Agenda 03/22/2011 Item #16F2
3/22/2011 Item 16.F.2.
EXECUTIVE SUMMARY
Recommendation to grant conditional approval of a Certificate of Public Convenience and
Necessity for NCH Healthcare System for ambulance service and approve a Budget
Amendment recognizing and appropriating the $250 annual renewal fee.
OBJECTIVE: That the Board of County Commissioners (Board) approve a Certificate of
Public Convenience and Necessity (COPCN) for NCH Healthcare System, authorization for the
Chairman to execute the permit and certificate; and approval of a Budget Amendment to
recognize and appropriate the $250 annual renewal fee.
CONSIDERATIONS: NCH Healthcare System currently operates ambulance transport under a
COPCN. Collier County Ordinance No. 2004-12, as amended, requires that NCH Healthcare
System annually renew its original COPCN and pay a $250 fee. Further, the renewal COPCN
may be approved routinely by the Board upon advice of the Administrator or the Board may hold
a hearing on same. The Administrator is the County Manager or designee. The County
Manager's designee is the Director of the Bureau of Emergency Services. The Administrator
recommends renewal of the COPCN, subject to the following conditions:
. Within forty-five (45) days of approval of the renewal, NCH Healthcare System must
staff a transport unit for all days and hours of operation for the Marco Island Urgent Care
Center location, Collier County EMS will not be required to supplement NCH Healthcare
System transports.
. Compliance with Chapter 401, Florida Statutes and Ordinance No. 2004-12, as amended,
NCH, among other things, must maintain in a daily log upon which shall be recorded the place or
origin, time of call, time of dispatch, time of arrival at scene, time left for hospital. time of arrival
at hospital, and charges for each trip made and such other operating and patient information as
may be required by Ordinance No. 2004-12. NCH must also maintain certification by the
County's Medical Director. These are areas in the past where NCH has been deficient. NCH
has assured staff that these requirements will be complied with in the future.
FISCAL IMPACT: $250 to be recognized and appropriated by Budget Amendment to
Emergency Medical Services Fund 490 for FYI] .
LEGAL CONSIDERATIONS: Section 10 of Ordinance No. 2004-12, as amended, provides
that the renewal certificate may be approved routinely by the Board, upon advice of the
administrator, or the Board may hold a hearing on same. Section 10 further provides that
renewals shall be based upon the same standards, as the granting of the original certificate along
with such other factors as may be relevant.
As such, if the renewal certificate is not routinely approved by the Board, then a public hearing is
necessary. The Board would then need to evaluate the facts in order to determine if competent
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3/22/2011 Item 16.F.2.
evidence exists that each of the following four standards as set forth in Section 7 of Ordinance
No. 2004-12, as amended, has been satisfied:
(l )That there is a public necessity for the service, In making such determination, the Board 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.
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,
In making the determinations provided for immediately 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 tbe recommended order shall be
advisory only,
This item is legally sufficient for Board consideration. This item requires a majority vote, -
JBW.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated
with this action.
RECOMMENDATION: That the Board of County Commissioners, subject to NCH
Healthcare System's compliance with the terms indicated above:
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3/22/2011 Item 16.F.2.
I, Find that the standards set forth in Ordinance No. 04-12, Section 7 have been met;
2, Approve the Certificate of Public Convenience and Necessity for the NCH Healthcare
System;
3. Authorize the Chairman to execute the Permit and Certificate; and,
4, Approve a Budget Amendment to recognize and appropriate the $250 annual renewal fee.
PREPARED BY: Dan Summers. Director, Bureau of Emergency Services
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3/22/2011 Item 16.F.2.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.F.2,
Item Summary: Recommendation to approve a Certificate of Public Convenience and
Necessity for NCH Healthcare System for ambulance service and approve a Budget Amendment
recognizing and appropriating the $250 annual renewal fee,
Meeting Date: 3/22/2011
Prepared By
Name: Bay Artie
Title: Supervisor - Accounting,EMS Operations
3/8/2011 ] 1 :52:25 AM
Approved By
Name: PageJeff
Title: Chief - Emergency Medical Services,EMS Operations
Date: 3/8/2011 12:21 :29 PM
Name: WhiteJennifer
Title: Assistant County Attorney,County Attorney
Date: 3/8/2011 ] :40:20 PM
Name: SummersDan
Title: Director - Bureau of Emergency Services,
Date: 3/8/201] 2:20:44 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 3/11/2011 3:29:28 PM
Name: PryorCheryl
Title: Management! Budget Analyst, Senior, Office OT Management & Budget
Date: 3/11/201] 4:34:3] PM
Name: IsacksonMark
Title: Director-Corp Financial and Mgmt Svs,CMO
Date: 3/14/201] 8:35:04 AM
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3/22/2011 Item 16.F.2.
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NeH Downtown Naplel HOlpltal
350 Seventh Street N,
N.plel, Fl34102
(239) 436.5000
NCH
3/22/2011 Item 16.F.2.
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NeH North N.plel HOlpltal
11190 Healthpark aivd.
N.ples, Fl34110
(239) 552.7000
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Health care
System
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November 15, 2010
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Ml" Dan Summers, Direetor
Bureau of Emergeney Sel'vices
Collier County, Plol'ida
"MEnGENGY MANNlllMENT
Su~iect:
Renewal ofCerlilicate of Public Convenience & Necessity for
NCH Healthcare S)'stem, Inc, Ambulllnce Sel'l'lces
DeOl' Mr, Stimmel's:
Pel'Suant to Collier County Ordinance 2004-12, plCllSC acccpt the lollowing updated infol'l1lRlion for the
renewal of the requio'ed certiflcale for 20 II :
A, NCH Ambulance Services is operated by NCH Healthcare S)'stems, Inc,. 350 7'10 Avenue North,
Naples PL 3410 I
B. NCH Ambulance Services l>rovidcs thc NCH Healtheare System, Ine, with inter-facility, and out
of county ambulance transports,
C. NCH operates no less than one (I) and np to three (3) gl'Ound units on immediate call at all times.
D, NCH Ambulance Sel'viees is located at 2157 Pine Ridge Road, Naples, Florida,
E, Attachments:
I. NCB Certificate of Liability Insurance
2. Schcdule of Rates Charged
3. Description of Vehicles
4. 3 COIliCI' County References
S. Fiullncial Data
6, Chcck for $250 Rcnewal Fee
Please conlaClme If you need any additional informalion.
Sincerely,
(;?D.4; c.~
PhiUi~C. gUlcher
ChiefOperatious Officcr
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Top 5% in tho Nallon for Ovorall Clinical f:xcollenco Six ConsoGlJ!ivo YoOI'3
www.NCHmd.ora
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3/22/2011 Item 16.F.2.
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ACORD" CERTIFICATE OF LIABILITY INSURANCE pago 1 of 1 r DAlE (MOODNVYY)
I......---' 10/21/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT aETWEEN THE ISSUINGINSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: litho .ortlll.aloholdorls on ADDITIONAL INSURED,lha polloy(les)muat be ondorsed. IrSUBROGATION IS WAIVED, subJe.t 10
tho tonus and conditions oftllo policy, certain polloles may require an endorsomont.A statomont on this certificate does notconfer rights to tho
cetCmcato holdGf In lieu of stich ondor$oJnont(s).
PRODUCER CONTACT
Willis Insuran06 Servloos of Georgia. "'&Ul=' _~.H!>)'
Ina. I f..H9NE 8'1-045-7318 888-461-2371L_
26 Century Blvd. E-MAIL
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NalJhvillo, TN 3'/230-5191 lNSURER{S}AJOfOROItIOcovau.oe. NAlC#
--- IJlSURERA: Travelers Indamnit.y Co. of luneriaa 25666-001
INSURED
Nell Healt::hoare System8, Ino. IN'SURER8: -
PO Box 413029 ~.~URe_~.s
Attn. ~her8sa Ouadi
Nopla8, pI, 34101 INSURt:RO;
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INSURER r:
COVERAGES
CERTIFICATE NUMBER' 14910564
REVISION NUMBER'
THIS IS TO CeRTIFY THAT THE POLICies OF INSURANCE LISTEO BELOW HAve BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD
INDrCATED, NOTWITHSTANDING A>f( ReQUIREMENT. TERM OR CONOlTlON OF ANY CONTRACT OR OTHER DOCUMENT Wlnl RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN8URANce AFFORDED BY THE POLlcrES OESCRraED HEREIN IS SUBJECT 10 ALL THE TERMS.
EXCLUSIONS AND CONOITIONS OFBUCH POLICIES, LIMITS 6HOWN MAY HAVe BEEN RliOU.~ pAID CLAIMS. ..
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SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCEll.EO BEFORE
YHE EXPIRATION DATE THEREOF, NOTICE WIll BE DELIVERED IN
ACCORDANC(:: WITH lHE ~OLlCV PROVISIONS.
NOH Healthoare systems, Inc.
Attn I Kevin Cooper
p,o. Box 413029
Naples, PL 34101
AUTHOfUZaORI!PRI!&I!HTATlVf
ACORD25 (20l0/0S)
Coll,3162347 Tp1, 1169373 Cert.14 564 @1 88-2010 ACORD CORPORATION,Allrlghlsr..erved,
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3/22/2011 Item 16.F.2.
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3/22/2011 Item 16.F.2.
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Jutras, Nancy
From:
Sent:
To:
Cc:
Subject:
Hernandez, Jose
Monday, November 16, 2010 3:56 PM
JUlras, Nancy
Kolinski, Juanlla
RE: NCH Ambulances
Nallcy,
Here i~ the informatlon you have requested:
AMBULANCE 11 Crusader VINIIlfDSS341'86DA54283 V
AMBUlANCE fORD 1991 [350 VIN#HDKt:3DFSKHA39711 V
Jose H. Hornandl!7.
Fixed Assets & Projects Accountant
NCH Hoallhcara Syslem
NapllilS, Fl.. USA
p, 239513 7616
Jose, harnand~z@.nchmd,or9
ij!
&iIii .\I~ase don't ~lf1nt lIils omallllnl(lf;~ you must
............"......."...........................".........................................................."..,......................................,..................,...,.......................".....,.................................................................,..".....
From: Kolinski, Juanita
Sent: Monday, November 15, 2010 3:27 PM
To: Hernandez, Jose
Cc: Jutras, Nancy
Subject: FW: NCH Ambulances
Jose,
Can you please check fixed assets to see what we have?
Juanita Kolinski
Accounting Manager
NCH Healthcare System, Inc,
(239) 513-7602
..................".....___,......................"........................................................................................................m_...._....................................."................".........................._.......m__n__.m......
From: Jutras, Nancy
Sent: Monday, November 15, 2010 2:43 PM
To: Kolinski, Juanita
Subject: NCH Ambulances
HI Juanlto-
I am helping Kelly wIth the Renewal of Certificate of Public Convenience and Necessity with the
County. One question It Is asking is the number and a brief descrIption of the ambulances. Do you
have that info? Thanks for your helpl
O.tf/~ .
<.7y~"JilbaO
Executive Assistant to the
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3/22/2011 Item 16.F.2.
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3 Collier County Residents for References:
Joseph Perkovich
NCH Healthcut'c Syslem, Inc.
350 ih Street North
Naples FL 34102
Mal'iann MacDonald
NCH Healthcare System, Inc.
350 ih Street North
Naptes FL 34102
Thomas Gazdic
NCH Hcalthcure S)'slcm, Inc,
350 7th Street North
Naples FL 34102
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3/22/2011 Item 16.F.2.
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P,loQwalerhouseCoopers lLP
4221 West Boy Seout Doulsverd
Suite 200
Tampa F~ 33S07.5745
Telephone (013) 220 0221
Facsimile (013) 229 3646
Report of IndepondentCertlfled Public Accountants
I
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To tho Board of Trustees of
NCH Heallhcare System, Inc.
I
In our opinion, the accompanying consolidated balence sheels and the related consolidated stalements
of oparatlons, of changes In net assets, and of cash flows presenl fairly, In sll malerlal respects, the
flnanclsl poslllon of NCH Heallhcare System, Inc, (the "System") at September 30, 2009 and 2008, snd
the resulls of theIr operations and their cash flows for the years then ended In conformity with
accounting principles generally accepted In lhe Untied Slates of America. These financial statements
are the responslbtilty of the System's management. Our responsibility is 10 express an opinion on
these financial statements based on our audits, We conducted our audits of these slalemenls In
accordance with auditing elendards generatiy accepled In the United Slates of America, Those
slanderds require thai we plan and perform lhe audit 10 obtatn reasonable assurance aboul whelher
the financial slalements are free of materIal misstatement. An audlllncludos examIning, on a lest
basis, evIdence supporting tha amounts and disclosures In the financial statements, assessing the
accounting principles used and slgnlflcanl esUmales made by managemenl, and evaluating Ihe overall
financial statement presentation, We balleve that our audlls provide a reasonable basis for our
opinion.
As discussed In Note 1 10 the consolidated financial statemenls, Ihe Syslem adopted lhe authorllalive
guidance for fair value measuremente on October 1,2008.
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NCH Healthcare System, Ino,
Consolldatad Balance Sheets
September 30, 2009 and 2008
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Assets
Currenl essets
Cash and cash equivalents
Investments
Due from pallents and olhers, nel of allowance for esllmaled
uncollecllbles of approxlmalely $29,620,000 in 2009 and
$22,578,000 In 2008
Assets limited as to use
InventorIes
Other currenl assets
Total current assels
Assets limited as to use
Self.lnsurance fund
Board.deslgnated assets
Assets held by Iruslee under bond Indenlures
Less: Assels IImlled as to use Ihal are required for currenl
lIeblllties
Inveslmenls In partnerships
Properly and equlpmenl, net of accumulated depreciation
Long.lerm Investments
Bond Issue costs
Olher assels
T alai assets
3/22/2011 Item 16.F.2.
2009 2008
$ 42,333,169 $ 52,428,452
54,178,929 44,971,931
52,343,809 55,218,355
15,563,050 16,693,448
8,366,268 8,095,794
6,792,116 9,726,054
179,577,341 187,134,034
13,126.612 16,929,091
91,446,890 66,383,910
11,187,504 11.050,408
115,761,006 94,363,407
(15,563,050) (16,693,448)
100,197,956 77,669,959
983,321 2,229,257
243,499,969 252,461,100
8,636,174 8,888,029
1,943,162 2,111,108
11,761,570 6,722,105
$ 546,599,493 $537,215.592
2
The accompenylng noles are an Integral parl of these consolidated financial statements.
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NCH Healthcare System, Inc.
Consolidated Balance Sheets, continued
September 30, 2009 and 2008
Liabilities and Net Assets
Current lIabllllles
Current portion of long.term debt
Current portion of estimated self.lnsurance lIabllllles
Accounts payable
Accrued expenses
Accrued Inlerest
Esllmaled third-party payor se\llements
Tolal currenltiabllllles
Long-term debl, excluding current portion
Estimated self.lll$urance Iiabllllles, excllldlng current portion
Olher lIabllllles
T olalllabllllles
Commllmenls and conllngencles
Net assets
Unrestricted
Temporarily reslrlcted
Permanently restricted
Total net assets
Totalllabllllles and net assels
3/22/2011 Item 16.F.2.
2009
2008
$ 8,617,146 $ 8,243,239
4,376,646 5,643,042
18,719,676 15,867,711
26,955,691 26,696,349
2,608,667 2,762,409
8,570,190 6,930,190
71,846,805 66,042,940
106,609,935 115,135,092
8,751,066 11,286,049
6,011,244 4,695,467
193,219,050 197,159,548
334,631,841
7,847,139
10,901,463
353,380,443
$ 546,599.493
322,477,864
6,414,353
11,163,827
340,056,044
$ 537,215.592
3
The accompanying notes ere an Integral part of these consolidated financial statements,
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3/22/2011 Item 16.F.2.
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3/22/2011 Item 16.F.2.
NCH Downtown Naples Hospital
350 Seventh St.,.IN,
Naples, fL 34102
(239) 436.5000
NCH
--...
NeH North Naple, Ho'pltal
11190 H.althpo,k Blvd,
N.ples, Fl34110
(239) 552-7000
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Healthcare
System
January 7, 20 II
Dan Summers, Direclor
BUI'eau of Emel'genc)' Services
8075 Lely Culluml pm'kway, Ste. 445
Nnllles, FL 34113
Subject: NCB Healtheal'e System COPCN Renewal Application
Oem' MI'. Summers:
As discussed in 0111' meeting of December 16,2010, I have included with this lelter additional
information I'ognl'ding NCH I lealtheal'e System's oppliealion (0 renew Olll' COPCN certificate,
Specifically, 1 have included: I) Olll' ope/'Rtionall)lan fOI' 20 II, 2) information on the Officers of
the NCB organization, and 3) infonnation onlhe lImbulance site locntions,
NCB Healthcare Syslem intends to opemle IWo ambnlances as inlel'-facility and oul ofconnlY,
non-emergency tl'anspol'l vehicles. Olll' plan calls for I) an mnbnlance to be stationed al (he North
Naples Hospital campus, located on Immokalee Road, 24 hoUl's pel' day, 7 days pel' week and 2)
an ambnlance 10 be slalioned at (he Marco Island Health Cenler located at 40 Heathwood Drive,
Marco Island, FL, (0 coincide with the Ccnter's hours of opcralion,
In order to implement this plnn, NCB will pnl'chase one additional ambnlance vehicle and secure
sufficient stafrlo opemle the ambulance service nt the level proposed above, NCB is ae(ively
pursuing both of these items and we antieltlate initiating this sefl'iee no later than Febl'nary IS,
201 !.
The NCH Healthenre System Andited Financial Stalements snbmitted with 0\11' ol'iginnl
appliention information are Ihe mosl current, We anlicipate 20 10 Statements 10 be available in
Febl'nal')' 20 II and will snbmit a copy (0 you a( (hot time,
Please conlact me if yon need any additional information,
Sincerely,
~~C~
Phillip C, Dutehel'
Chief Operations Officer
c: Allen Weiss, MD
Kelly Daly
Burl Snunders
AlIachmenls
11"'-.
fV ~O~O~M~! ~ .gl~~L;;I~.~:
Top 5'Y" in tho Nation for Ovorall CllniGnlt:xGollenGo Six CO!lfi0QuHvo Y"fli"<
www,NCHmd.oru
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3/22/2011 Item 16.F.2,
NCH HeallheRl'e System, Ille,
NCH CORl'ORATE OFFICERS
2010-2011
350 7\1. Stl'eot North
Naples FL 34101
239-436-5100
JOSOllh I. Perkovich
Chah'IllRn
Aurora Estevez, MD
Chief Medical OfficeI'
Vicki D. Hale
Chiof FinRncial Officol'
Mariann MacDonald
lsl Vice Chah'
Gary Parsons, M.D,
Chiof Modical Offlccr
NCHMD
Ambassadol' Frances Rooney
2"d Vice Chair
Michael Riley
Chicf Strlltcgy Officol'
Brian C, G. Settlc
Chiof HUllllIll Resources Offleel'
EdwinJ. Stedem
Seel'ctnryffl'cnsul'cr
Michele Thoman
ChtefNul'sing & Clinical Officel'
Allen S. Weiss, M.D.
President & CEO
Susan B. Wolff
Chief InforlllatIon Offlccr
Beth Martin
Assistant Secl'etal'Y
Kevin D. Cooller
Chief of Staff/General CouJlsel
Phillip C. Dutcher
Chief Operatlolls Officer
NCH HealtheRl'c System
William Edwards
Chief Administrative Officer
NCHMD
*birthdates available upon requeset
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3/22/2011 Item 16.F.2.
NCH North Naples Hospital
11190 Health Park Blvd,
Naples FL 34110
Marco Healthcare Center
40 Heathwood Drive,
Marco Island FL 34145
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3/22/2011 Item 16.F.2.
COLLIER COUNTY FLORIDA
Renewal of Class "B" COPCN
Name of Service:
NCH Ambulance Services
Namc of Owner:
NCB Hcalthcare Svstem
Principle Address of Service: 2157 Pille Ridgc ROUlI, Nnnl~~,J'loridll
Business Telephone:
(~}.2l.lli. 7080
Description of Service:
Post hospital intrafacilitv transJl.9.rls lllld \)\1101' COl.1ll1V Imnsp.orl l'or
the NCH Bealthcare Svstem
Number of Ambulances:
3 Grolltl!,1 Units~NCII ly.illllperalc.J.!.Q.Jsss limn on. (I) IIl1d ylL!Q
!.bree {J} Ground.Units 011 immedLatc ellllll! nlltil'l!;:!.
See attachment for description of vehicles,
This pennit, as provided by Ordinance No, 2004-12, as amended shall allow the above named
Ambulllllee Service to opcmte post hospilul intrafacility lrallsp0l1s between its facilities and out
of COllllty Inmsp()rls for a let, or churge f(,r Ihe f'ollowillg Url'lI(s): Coll.i9I.~OunILullllI Ihe
e"ph'ulion dllte hereon, exeepl lhal Ihis permit Illny be revoked by Ihe I.lonrd of COIIIlI)'
COlllmissioncrs of Collier COllnty I1llUl)' lime Ihe service named herein shall fuillo comply wilh
Chllplcr 401, Flol'idll Slatules, lllld any local. stale or fcderullulI's or reglllliliollllppliemiolllo Ihe
provisions of Emergency Medical Services. Within forty-five (45) days of approval of the
renewal, NCH Healthcare System must staff a transport unit for all days and hours of operation
for the Marco Island Urgent Care Center location. Collier County EMS will not be required to
supptement NCH Healthcare System transports.
Issued and approved this
day of
,_.2011.
ATTEST:
DWIGHT E. BROCK, CLERK
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLOr.IDA
, Deputy Clerk
Fred W. Coyle, Chairman
Approved as to form and legal
sufficiency:
~:€D0.~,
.Jeilriffer B, White
Assistant County Attorney
Packet Page -1229-
- 3/22/2011 Item 16.F.2. .
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