Backup Documents 07/09/2013 Item #16E 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE E
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County torney e
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. Colleen M. Greene, ACA County Attorney Office 110 13
4. BCC Office Board of County Gk—k
Commissioners /5/
5. Minutes and Records Clerk of Court's Office re q(1(21 1,
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Colleen M. Greene,ACA Phone Number 252-8400
Contact/ Department
Agenda Date Item was July 9,2013 / Agenda Item Number 16-E-9 /
Approved by the BCC J
Type of Document Settlement Agreement Number of Original 3
Attached Documents Attached
PO number or account n/a
number if document is
to be recorded
•c\�.C.-"& mes s �o Co\\ceeNr■
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? CMG ,\ �
2. Does the document need to be sent to another agency for additional signatures? If yes, CMG
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be CMG
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's CMG
Office and all other parties except the BCC Chairman and the Clerk to the Board only
5. The Chairman's signature line date has been entered as the date of BCC approval of the CMG
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CMG
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 07/09/13 and all changes made CMG
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by th CMG
BCC, all changes directed by the BCC have been made,and the document is ready f r the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revise . . ;Revised 11/30/12
16E9
MEMORANDUM
Date: July 15, 2013
To: Colleen Greene, Assistant County Attorney
County Attorney's Office
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Settlement Agreement— Collier County EMS
Attached are three (3) originals of the agreement referenced above, (Item #16E9)
approved by the Board of County Commissioners July 9, 2013.
Please forward for additional signature and return a fully executed original back
to the Minutes and Records Department to be held in the Board's Official
Records.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachments
STATE OF FLORIDA
DEPARTMENT OF HEALTH
BUREAU OF EMERGENCY MEDICAL OVERSIGHT
DEPARTMENT OF HEALTH,
Petitioner,
V. Case No. 2011-17540
COLLIER COUNTY EMS,
Respondent.
SETTLEMENT AGREEMENT
Collier County EMS, referred to as the "Respondent," and the Department of
Health, referred to as "Department," stipulate and agree to the following
Agreement and to the entry of a Final Order of the Bureau of Emergency Medical
Oversight, referred to as "Bureau," incorporating the Stipulated Facts and
Stipulated Disposition in this matter.
Petitioner is the state agency charged with regulating emergency medical
services pursuant to section 20.43, Florida Statutes and Chapter 401, Florida
Statutes.
STIPULATED FACTS
1. At all times material hereto, Respondent has been licensed as an AIR-
ALS service provider in the State of Florida.
2. The Department charged Respondent with an Administrative
Complaint that was filed and properly served upon Respondent, alleging violations
1
Venice Ambulance Service,2012-11091
EMS Liccnsure Settlement Agreement cff.04-10-2013
�r7
_ _ - - --- -- 16E9
of Chapter 401, Florida Statutes, and the rules adopted pursuant thereto. A true
and correct copy of the Administrative Complaint has been furnished with this
Settlement Agreement.
3. Respondent neither admits nor denies the allegations contained in the
Administrative Complaint.
STIPULATED CONCLUSIONS OF LAW
1. Respondent admits that, in its capacity as a licensed AIR-ALS service
provider, it is subject to the provisions of Chapters 401, Florida Statutes, and the
jurisdiction of the Department and the Bureau.
2. Respondent admits that the facts alleged in the Administrative
Complaint, if proven, would constitute violations of Chapter 401, Florida Statutes,
as alleged in the Administrative Complaint.
3. Respondent agrees that the Stipulated Disposition in this case is
acceptable to Respondent.
STIPULATED DISPOSITION
1. Pine - The Bureau of Emergency Medical Oversight shall impose an
administrative fine of two thousand dollars ($2,000.00) against the license of
Respondent, to be paid by Respondent to the Florida Department of Health and mailed to
the attention of Kimberly Moore, Section Administrator, Department of Health, Bureau of
Emergency Medical Oversight, Investigation Section, 4052 Bald Cypress Way, Bin A22,
2
Venice Ambulance Service,2012-11091
EMS Licensure Settlement Agreement cif.04-10-2013
(;)
16 E
Tallahassee, FL 323994722, within twenty-one (21) days from the date of receipt of this
Agreement.
2. Reprimand - The Bureau of Emergency Medical Oversight reprimands
Collier County EMS for violation of Chapter 401, Florida Statutes.
STANDARD PROVISION$
1. Enforceability — It is expressly understood that this Agreement is a
legal and binding document and is fully enforceable against all parties in any court
of competent jurisdiction. The signatories hereto are vested with the authority to
execute this Agreement on behalf of their respective principals, and as designated
representatives, to fully bind such principals.
2. Future Conduct - In the future, Respondent shall not violate Chapter
401, Florida Statutes, or the rules promulgated pursuant thereto, or any other
state or federal law, rule, or regulation relating to its providing of AIR-ALS service.
3. Purpose of Agreement - Respondent, for the purpose of avoiding
further administrative action with respect to this cause, executes this Agreement.
Respondent expressly waives all further procedural steps and/or judicial review of this
subject matter. The parties hereby agree to waive all claims, rights, charges, recoveries,
and amounts with respect to the subject matter of Case Number 2011-17540.
4. Waiver of attorney's fees and costs - The parties hereby agree
they will bear their own attorney's fees and costs resulting from prosecution or
defense of this matter. Respondent waives the right to seek any attorney's fees or
costs from the Department and the Bureau in connection with this matter.
3
Venice Ambulance Service,2012-11091
EMS Licensure Settlement Agreement cif.04-10-2013
_ _ _ _ _ 16E9
SIGNED this 9th day of July 2013.
ATTEST
D r t1T E. BRO Clerk
. _ FOR COL E° f OUN EMS
Attost as WI s _.
signature QM Ir
Name a org a A. Hiller, Esq.
Approved as to form and legality Title Chairwoman
0600-6MZ Date
Assistant County Attorney -7 CO3
APPROVED this day of , 2013.
FOR BUREAU OF EMERGENCY MEDICAL
OVERSIGHT
By: John C. Bixier, Administrator
Emergency Medical Services
Florida Department of Health
4052 Bald Cypress Way, Bin #A22
Tallahassee, FL 32399-1722
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Venice Ambulance Service,2012-11091
EMS Licensure Settlement Agreement eff.04-10-2013