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Agenda 09/10/2013 Item #16E16 9/10/2013 16.E.16. 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 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. It should be noted that Staff will be bringing a future item to the Board to recommend an amendment to the medical transport ordinance to allow the Board to issue renewals to extend the COPCN for Class 2 inter-facility transport services in Collier County for a period of two years. 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: This item is approved as to form and legality and requires a majority vote for approval. -JAB RECOMMENDATION: Recommendation to award a Class 2 Certificate of Public Convenience and Necessesity to Ambitrans Medical Transport Inc. for a period of one year. Prepared by: Dan Summers, Director, Bureau of Emergency Services Packet Page-1644- 9/10/2013 16.E.16. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.16. Item 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. Meeting Date: 9/10/2013 Prepared By Name: BoniChristine Title: Administrative Assistant, Senior, 8/22/2013 9:27:44 AM Submitted by Title: Director-Bureau of Emergency Services, Name: SummersDan 8/22/2013 9:27:45 AM Approved By Name: SummersDan Title: Director-Bureau of Emergency Services, Date: 8/22/2013 11:21:40 AM Name: pochopinpat Title: Administrative Assistant,Facilities Management Date: 8/22/2013 12:35:20 PM Name: BelpedioJennifer Title: Assistant County Attorney,County Attorney Date: 8/23/2013 4:47:31 PM Name: PriceLen Title: Administrator, Administrative Services Date: 8/27/2013 10:42:17 AM Packet Page -1645- 9/10/2013 16.E.16. Name: BelpedioJennifer Adok Title: Assistant County Attorney,County Attorney Date: 8/27/2013 5:01:11 PM Name: KlatzkowJeff Title: County Attorney Date: 8/28/2013 10:40:28 AM Name:PryorCheryl Title: Management/Budget Analyst, Senior,Office of Manag Date: 8/28/2013 10:55:08 AM Name: OchsLeo Title: County Manager Date: 8/29/2013 5:09:31 PM Packet Page -1646- I 9/10/2013 16.E16. ch ° o - •= b N > o ' 0 c y o U Q. ag a.) U • ca o`. y s N ..:. N F, o U E > r " 4.. O v C Cl) a) �." 0 o V h V .0 v W m c m .2 i ,is Cl) z w 3 b a) = 0 tO o x H z �, w e o • 0 Z z cr , ° — c CO an c 00 a Q ro n `i' Q o �., c U C/1 U o w^ .3 0 N rd W. Q 414 .° V 'ti N 0 0 N 6, W n 'c a� o F �.: H .a o W 0 ., 43� ., > W a�b a? 0 9 ea iii p p o U)010 0 O ° w w W a) 0 'Uo ci [) ao ❑ o F Q z o w ° 0 w 2 w a> .0 5 a a) 5 °: o C...) a.. >. c 4., C a W V 0 g U v U y e2. 2 6 z - 4 .- ^ V '97 1:1 0.o o - CO U i y ; c -a $ 4., .N aV b .a c 0 v °0 v 8 U .d v A L4 00 J a) >, V acal E 0 V o Ga o 7 c Cl)' Q vi' . w — o W W W E-' F-' .o QU g a a v) x a) 3 3 33 w a = - ¢ Q ¢ ., Q Packet Page-1647- 1 9/10/2013 16.E.16. 4351 Pinnacle Street Charlotte Harbor, FL 33980 AMBITWIS (841) 743-3665 ~ Fax: (941) 629-7314 July 12, 2013 Walter Kopka EMS Chief CoUIer County EMS 8075 Le ly Cultural Parkway Suite 267 Nap|en, FL 34113 Re: COPCN Renewal Application Dear Chief Kopka: Ambitrans Medical Transport, Inc. (Ambitrans) is pleased to submit the enclosed renewal application to Collier County for its consideration in the issuance of a Class 2 Certificate of Public Convenience and Necessity (COPCN) to provide ambulance transportation within Collier County. Since 1995. Ambitrans has specialized in the transportation of inter-facility transports by ambulance. With our vehicles licensed and permitted through the State of Florida's Bureau of EMS, our fleet of advanced life support and basic life support ambulances serve Southwest Florida on a daily basis. Transports from hospital to hospital, hospital to nursing homes and nursing homes to hospital' continues to represent our core business. While Ambitrans is proud to work in conjunction with EMS organizations in Sarasota and Charlotte counties to mitigate their response to non-emergent calls for assistance, our company focus remains committed to servicing the non-911 market. For the last nine (9) years, Ambitrans has been rendering Basic Life Support, Advanced Life Support and Critical Care Transport to patient of the Physicians Regional Heatthcare System and the NCH Transports from nursing homes to hospitals are non-life threatening in nature ~,. � �~~~��~~ ~�~ .�~�°~ ^��°� '-.—_^.� ~�~~^~~.�-�_�~~~~~^'~°~~~~~~°~~ Charlotte County • Collier County • Lee County ° Sarasota County mmww.ambitrano.00m 00111‘^ °�� Packet Page-1648- 9/10/2013 16.E.16. Page Two Chief Kopka Collier County COPCN Healthcare System who required service to facilities located outside of Collier County's limits. These out-of-county transports typically average over sixty (60) miles in distance. Since commencing operations within Collier County in 2012,Ambitrans has transported over 3,000 patients point-to-point within the county. Ambitrans operates twenty-four hours per dmy, seven days per week. Requests for transportation are received through our Communications Center housed in our corporate offices in Port Chadotte, with our personnel and vehicles deployed from our satellite locations in Naples, Cape Coral, Port Charlotte, Venice and Sarasota In the absence of a formal COPCN oppl|oatinn, items outlined in Section 50-55 of the Collier County Ordinance have been addressed within this document as well as other materials we felt were of importance in your renewal process. We welcome the opportunity for staff to conduct an on-site review of our premises and meet the personnel who are responsible for making us the quality organization that we are. Upon reviewing the enclosed information. should you have any further queyiionn, please do not hesitate to contact me at (941)613-6427. Sincerely. .71.>" Alan J. Skavroneck Chief Operating Officer AJS. hms ~ , , ~_ -~. Charlotte County Collier County Lee County Sarasota County woww,e mbbrenscoin Packet Page-1649- 9/10/2013 16.E.16. Ambitrans Medical Transport, Inc. — Collier County Arnik. 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, 64,4351 Pinnacle Street, Charlotte Harbor, FL 33980 50% Lorraine B. Grant, 58,4351 Pinnacle Street,Charlotte Harbor FL 33980 50% Alan J Skavroneck 48,4351 Pinnacle Street, Charlotte Harbor, FL 33960 0% Amitt, Packet Page-1650- 9/10/2013 16.E.16. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (2) The boundaries of the territory desired to be served. Collier County Packet Page-1651- 9/10/2013 16.E.16. 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. Now offok Packet Page-1652- 9/10/2013 16.E.16. Arnbitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (4) The address of the intended headquarters and any substations. Arnbitrans corporate office is located at: 4351 Pinnacle Street, Port Charlotte, FL 33980 -4- A* - 4iimatrit*.*4' I Our Collier County substation is located at: 2157 Pine Ridge Road, Naples, FL 34109 (former NCH ambulance station) mt. 41, 45, it4 I '""""*. "'"*"" '73te '7" 7- "*- - • 2 ° Our auxiliary substation to backup the Collier County operation is located at: 935 NE, r'Terrace, Cape Coral, FL 33909 Packet Page-1653- 9f10/2013 16.E.16. Ambitrans Med'Cal Transport, TD[� - CrJl'�� � ' County Amo, COPCN Renewal �^ ^���'��6�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. Tnday. Am/bitrmnw 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 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 ost* 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 Couroe end 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 Peace River Medical Center in Port Charlotte as well as servtng as the Medical Director for Charlotte County Fire and EMS. oin4, Packet Page-1654- 9/10/2013 16.E.16. 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 Tarniami Trail Naples, FL 34112 Senator Garrett Richter 2320 Harrier Run Naples, FL 34105 Packet Page-1655- 9/10/2013 16.E.16. Ambitrans Medical Transport, Inc. — Collier County Artok 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 $39500 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 1V Supplies $20.00- $25.00 oak Packet Page-1656- 9/10/2013 16.E.16. 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-1657- 9/10/2013 16.E.16. 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 $250.0© is attached hereto as Exhibit Packet Page-1658- 9/10/2013 16.E.16. 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 -1659- 9/10/2013 16.E.16. Apok EXHIBIT A STATE OF FLORIDA 3689 DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL OVERSIGHT ADVANCED LIFE SUPPORT LICENSE This is to cenify that AffilliTRANS MEDICAL TRANSPOkT, ?Same O i l rovider 4351 PIA(LF SIKEEL PORT OLARLOTTE,FL 3.39g0 Address has complied with Chapter 401.Florida',tansies,and Chapter 641-1,Florida Administrative Code.and is authorized to operate as an Adsaneed I Life Support Service subject to any and all imitations specified irt the applicable Certificate(st of Public Convenience and Neeessa,s, For the C'.nunty.ties) TRANSPORT NON-TRANSPORT CliARI,0111,...COLLIER.,LEE Courny(iest (.merstenc edica!Serstces A II• istratnr °sista Department af I lealth . • l)ale''05'311.'201i Expires:0Kt:19/201S DIA I own I 6 'Mar& i T his certificate shall he posted in the above mentioned establishment Amok Packet Page-1660- 9/10/2013 16.E.16. GRANT-6 OP ID:JS AC-C:7W CY CERTIFICATE OF LIABILITY INSURANCE DATE DAMIODYTTTT) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 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(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polioy(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), PRODUCER Phone:941-922-0245 CONTACT Bouchard-Sarasota .FAX 5310 Clark Road Suite 1 Fax:941-923-4126 rk42,170,Exp pvc,#401 Sarasota,FL 34233 E4tAIL ADDRESS: Brian Wyies INSURERISI AFFORDING COVERAGE , NAIL INSURER A:Markel insurance Company 38970 INSURED Gnxnt Medical Transportation INSURER B: Ambulance Mgmt Services,LLC Ambitrans Medical Transpon.,1 INSURER C: Venice Ambulance Service,Inc. INSURER D: 4351 Pinnacle Street • Charlotte Harbor,FL 33980 INSURER E: _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 'AWL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE 'IFLSR.WM POLICY NUMBER BAMTDDITYYTTI'(MMIDD/TYYTI LIMITS GENERAL LIABILITY ,EACH OCCURRENCE '$ 1,000,000 AN A X,, ' DAHALIr"MANS rt.) i COMMERCIAL GENERAL LIABILITY !MTK7000259600 07101/2013 07/01/2014'pREmiscs(E . - , .$ xi o-carerice, ; 100,000 CLAIMS.MADE X occur ' mt u ExP(Apy one WAPITI $ 10.000 .. . X ,Professional Liab , MTK7000259500 07/01/2013 07101/2014 PERSONAL&ACT/INJURY $ 1,000,000 GENERAL AGGREGATE 1$ 3,000,000 • GMT.AGGREGATE.LUNT APPLIES PER I ' . : !PRODUCTS•COMP/OP AOC I$ Included PRO , X POLY Am LOC. , . ;$ AUTOMOBILE LIABILITY ; COMBINED SINGLE UNI■I , !Ea accOenti .$ 1,000,000 , A .ANY AUTO , IMTA7000259600 07/01/2013 07101/2014 Boon r IN !Pot PPE S AU.OIAR.IED ' v I SCHEDULE() I . i 1 AUI OS ,l's !AUTOS , BODILY INJURY;IRer accrar.//,S v . NON OWNED , . 1 , PROPERTY DAMAGE 1$ X I HIRED AUTOS , A .Autos 'iRor t.t=derttl , I . . 1 , I$ X UMBRELLA LIAR X !OCCUR . ' 'EACH OCCURRENCE I$ 2,000,000 . . , , B EXCESS L 07/01/2013 07/01/2014.AGGREGATE , UX . !cummsmAIDE; :WITU000259800 „s 2,000,000 • • , _ BED A :RETENTIONS 10,000; i WORKERS COMPENSATION . WC STATU- OTH , ,T , , AND EMPLOYERS'UABILITY yi N , ' ORY I BAITS ER 1 ANY PROPFDETOR/PARTNER/EXECLITIVE ; --1 , ;E t EACH ACCiDENI S I OFFICER/MEMBER EXC LUDED N I A IManaatery in NH) I DI.SEASE I-A EMPLOYEE $ . It veS GELSCADO unary DE SCRIP 1 ION OF OPERATIONS helree . ,4 i DISEASE-POLICY t IMIT $ , . . . . . . . . DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ADM 101,Additedffid karnioriuS Schedule,II more space is required) .barbarahyde@ doh.s tate.fl.us CERTIFICATE HOLDER CANCELLATION FL.DEPT2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fl.Dept of Health,Bureau ACCORDANCE WITH THE POLICY PROVISIONS. of Emergency Medical Services Attn: Barbara Hyde AUTHORIZED REPRESENTATIVE 4052 Bald Cypress Way MB C-18 Tallahassee,FL 32399-1738 4 . C 1988-2010 ACORD CORPORATION. All rights rese ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD R Packet Page-1661- 9/10/2013 16.E.16. .. ......................... r ! /V I Y �. NLY I FORMA EXHIBIT i ( CVtaE T R6Ab 4 i1�.°i C t�pAC k(TfJ t Slf}7t Ei ;4 t tlt5 6t1 Yt 5} Pik{NLl i AR fi B F kT tit 33 4 .' 4+° x '.. `- fit '"' r 1 iz .d �'� ' < m � Y"` :7. & a .. " I ? KF h 4 0.i ,e .g � 4 x �, r r �' z d k- I'''' .7. Ri @$�d #Y' WhQ a#."fi.i$t +N" k g& „ 1 gi. a T s din-, cy+ §°-BOARD.r `M -. �£ 3 '� "' 4u "z fi 4s, : v�l.Renewal .._,......�. ....,_.,..__.,.. . _ Alialk Packet Page-1662- 9/10/2013 16.E.16. 11 ,Ai1t=JEa BRIAN W. CROSLAND, CPA, PL D CERTIFIED PUBLIC ACCOUNTING&CONSULTING KRLSTT L.RANDOLPH Aamuco,bermvre Or Cr"...cett Ptmuc Accowtwttrs FL tUMA INsimrrE OF Caannwsr PuINAC ACrotWrANrS SHAWN M.C1.Muc CPA MEDICAL Uaow,MANACE+ewr ASSCCTAtx>.+ CommuNriv ASSOCIAn014 t$SnriTfe 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 May 31, 2013. 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. 90 77,1 2 July 9,2013 Punta Gorda,Florida 201 W.MARION A VENUE,Sunt 1204 Puri'A Gomm,FL 33950 PHONE:(941)629-1197 FAX:(941)205-5279 Packet Page-1663- 9/10/2013 16.E.16. Ambitrans Medical Transport, Inc. and Subsidiaries Statement of Assets and Liabilities of the Ambulance Transportation Operations Income Tax Basis of Accounting May 31,2013 (Unaudited) Assets Current Assets: Cash available for ambulance transportation operations $ 500,000 Property and Equipment: Office equipment and computers 80,669 Machinery and equipment 182,004 Medical transportation vehicles 1.303,116 1.565,789 Less accumulated depreciation (1,470,681) Property and Equipment,net 95,108 Total Assets $ 595,108 Liabilities Current Liabilities: Accrued profit sharing $ 119,232 Other liabilities 19,900 Notes payable to banks 122,390 261,522 Lona Term Liabilities: Notes payable to banks 299,756 Less current portion above (122,390) 177,366 Total liabilities 438,888 Net Assets Over Liabilities,income tax basis $ 156,220 , Read Independent Accountants'Compilation Report Packet Page -1664- COLLIER COUNTY FLORIDA 9/10/2013 16.E.16. 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 2013 ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CLERK COLLIER COUNTY, FLORIDA ,Deputy Clerk Georgia A. Hiller, Esq., Chairwoman Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney W37 0\'3 Q�2 Packet Page-1665- 9/10/2013 16.E.16. ATTACHMENT "A" Ambitrans Medical Transport Vehicle Listing 1FDXE45F23HB15317 Vehicle Permit (ALS) 15452 1FDSS3ES4BDA26137 Vehicle Permit (ALS) 16462 1FDSS3ES7BDB27799 Vehicle Permit (ALS) 17025 1FDSS3ES7BDB27804 Vehicle Permit (ALS) 17026 1FDSS3ES1BDB27801 Vehicle Permit (ALS) 17027 1FDSS3ES3CDA18371 Vehicle Permit (ALS) 17149 1FDSS3ES5CDA18372 Vehicle Permit (ALS) 17150 1FDSS3ES6BDB36820 Vehicle Permit (ALS) 17356 1FDSS3ES4DDB02264 Vehicle Permit (ALS) 18015 1FDSS3ES8DDB02266 Vehicle Permit (ALS) 18016 1FDSS3ES7DDB06017 Vehicle Permit (ALS) 18017 1FDWE35F92HA44797 Vehicle Permits (BLS) 4133 1FDXE45F2YHB54092 Vehicle Permits (BLS) 4228 1FDSS3ES3BDA26145 Vehicle Permits (BLS) 4355 1FDXE45F73HB48975 Vehicle Permits (BLS) 4470 1FDSS3ES6BDA26138 Vehicle Permits (BLS) 4475 1FDSS34P78DA64922 Vehicle Permits (BLS) 4476 1FDSS34P09DA59420 Vehicle Permits (BLS) 4615 1FDSS3ES5ADA25626 Vehicle Permits (BLS) 4677 1FDSS3ES6ADA31208 Vehicle Permits (BLS) 4678 As of August 14,2013 Packet Page-1666-