PER "o''EF"9 I.o" 6ENERA! AC'GREGAIE 10,ooo-000 10.000,000 A I At! r ---l o..o-.uAl[Y xror\aEo t-___lsctc,qr.EoI ^JrG I Lt,Ios I retoruros f]ffilTt xrlo0 0 5 816 NACI.o0851-03 LO /Ll2016 LO /Ll2o!5 t0 / 1/ 2017 ro / 1/ 2ot1 UANEOSINGIEIIMIT 10,000,000 @(rLY INJURY(Pi FE) 8@rLY rruURY(r\., &dar) B r.rrra.re trer [!_.] occr,n rreg rree I lcrlre-r^q 020780835-02 L0 /1/20L6 LO/r/2071 €ACH OCCURRENCE 15, 000, 000 ^GGREGAIE 15.000,000 ao I laererno.r c rxrlrlpYEtl'u rJrY Yri| ^xY ProPeElOR/P a EfUE{CLtfl\E T.-;1 oFFrcER/taEuE€RExcu,DED" LaJ DtiCRrPTtOar OF GRAIIO,TS iaoi wc2 016EPP0 03 9I L0 /r/20L5 LO/7/2077 -- I PER I toTli-I I<T^TITF I IFrl E L EAC8 ACOE|vT 1,000,000 E L OSE'S€ - EA EgPIOYEE 1,000,000 E L OSEAS€ , r'CltrCY ULrl 1,000,000 @anl Rdrtt. lkrtanr, dvor.tL.id rlrco *ro r. nqlh.l trgutP1o.at.1 NrE6t 'g.rlnol. rrlbc ol llorld.golDola SDorE XrBrgGDaat, LLC tfatlv6 Amrlcan lr.val. LLc 86l,B0I. rrlt 8ttc.t ProPcrtl.., 5365 Taft. L&C Plr.t t!.rlcrD Xu.l'c & Eit.rtrlDEcDt,LLC SHOULO AXY OF THE AAOVE DESCRIEEO POUCIES 8E CA'ICELLED BEFORE THE EXPIRATION DATE IHEREOF. NOICE TMLL 8E O€TTVERED IN ACCOROANCE VITTH lHE POLICY PROMSOT{S s.6tnol. trlb. o! llorld. 5300 atlrll Eg tordP.!brok. PlD.t, lL 3302{ ACORD 25{201,Uor)ThG ACORD n.me and loeo.to rtglttorod m.tb otACORO l!!6lY6d. 16.E.5.a Packet Pg. 742 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) lam leq /lroleq p€ure! ,o sattu PUe afiBl aql 'a -9l!E!9 x o\ F; =2 ZFg E5 g43 13 =.Ee -6.u ?E o E= Fo! I O Fo x_ zt TIJ o(, HrlrgH Jo tN:lrtr8Yd3o YOTUOU JO frVJ.ST9Z-0Ee z -) .. Fo(,) =llJ_d u{i s =EEi= s3E o ot! oE. o 0) l 'o o ;o (DE JI! ui) od uJo5 J FEol! $ o E oc =o o)o ! 0) E(uc doFooo J Iou, =a-F ts J clo tlJvlo trJt t! J o_Lo C) uJoz trD -ait u.r F!Jlr<r^r=;oZJE'< =c) EE HEzo (r, =o o a.oJlJ- ILo ulF Fv, 16.E.5.a Packet Pg. 743 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) z^ .2 1) Ea,ur.a tr,-H E,''.59 *.+ i Eltr6',,9! : t- 'i:i g..E )Eo >t tro()F.a9 o "=g 'O l-aut<a'E(uF }{=tu c).=>.,I EE E El :B $ Yxl E F s E{I {E ? .EfiI EE Etsr;l xG E &'rl Eg E FEI EF Z E.El Ez g#l $+ +JliEoU (h (_,t_ 4L<octs € 6Bcts Uo *{ O-,da42QHeoe\Ia,lJ E\IU eEcH €HoU AHocl+) CJo cf) A)<Ho 4:)'-= a6q >'SaWb0l=AAH5\l .Fl =EaPuu9< d,cd(=€t+,1 A,-t tia€+J ci;*U!\,d{=J H(n? H.tstr dEol $.'ro -g \ rg4irr liNS -I -i C)rG,L- l-l L'r. iJi O llr\.):CtO. t!gEI a =.-.,{ E'E A..... - 5a'= t-J <= a].oo f-z Lrl =I O f-F p I I 0,f;fai E- 16.E.5.a Packet Pg. 744 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) Seminole Tribe of Florida Fire Rescue ATTACHMENT #8 COPCN Application Collier Countyd cE?iTIiiHrE oF LrABrLrrY rNSURf;fi& CERNFIC TE I{OLDER CAI{CELLATIOX MRH THIS CERNFICATE IS ISSU€O AS A iIATTER OF II{FOR ATIO CERTIFICATE DOES TOT AFFIRflATIVELY OR IIEOANVELY A E D, EXTEID OR ALTER fHE COVERAGE AFFOROED BY THE POUCIES BELOW. TH|S CERTIFICATE OF lNSURAi{CE OO€3 raOT COISITUTE A COi|TRACT BETUVEEX THE tSSUtt{G |I{SURER(S), AUTHORTZED REPRESEiIIANVE OR PROOUCE& AXD THE CERNFICATE HOLOER. the tenns and condldona ot tha pollcy, cortaln pollcloa may Bqulro an ondoEemonl A rtatoment on tht! co.tmcato dos!not conL. rlghl! to tha confbats holder ln lleu ot ruch Advrncad lnaurrncr Undorwttorr 3250 N. 29th Avc Hollytvood, FL 33020 Hsry Wayno Loa, MD cro S.mlnolo Trlbs of Florlda 6300 Surllng Ro.d Hollywood, FL 3302,1 CERTIFICATE NUMBER: THIS IS IO CERTIFY THAT T}€ POLICIES OF INSI'RANCE LISTEO SELOW HAVE BEEN ISSLED TO THE INSUREO NAMEO AAOVE FOR THE POIICY PERI@ I}OICATED, I'IOT\'VTHSTANDiNG ANY REQUIREMENT. IERTI OR CONOITION OF A Y CONTRACT OR OITIER OOCUMENI WITIJ RESPECT TO VII.IICH THIS CERTIFICATE MAY BE ISSI.'EO OR MAY PERIAIN, TTIE INSURANCE AFFOROEO AY THE POLICIES OESCRBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES LII'ITS SHOIAA MAY HAVE AEEN REO(]CEO BY PAID CLAIMS, og,El^r t|^lulY-l *ra*^a *o" a a,^",.*-T--l "*r". o. l-l *"*-1- € CH OCCURR€rcE I irED EXP (^ry F.6)! PERS€'IAT IT ADV ITIJURY G€NERAAG6REGAIE GEN'L A6GRE6ATE LIIIIT APPLIES P€R mooocTs , colrP/oP acc t tm.trJAx.lrY I *, ^.oIeuomroI^urc u l"neoewos I I SCI]EDULEO AUTOS EO AUTOS con6lNEo srNGlE uilrI EOOLY IiLURY (Pr pds)I a@rLY |NJ{JRY (Px did.nr}J ! I uEeEu.r ru! | loccuR ErcEls !ra! l--l ".r,rrrr oa E CH OCCLFRENCE I AGGREGAT€ o.o | 1""r.*o.,r wotxcit coFCll3 lloll At{o EPtolEit IJAIaJIY Ylt ^NY PROPRIETOR]PARINE&E(€CUT IVET_I sncE&raEIEEi ETCIUOEO? I I {I. rr.!.., h xxl .f <erfrr6N .tF .tPER^IaxlS d- rla sf^Trr- I ioll! €L €rcB ACCIO€NT E L OSE SE. EA ETPIOYEE E L clSE]^S€, POLlc'/ UMl-r Prot Ltab Clalm! ilado ,U5rO5 R.tro D.t. PEO0000032,!111 u/05/20r'i t250,000 Esch Clalm 3750,000 Aggr?gate 37.50O deductible DCtCBPrOrrt Oa OP€R rrlis ' L()cAlrOX! /VElllCLES l^n&n ACOiO loi, Addtrool R.d,t. !kn.dd., i tun 9.c. rr -qslrd) SHOULD AXY Of TIIE ABOV€ D€SCRIBED POUCIES AE CAI{CEI.JID EEFORE Tho scminoto Trlbo ot Florld. I iiii;-E;in;bi' oarE rHEiEoF, M)rcE rnrl a€ o€trvERED rf, 6300 Sdrllng Rd I Accof,D^xcE wtrH rxE PoucY PRovlsol{s. Hollywood, FL 33024 AUnlonZEOiE lrEt€f,r lWE 4/,a.cd c!,.aa.cz ad."t".zL., //.-o O 1986-2010 ACORD CORPORATIOT{. All dght r€s.rvod. ACORo 25 (2010/05) I ofl ts1356598/U1356595 Tho ACORO n.me and logo a.o .oglllered marta ot ACORO ACORD," 16.E.5.a Packet Pg. 745 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) ATTACHMENT #10 COPCN Application Collier CountySeminole Tribe of Florida FY17 Budget Fire Rescue Department Revenue 7,465,700 Salary & Benefits L3,322,700 70000-Contract Services 351,100 70045-Hardware/Software Maintenance Contracts 50,000 04-Contract Services 411,100 71000-Telephone & Communications 6,300 71010-Wireless Communications 31,900 71315-Cable/Satellite 3,100 05-utilities 41,300 71500-Building & Grounds Maintenance 57,700 71740-Gas, Oil, & Diesel Fuel 151,400 71750-Equip Maintenance & Repair 76,100 71755-Vehicle Repair And Maintenance 268,400 05-Maintenance 553,600 71800-Equipment 240,700 71815-Medical Equipment 10,200 71835-Audio/video 6,800 07-Equipment 257,100 72000-Equipment Rental & Lease 3,000 72040-Vehicle Leases 5,000 08-Rental & Lease 8,000 73000-Office Supplies 6,900 73060-Office Furniture 3,000 73070-Printing 5,300 73200-Postage & Mailing 300 73300-Dues, subs & Books 15,400 73400-Department Food Supplies 1,500 73500-Department Supplies 205,000 7351o-Copy Machine Expense 18,600 73530-Uniforms 82,800 7375o'Construction Materials & Suppl 7,400 09-Supplies & Material 342,200 74020-Mileage Reimbursement 2,000 74090-Parking And Tolls 200 74460-Airfare 2,704 74470-Hotel 72,204 74480-Rental Car 100 74490-Meals 5,700 10-Travel 22,300 75210-Motor Vehicles lnsurance 115,100 12-lnsurance 116,100 75890-lmmokalee Fire Rescue 75,000 75855-St. Lucie Co. Fire Rescue 25,000 75850-City Of Hollwood Fire Rescue 300,000 14-Security & Protection 400,000 76030-workshop/training 26,700 76200-Meeting Fees & Expense 200 15-Trainin&/Meetings 26,900 16.E.5.a Packet Pg. 746 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) seminore Tribe of Frorida ATTA.HMENT#1. ""t"Affillff"'il FYU Budget Fire Rescue Department 75550-Community Activities 2,500 17-Event Activities 2,500 79020-Food & Beverage 3,900 79095-Auction Fees 100 79100-Bad Debt Expense 258,000 20-Other 262,O00 94000-lnterest 27,904 94030-Capital Lease Payments 375,500 31-Finan€ing 397,400 71825-Computers & Printers 43,000 79135-Software License Expense 81,500 37-lnformation Technoloty 124,500 Total Expenses 2,95s,000 Total 8,822,000 16.E.5.a Packet Pg. 747 Attachment: Initial Application for Seminole Tribe CoPCN (3086 : Seminole Tribe of Florida Fire Rescue Department) COLLIER COUNTY FLORIDA Cle*r (1, end Clesr .2' COPCN Name of Service: Seminole Tribe of Florida Namc of Owner: Seminole Tribc of Florida Principlc Address of Service: 6300 Stirline Road Hollywood. FL 33024 Busincss Telephone: (954) 966-6300 Description of Service: Class "1" Emergency Medical Transoort: Class ..2', Intra-faciliw and out-of-county transport for tribal membcrs. Number of Ambulances: (2) Two. (1) One Fire Engine 1250 GMp pumper. and fl) One Fire/EMS S uoervisorv Vehicl e. See attachment "A" for description ofvchicles. This pennit, as provided by Ordiunce No. 2004-12, as amendeq shall allow the above naned Ambulance Service to operate intra-facility and out ofcounty transports for a fce or charge for the following area(s): Seminole Tribe ofFlorida Fire Rcscue Department borurdaries for one year fiom the date executed herco& except thal this p€f,rnit may be rcvokcd by thc Board of County Commissioners of Collier Courty at any timc the service namcd herein shall fail to comply with any local, state or fcderal laws or rcgulation application to the provisions of Emergency Mcdical Serviccs. Issued and approved this day of 2017 ATTEST: DWIGHTE. BROCK CLERK ,Depny Clerk Approved as to form and legality: Jennifer A. Belpedio Assislart County AttorDey BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA Penny Taylor, Chairman ^F ^t's" o\- [ 17.EMG.00390/ l3]3747l I l /.\{>-1\..Q,/ 16.E.5.b Packet Pg. 748 Attachment: Seminole Tribe 2017 Stamped Permit (3086 : Seminole Tribe of Florida Fire Rescue Department) WHEREAS, WHEREAST ATTEST: DWIGHT E. BROCK, CLERK , Dcputy CIGrk Approved I ao form and lcgality: SEMINOLE TRIBE OF FLORIDA FIRE RESCUE CERTIFICATE OT PUBLIC CONVENID,NCE AND NECESSITY WHEREAS, thc SEMINOLE TRTBE OF FLORIDA FIRE RESCUE (hcreinaftcr .,seminolc Tribe") wishcs to proido intra-facility transports and out ofcourty transpons for a fee or charge; and, it has bccn dcrnonstratod that thcre is a ne€d for this ombulancs s€rvicc to opcratc wifiin the boundary of thc Scminolc Tribe in Immokalee thc above mentioned service has indicatcd that it will comply with all requircmcnts of Chspter 4Ol, Florida Siatutcs, goveming €mergency m€dical tclecommunications and transportation, the Board of counry commissioners of coLLlER couNTy hcr€by issues a ccrtificarc of public convcnicncc and Neccssity to this ambulance service for onc ycar from effcctive dste. ln issuing this ccrtificatc, it is unddsaood that thc above named Embulancc scrvicc will m€cl the rcquircmcnts ofOrdinance 2O(N-12, as amendcd, applicablc laws and rcgulations and provide service on a 24 hour basis. BOARD OF COUNTY COMMISSIONERS COLLIER COTJNTY, FLORIDA Penny Taylor, Cheirman Jennifer A- Bclpedio Asistrmt Couty Attomcy s's\'*\J Ilate Signed Efrcctivc DEl.: Msy 9, 20 I 7 Expiradon Darc: May I , 20 I 8 16.E.5.c Packet Pg. 749 Attachment: Seminole Tribe 2017 Stamped Certificate (3086 : Seminole Tribe of Florida Fire Rescue Attachment “A” Seminole Tribe of Florida Fire Rescue Department Immokalee Reservation Station VIN List - 2017 . Two (2) Medical Rescue Units (Ambulances) - Rescue 38 - Class l&2 ALS Transport and Intra-Facility (FL-ALS Permit # 19849) - Rescue 238 Class l&2 ALS Transport and Intra-Facility (FL-ALS Permit # 14456) . One (l) Fire Engine 1250 GPM Pumper - Engine 38: Class 3 ALS Non-Transport (FL-ALS Permit #15633) . One (l) Fire/EMS Supervisory Vehicle - Battalion 38: Supervisor, Exempt [Rescue Services (Non-ALS)w/ Paramedic)] 16.E.5.d Packet Pg. 750 Attachment: Seminole VIN List (3086 : Seminole Tribe of Florida Fire Rescue Department)