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Agenda 09/09/2014 Item #16E10 9/9/2014 16.E.10. EXECUTIVE SUMMARY Recommendation to renew the annual Certificate of Public Convenience and Necessity (COPCN) for Ambitrans Medical Transport, Inc., to provide Class 2 inter-facility transport ambulance service for a period of one year. OBJECTIVE: To renew the Certificate of Public Convenience and Necessity(COPCN) issued to Ambitrans Medical Transport Inc. (Ambitrans) for Class 2 inter-facility transport services in Collier County for a period of one year. CONSIDERATIONS: A COPCN may be approved routinely by the Board as provided by Section 50-60 of the Collier County Code of Laws and Ordinances governing medical transportion services. Staff has deemed Ambitrans' renewal application as complete and recommends that the COPCN be renewed for one year. A Class 2 operator provides post-hospital inter-facility medical transfer services,both within and outside the County. Section 50-60 of the Code of Laws and Ordinances provides: Each certificate holder shall file within 90 days of expiration, an application for renewal of his certificate. Renewals shall be based upon the same standards, as the granting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a $250.00 renewal fee. The renewal certificate may be approved routinely by the board, upon advice of the administrator, or the board may hold a hearing on same. These requirements have been met and the administrator recommends renewal. FISCAL IMPACT: There is no fiscal impact to the Board for the granting of this certificate. The Board is requested to accept and recognize as revenue in Fund(490)the$250.00 application fee with the corresponding application. GROWTH MANAGEMENT IMPACT: There is no Growth Management impact. LEGAL CONSIDERATIONS: A hearing is not required for renewal. If a hearing is held,the Board must find that the standards set forth in Section 50-57 of the Code of Laws and Ordinances have been satisfied based on competent evidence as follows: (1) That there is a public necessity for the service. In making such determination,the Board of County Commissioners shall consider,as a minimum,the following factors: a. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the County. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. Packet Page-2375- 919/2014 16.E.10. c. The effect of the proposed service on the overall cost of EMS service in the county. d. The effect of the proposed service on existing hospitals and other health care facilities. e. 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. (2) That the applicant has sufficient knowledge and experience to properly operate the proposed service. (3) That,if applicable,there is an adequate revenue base for the proposed service. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. This item is approved as to form and legality and requires a majority vote for approval. —JAB RECOMMENDATION: Recommendation to renew the Certificate of Public Convenience and Necessesity for Ambitrans Medical Transport, Inc., to provide Class 2 inter-facility transport ambulance service for a period of one year. Prepared by: Dan Summers,Director,Bureau of Emergency Services Packet Page-2376- 9/9/2014 16.E.10. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.10. Item Summary: This item requires that ex parte disclosure be provided by Commission members. Should a hearing be held on this item, all participants are required to be sworn in. Recommendation to renew the annual Certificate of Public Convenience and Necessity(COPCN)for Ambitrans Medical Transport, Inc.,to provide Class 2 inter-facility transport ambulance service for a period of one year. Meeting Date: 9/9/2014 Prepared By Name:HeinrichsbergKathy Title:Executive Secretary,Bureau of Emergency Services 8/29/2014 11:28:21 AM Submitted by Title: Director-Bureau of Emergency Services,Bureau of Emergency Services Name: SummersDan 8/29/2014 11:28:22 AM Approved By Name: pochopinpat Title:Administrative Assistant,Administrative Services Division Date: 8/29/2014 12:12:17 PM Name: KopkaWalter Title: Chief-Emergency Medical Services,EMS Operations Date: 8/29/2014 1:03:50 PM Name: SummersDan Title:Director-Bureau of Emergency Services, Bureau of Emergency Services Date: 8/29/2014 1:32:25 PM Name: PriceLen Title:Administrator-Administrative Services,Administrative Services Division Packet Page-2377- 9/9/2014 16.E.10. Date: 8/29/2014 5:09:23 PM Name: BelpedioJennifer Title: Assistant County Attorney,CAO General Services Date: 9/2/2014 9:23:26 AM Name: KlatzkowJeff Title: County Attorney, Date: 9/2/2014 10:48:53 AM Name: KimbleSherry Title: Management/Budget Analyst, Senior,Office of Management&Budget Date: 9/2/2014 11:07:58 AM Name: OchsLeo Title: County Manager, County Managers Office Date: 9/2/2014 11:17:25 AM Packet Page-2378- 9/9/2014 16.E.10.- 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 day of ,2014 A" I hST: BOARD OF COUNTY COMMISSIONERS DWIGHT E.BROCK, CLERK COLLIER COUNTY, FLORIDA ,Deputy Clerk Tom Henning,Chairman Approved as to form and legality: Jennifer A.Belpedio a�,l,`b` Assistant County Attorney Packet Page-2379- 9/9/2014 16.E.10. O Q cQ 0 v O U W 2 U 5 Z U 3 E 0 =O .o ao 0 L4 f..� Z !n is o .g C w .",t. 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Ambitrans Medical Transport .-� 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 1FDSS3ES7BDB278O4 Vehicle Permit (ALS) 17026 1FDSS3ES6ADA312O8 Vehicle Permits (BLS) 4678 1FDWE3FSXADA32546 Vehicle Permit (ALS) 18487, 1FDWE3FS1ADA32547 Vehicle Permit (ALS) 18534 1FDXE45F2YHB54O92 Vehicle Permits (BLS) 4228 1FDSS3ES6BDB36820 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 AN Packet Page 72381- 9/9/2014 16.E.10. • Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application Sec. 50-55 Procedure for obtaining certificate. An applicant for a certificate shall obtain forms from the department to be completed and returned to the division administrator. Each application shall contain: (1) The name, age and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all of the stockholders holding more than 25 percent of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. Corporate Officers/Directors Michael J. Grant,65,4351 Pinnacle Street,Charlotte Harbor, FL 33980 50% Lorraine B. Grant, 59,4351 Pinnacle Street, Charlotte Harbor, FL 33980 50% Alan J. Skavroneck,49,4351 Pinnacle Street, Charlotte Harbor, FL 33980 0% Vanessa Oliver, 33,4351 Pinnacle Street, Charlotte Harbor, FL 33980 0% Packet Page-2382- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (2) The boundaries of the territory desired to be served. Collier County Packet Page-2383- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (3) The number and brief description of the ambulances or other vehicles the applicant will have available. Ambitrans currently has twenty (20) vehicles available to its fleet. These units are permitted with the Bureau of EMS as Advanced Life Support and Basic Life Support vehicles. Through the use of the company's computer aided dispatch software, Zoll Data RescueNet Dispatch-Billing TM', management is able to staff according to anticipated demand. Staffing levels and patterns are determined using historical data and other internal statistics. Vehicles are posted in accordance with direction from our communications center personnel to specified areas to aid in proper deployment and call response. In the event of increased call volume,Ambitrans has the ability to schedule additional labor and resources to meet any unforeseen increase in market demand. Packet Page-2384- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (4) The address of the intended headquarters and any substations. Ambitrans corporate office is located at: 4351 Pinnacle Street, Port Charlotte, FL 33980 { _ _ - I-- Our Collier County substation is located at: 2157 Pine Ridge Road, Naples, FL 34109 (former NCH ambulance station) 01* : v _ k{ u Our auxiliary substation to backup the Collier County operation is located at: 935 N.E. 7th Terrace, Cape Coral, FL 33909 rte. Packet Page-2385- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (5) The training and experience of the applicant. Ambitrans Medical Transport, Inc. was incorporated in 1983 to provide Para transit services to the residents of Charlotte County. In 1988, ownership of the company transferred to its current principals. In 1995, Ambitrans commenced its ambulance operations. Today, Ambitrans operates in Charlotte, Collier, Lee and Sarasota counties. Ambitrans is compliant with Florida Statute 401 and Florida Administrative Code 64J in accordance with standards set forth by the Bureau of EMS and Department of Health as evidenced by the recent site inspection conducted by the Bureau. Our state license is valid through June 2015. A copy of our state license is attached hereto as Exhibit"A." As noted on our enclosed organizational chart, the management team at Ambitrans collectively has over 200 years of experience in the EMS industry. We employ personnel who are specifically assigned to our Training and Quality Assurance Department. Patient care reports are reviewed for quality assurance and adherence to our medical protocols and standards of care. Our education team is also responsible for our in-house training, which includes CPR, Advanced Cardiac Life Support, Pediatric Advanced Life Support, Emergency Vehicles Operators Course and on-going continuing education units needed for bi-annual certification renewal. Ambitrans' experience is not limited to Southwest Florida; our Chief Operating Officer serves as the President for the Florida Ambulance Association as State Surgeon General appointee to the Emergency Medical Services Advisory Council. Dr. Daniel V. O'Leary serves as our medical director of record as mandated under Florida Statute 401.265. This is in addition to his normal day-to-day duties as an emergency room physician at Bayfront Port Charlotte as well as serving as the Medical Director for Charlotte County Fire and EMS. Packet Page-2386- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (6) The name and addresses of three Collier County residents who will act as references for the applicant. Patricia Davis 212 Napa Ridge Road East Naples, FL 34119 Representative Matt Hudson 3301 East Tamiami Trail Naples, FL 34112 Senator Garrett Richter 2320 Harrier Run Naples, FL 34105 Packet Page-2387- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (7) A schedule of rates which the service intends to charge. Code Service Description Rate A0428 Basic Life Support Base Rate $395.00 A0429 Basic Life Support Base Rate $425.00 A0426 Advanced Life Support Base Rate $395.00 A0427 Advanced Life Support Base Rate $500.00 A0433 Advanced Life Support Base Rate—Level 2 $725.00 A0434 Specialty Care Transport Base Rate $900.00 A0425 Per Loaded Mile $10.00 A0999 Oxygen $45.00 A0999 Drugs $10.00- $25.00 IV Supplies $20.00- $25.00 Packet Page-2388- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (8) Such other pertinent information as the administrator may require. No additional information was requested by the administrator at the time of submission. However, for your convenience, Ambitrans has attached hereto a copy of its Certificate of Insurance as Exhibit"B.° Packet Page-2389- 9/9/201416.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (9) An application or renewal fee of$250.00. (Exception Collier County EMS). A copy of Ambitrans' check in the amount of$250.00 is attached hereto as Exhibit NC.N Packet Page-2390- 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (10) Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. Ambitrans'financial data is attached hereto as Exhibit"D." Packet Page -2391- 9/9/2014 16.E.10. z o g o w a• (".-,' x c T ® '° c`oo y '$ m cO :o CA 5• o W o 0 K' '1, W C N ul Er M ., m = C ov) " O A § cg =° < mm N y a r -3 D a °O D a go 1 cm ° s' T ? "°' � � m 4 5 yr m - O o a � m -n no � > m Zn cy s A mnZ,2p a ° 7 1.. , C '< -4 A , .,jr Ar q . � „j m . Y� . n � D 5. a S a r Cam 11 z zN n m 0 N r O rn ro 2. R. ° to o 0 Xi � .�\ y' E. z a_ = ° col 0 / ► ` a0 w Cht CO D .. CO ■ Packet Page-2392- 9/9/2014 16.E.10. �"•.N GRAN-01 OP ID:SC 11.:7" CERTIFICATE OF LIABILITY INSURANCE �07/03r2o an I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS t " CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 1 PRODUCER Phone:941-922-0245 REACT Bouchard-Sarasota Fax:941-923-4126 PNONE FAX 1 5310 Clark Road Suite 1 urc.No.Ertl: (A/C,No): Sarasota,FL 34233 Brian Wyies ADDRESS: INSURERS)AFFORDING COVERAGE NAIC e INSURER A:Markel Insurance Company 38970 INSURED Grant Medical Transportation INSURERS: Ambulance Mgmt Services,LLC Ambltrans Medical Transport,I INSURER C: Venice Ambulance Service,Inc. INSURER D: 4351 Pinnacle Street INSURER E: Charlotte Harbor,FL 33980 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR ADDLBUHR POLICY EFT 'POLICY EXP LIMITS u TYPE OF INSURANCE ,,, POLICY NUMBER p.uaaa •• a GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY MTK7000259601 07/01/2014 07/01/2015 DAMAGETORhNTED 100,000 PREMISES(Ea occunsnce) S CLAIMS-MADE DT I OCCUR MED EXP(Any one person) S 10,000 X Professional Liab MTK7000259601 07/01/2014 07/01/2015 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS-COMP/OP AGG S included 71 POLICY a LOC $ .----` AUTOMOBILE LIABILITY Ea accident)SINGLE LIMIT S 1,000,000 ANY AUTO MTA7000259601 07/01/2014 07/01/2015 BODILY INJURY(Per person) S — AL L O X SCHEDULED BODILY INJURY(Per accident) S X HIRED AUTOS X AUTOS AU OS ED (Per OaE ntDAMAGE S ) S X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 2,000,000 A EXCESS UAB CLAIMS-MADE MTU000259601 07/01/2014 07/01/2015 AGGREGATE $ 2,000,000 DED X RETENTION S 10,000 S WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'UABILJTY YIN ITORY UMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N r A E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S M yes,desatbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is/squired) CERTIFICATE HOLDER CANCELLATION EVIDENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE ■ ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Packet Page-2393- B 9/9/2014 16.E.10. Check Removed EXHIBIT C Packet Page-2394- / 9/9/2014 16.E.10. BRIAN W. CROSLAND,CPA, PL CERTIFIED PUBLIC ACCOUNTING&CONSULTING KwsTI L RANDOLPH AMERICAN IWSTTTUTE OF CEm1PIRD PUBLIC ACCOUNTANTS FLORIDA Immure OF CERTIFIED PUBLIC ACCOUNTANTS SHAWN M.CLARK,CPA MEDICAL GROUP MANAGEMENT ASSOCIATION COMMUNITY AssoCIATIONS INSTITUTE INDEPENDENT ACCOUNTANTS'COMPILATION REPORT To the Board of Directors Ambitrans Medical Transport,Inc. Charlotte Harbor,Florida We have compiled the accompanying statement of assets and liabilities of the ambulance transportation operations of Ambitrans Medical Transport, Inc. and subsidiaries as of June 30, 2014. This financial statement has been prepared on the income basis of accounting utilized by the Company for federal income tax reporting purposes. We have not audited or reviewed the accompanying financial statement and, accordingly, do not express an opinion or provide any assurance about whether the financial statement is in accordance with the income tax basis of accounting. Management is responsible for the preparation and fair presentation of the financial statement in accordance with the income tax basis of accounting and for designing, implementing, and maintaining internal control relevant to the preparation and fair presentation of the financial statement. Our responsibility is to conduct the compilation in accordance with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified Public Accountants. The objective of a compilation is to assist management in presenting financial information in the form of a financial statement without undertaking to obtain or provide any assurance that there are no material modifications that should be made to the financial statement. The accompanying statement was prepared for the purpose of presenting the assets and liabilities of the ambulance transportation operations of Ambitrans Medical Transport, Inc.and subsidiaries, and is not intended to be a complete presentation of Ambitrans Medical Transport, inc. and subsidiaries consolidated assets and liabilities. Accordingly, this report and related financial statement is restricted for use only by known third parties with knowledge of these restrictions and should not be used for any other purpose. August 18,2014 Punta Gorda,Florida 201 W.MARION AVENUE,SUITE 1204 Pun*GoRDA,FL33950 PnorE:(941)629-1197 FAN:(961)205-5279 EXHIBIT Packet Page-2395- D J 9/9/2014 16.E.10. Ambitrans Medical Transport, Inc.and Subsidiaries Statement of Assets and Liabilities of the Ambulance Transportation Operations Income Tax Basis of Accounting June 30, 2014 (Unaudited) Assets Current Assets: Cash available for ambulance transportation operations $ 500,000 Property and Equipment: Office equipment and computers 88,989 Machinery and equipment 245,735 Medical transportation vehicles 1,636,538 1,971,262 Less accumulated depreciation (1,781,661) Property and Equipment, net 189,601 Total Assets $ 689,601 Liabilities Current Liabilities: Accrued profit sharing $ 123,589 Other liabilities 14,925 Notes payable to banks 224,462 362,976 Lorca Term Liabilities: Notes payable to banks 472,783 Less current portion above (224,462) 248,321 Total liabilities 611,297 Net Assets Over Liabilities, income tax basis $ 78,304 Read Independr— —"flat ion Report Packet Page-2396- 9/9/2014 16.E.10. 1 0 N 7 i m cc __ 00. 3 to _ J�} -2Mco co.c LL 0 I I 4.... I OoI 0 I glitin WU0 CO. 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