Backup Documents 09/11-12/2012 Item #16E 3ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16E3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 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 #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1.
a ro riate.
(Initial)
Applicable)
2.
9/11/12
Agenda Item Number
16E3
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Resolution, Grant Application and
i
3 (M & R —Need
5. Ian Mitchell, Supervisor
Board of County Commissioners
KA-
j
6. Minutes and Records
Clerk of Court's Office
- Try\
(vz(rz-_
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Artie Bay
Phone Number
252 -3740
Contact
a ro riate.
(Initial)
Applicable)
Agenda Date Item was
9/11/12
Agenda Item Number
16E3
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Resolution, Grant Application and
Number of Original
3 (M & R —Need
Attached
Distribution Form aao a- I Qq
Documents Attached
Originals Back)
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a ro riate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
00
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike- through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final negotiated contract date whichever is applicable
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 91// (enter date) and all changes
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16E3
MEMORANDUM
Date: September 13, 2012
To: Artie Bay, Accounting Supervisor
EMS Operations
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Resolution 2012 - 149 /Application for and use of EMS County Grant
Funds
Grant Application and Distribution Form
Attached for your records, is a certified copy of the Resolution and Originals of the
Grant Application and Distribution Form referenced above, (Item #16E3) adopted by
the Board of County Commissioners on September 11, 2012.
If you have any questions, please call me at 252 -8411.
Thank you.
Attachment
16E3
RESOLUTION NO. 2012 - 14 9
RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,
CERTIFYING THAT THE APPLICATION FOR AND USE
OF EMS COUNTY GRANT FUNDS WILL IMPROVE AND
EXPAND PRE- HOSPITAL EMS DEPARTMENT
ACTIVITIES AND WILL NOT SUPPLANT EXISTING
COUNTY EMS BUDGET ALLOCATIONS.
WHEREAS, EMS Department Paramedics and Paramedic/Firefighters provide
basic and advanced life support care and highly technical service to the citizens and
visitors of Collier County; and
WHEREAS, the purchase of equipment and provision of training shall greatly
enhance the effectiveness of pre - hospital emergency medical care.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
The $74,895.00 in the EMS County Grant will be used for training and to purchase
medical /rescue supplies /equipment and these funds will not be used to supplant existing
EMS Department budget allocations.
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County, Florida, this day of , 2012.
ATTEST:
DWIGHT E. BROCK, Clerk
B •�L�il
D�p CL
��' cl
Approved as to form and
legal sufficiency:
Je . Wright
As stant County Attorney
BOARD OF COUNTY COMMISSIONERS,
COLLIER COUNTY, FLORIDA
BY:
FRED W. COYLE, Chair
Item #
Agenda
(�
Date
Date
Recd
— ,;.
j )UP; 'mark
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16E3
EMS COUNTY GRANT AP UCATION
FLORIDA DEPARTMENT OF HEALTH
Bureau of Emergency Medical Services
Complete all items
z. certification: (The applicant signatory w o as author' to
documents for the county) I certify that all Information and data in this EMS county grant and other 7andits
attachments are true and co h/ grant applicatioy signature acknowledges and assures that the County shall
fully with the conditions ouflln a Fjid? Eips 9Ounty Gant Application.
S(enaft gyre• •
4%ff U140 reports and may request Project changes• grant
he signeactivities. nd tin's
he contact authorized to sign p e.)
person may be the same.)
Name: Walter Kopka
Position Title: Assistant (%hiaf
a
current levels of county expenditures.
f1M
Pages if necessary)
Collier County Emergency Medical Services
OH Form MM. nansmgA
ATTEST:
DWIGHT E. BROCK CLERK
F.A.C.
3
ApP ve as to form and I sufficiency
Je E. right, Assistant County Attorney
16E3
BUDGET PAGE
A. Salaries and Benefits:
B. Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an
agency, such as, commodities and supplies of a consumable nature excludInG expenditures classified as
operating capital outlay (see next cateaorA
E
C. Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other
tangible personal property of a non consumable and non expendable nature with a normal expected life
of one (1) year or more.
DH Form 1884, December 2008
4
Grand Total I $_74,895.00_^
16E3
FLORIDA DEPARTMENT OF HEALTH
EMS GRANT PROGRAM
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with the provisions of Section 401.113(2)(a), F. S., the undersigned hereby
requests an EMS grant fund distribution for the improvement and expansion of pre - hospital
CItA0
Name of Agency: Collier County Board of County Commissioners
Mailing Address: 3299 Tamiami Trail East, Suite 303
Naples, FL 34112
Federal Identification number __59- 6000558
Authorized Official: 'I-Uel W C" L 9l ) 1 IQ
Fred W. Coyle, Chairman
Type Name and Title
Sign and return this page with your application to.
Florida Department of Health
BEMS Grant Program
4052 Bald Cypress Way, Bin C18
Tallahassee, Florida 32399 -1738
Do not write below this line. For use by Bureau of Emergency Medical Services personnel
Grant Amount For State To Pay: $ Grant ID: Code:
Approved By :
Signature of EMS Grant Officer Date
State Fiscal Year:
0EMIzation Code Q, Q� 0012ct Code
64- 42- 10- 00-000 750000
Federal Tax ID: VF
Grant Beginning Date: Grant Ending Date:
Alt
tS .7P, Ded'emba ,2008
�(R�fll T E. 8R(?fCERK
t e s A �i3 1�fi t red* 1�
Appr a as to form and lega fficiency
64J- 1.015, FA C. Jeff . W ight, Assistant County Attorney
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