Backup Documents 11/13/2012 Item #16E 1ORIGINAL DOCUMENTS CHECKLIST & ROl
TO ACCOMPANY ALL ORIGINAL DOCUMENTS
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The co,
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the docu .
exception of the Chairman's signature, draw a line throu routing lines #I through #4, complete the checklist, and forward
G SL1 6 E
'TO
GNATURE
Meted routing slip and original
it is already complete with the
Sue Filson (line #5).
Route to Addressee(s)
(List in routing order
Office
Initi
Is
Date
1.
Agenda Date Item was
11/13/12
2.
1 E `
Approved by the BCC
resolutions, etc. signed by the County Attorney's Office and signature pages from.;`.
-
3.
Type of Document
Permit and COPCN
Number of Original
2 — M & R — Please
4. f f
AQ
T�4
L
k k 4\ 2
5. Ian Mitchell, Supervisor
Board of County Commissioners
Office and all other parties except the BCC Chairman and the Clerk to the Board
6. Minutes and Records
Clerk of Court's Office
3.
m
4RQQzk 14 fthw4r1t °1+ r-
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the pers n 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.) If
Name of Primary Staff
Artie Bay
Phone Number
252 -3740
Contact
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Agenda Date Item was
11/13/12
Agenda Item Number
1 E `
Approved by the BCC
resolutions, etc. signed by the County Attorney's Office and signature pages from.;`.
-
Type of Document
Permit and COPCN
Number of Original
2 — M & R — Please
Attached
Chairman and Clerk to the Board and possibly State Officials.)
Documents Attached
return originals.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes
N/A (Not
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.;`.
-
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
! 7 ,: 7
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
'?
signature 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.
'7
Some documents are time sensitive and require forwarding to Tallahassee within a certain
1
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 11/13/12 (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 1.24.05
16t 11
MEMORANDUM
Date: November 19, 2010
To: Artie Bay
EMS, Operations Analyst
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Certificate and Permit Application
Attached please find one (1) original document referenced above, (Agenda Item
#16E1) approved by the Collier County Board of County Commissioners on
Tuesday, November 13, 2012.
Please forward a fully executed original to the Minutes and Records
Department for the Board's Records.
If you have any questions, please call me at 252 -8411.
Thank you.
jl�jlm �M'
th 30
C,
F-�
J
r
Idk
y
a
a
a
y' \
th 30
C,
F-�
Idk
i
� r-
M
CD
a
a
a
v
(D
Oo
r
sw
O
w
'
.J
v�
-s
i
� r-
M
CD 0 O CD y (D ,=i fD
r" CD P� ( N N • n
S
w y O
�y I r
w / ao CD f/ a, 0 r
C CD
a p E <. no
o'
Z = C � r O
5' 0 a o o m C
a oa .<
N < A
W G d
n fj' :+ CD S ?.
N n cD N.
CD CD S m
CL n B w y � p
�= 4. n m O C m
t� CD (D °: _� c. z
CD
CD c 1,
Z O 10
CL d O
G o _
Y p c w
0
C
y O 0
R» o w o-
v
CD
O CD <
CD N N C fAD d
CD
CD o
3 po, 3 0
CD
n G y �,
O � n ° C_°
o CD o
Z (D r. s
cr
y CD n n n
C 3 w y m 0 <
o 0 ° o
CL
O O
(DD • 'O'i W lD "''
CD -Ot LA
A� �
C
.yi ; N
LA
A
h iii o
n
yRnyr o
�a
f� o
�yc
J
ei�
a
a
a
CD 0 O CD y (D ,=i fD
r" CD P� ( N N • n
S
w y O
�y I r
w / ao CD f/ a, 0 r
C CD
a p E <. no
o'
Z = C � r O
5' 0 a o o m C
a oa .<
N < A
W G d
n fj' :+ CD S ?.
N n cD N.
CD CD S m
CL n B w y � p
�= 4. n m O C m
t� CD (D °: _� c. z
CD
CD c 1,
Z O 10
CL d O
G o _
Y p c w
0
C
y O 0
R» o w o-
v
CD
O CD <
CD N N C fAD d
CD
CD o
3 po, 3 0
CD
n G y �,
O � n ° C_°
o CD o
Z (D r. s
cr
y CD n n n
C 3 w y m 0 <
o 0 ° o
CL
O O
(DD • 'O'i W lD "''
CD -Ot LA
A� �
C
.yi ; N
LA
A
h iii o
n
yRnyr o
�a
f� o
�yc
J
ei�
At
fl
16E 1
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2013
Name of Service: Collier County Emergency Medical Services__
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway Naples Florida 34113
Business Telephone: 239 252 -3740
Emergency Telephone: 9 -1 -1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty:
Number of Ambulances on 12 hour duty:
Number of reserve Ambulances:
Number of non - transport ALS vehicles
Number of Medivac helicopter: 1
23 ground units (ambulances)
1 ground unit (as needed during season taken from reserve fleet)
11
12
See attachment "A" for description of vehicles.
This permit, as provided in Ordinance 04 -12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the
expiration date 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
applicable to the provision of Emergency Medical Services.
Issued and approved -this day of 1 ('� 2012.
ATTEST:t, BOARD OF COUNTY COMMIESSIONERS
Dw ht �LI COLLIER COUNTY, FLORID
�u C Fred W. Coyle, Chairman
App! � e o dorm efficiency:
Jeffrey
County
0 0 0 0 0 0 0 0 0 0
mA ib to 0 0 m h &C �
N N N N N N tV N
O M M
O N N n CO M M
O QOON fo
¢ Q¢aon �t�UU
wbOc��ayDtay -�
h.n h�Q (�'J�Fr
O C 0 �
XU- U.
O r r r r r N N N N
O
O N N NN`
ti O`e� G OQ'
GI � W d d Ql M O m N
V U'UUUUU UC}U
0
000aonwNNNN
p p O r r r r
0 0 0 0 0 0 0 0 0 0
�
N N N N N N N N N N
N
t
Z
Q'
J
a a a a w
wwwlaz
�0000* °�28
o LL O
G (L (L 0. J. � tOL U. LL
�
LL
(Y)
V O O O O w 0 0 0 a
aaaarrZaaaa
w 0 0 0 0 Q 0 0 0 0
0
a u w u. IL w U. k LL U.
a
0
w
zzzzzzrt - mss-
3
m
J J J J J J J J
m
J 1
¢¢¢QQQ¢¢¢Q
p
J
�p aa
n <A fhD tOC
N N
r 47 O O N W
t0 (O (O CO 0 0 n h n n
16t 11
a
O
O
O/
�a
a
g $SoSoSSS$SSS$
lL CD O b t° o W q; o wn 6 mA ui td u7
CY N N N N N N N N N N N N
m
•° r � ?�� tnt�/ v�t�r a�'i m gaoao W
l min
9 U 0
S U QQ g Q U v�U U U
� 1LtLttts u.o�L
UUUUU � � ¢UQUU�{{Ua QUFQU
QQ QQ }� - ai�NNNNNViV
N N LL LL a= z V N N N fu.I N Q N
N
O E�NVv N �v� < O 0 8 0 0 0 0^ ~v
40 CD Q) v7a�i °o�rn_�e�V��a3���ad��
N�r r O� 0 0 � C� r r r r •r 0 0 O O O �Y
y �Y irk M�a�ia3�CD aae�nlae3r�i
O r r O O O O O O O O O O O O O O O O O O
i
�. �. •. cc � �. a. i. m tCipp. 0 49
t0 W � � a6 W � A N m � a0 0 � m d � �
m o m m m m o m m m m m m m m m m g�_ R_
U G'3 UV (U C�UUUUUV UUUUUUUUUUU
°c N oC cD0 c 4N 30 N O r ofoo`ci N `c� N o N
N N N N N N Y N N N �
,o oob��d�a��w0 ?w,�a�
4 V) Z'
SSFC
uFiwuFiuri�avv��pwnFiwLUwZw
W I Q< Q Q 4=� Ix n f" Q d Q Q Q w Q
1 LL
i
I
�,
ZZOOZC9O 007 00 wzzzzzW Zl
m a Z Z j 2 Z Z Z Z w w-- w w
Z Z' fa" 1"' Z Z w .J -J J d J� .J I
U uuiiw(Dwu�i�awOOZ 4owwwwww�wi
OClSD t-r- FI-1 -F W w�tY W wO.FFFF -FG F
W Z co U Z y U U N w w U U U U N U
W i LL Z
m
F d F }- F} -}-f -Z ZF-F Z ZZF} -
FF FZFI
y
ANN Cncn(nlnt!) �Uyfntn�AtncAtn�AfAU�Atn1
aa« aa¢aaaaa� <aaaaaa¢¢II
O r N (OD N A N N N N N N N+
uj 00 O r r r r N N
C}. pl N N N N N
r �
i
16E 1
01000888<>000
SO$S °
IR oOp o,000 o
N N N N N N N N N O O
N N N COY N
r N M N S h to C4
N I'M
W
r r r r � rf r r r ILY tq N N M M M
O O N wMi M O ,�Oj X 1L m CO CO CD co
as Cox wwWwW
Q Q O Q o o G a o m m 0 0 0 0' U
IL tL w tL w w U- LL LL U. to O t0 W) o
UUUCic.:UCici:i to u.0 1Lu
LL IJL
N N N N N N N N N •N r y- r e r r r
i
00000�nn00000aoo
00000SSg�oY ��ii �0v0000
r-
..r•- r r er-• r r r 0 0 0 0 0
UUGit3UU3 UUUU_UUUUc3
M O O CpO CO p0p CD ' 0 N O O O O O O O
O S O S O S O C3, S S S 0 0 0 0 0
N N N N N N N N N N N N N N N N
US W !Li W W W W w W m r0 O o
FF}-FF F FFF J Ot°lnt°
W
a
Q'
UU 000dc oCJOZ
I Z Z Z Z 2 3 Z Z Z Z J W p C O C o
wnilw°�w uttwttttww LL{°LuO.LLL
Ny�Nti�tatF»NNL W
it. t
i
ytntnNfnG�U� oNUN NUyUU
aca¢aa¢a <¢aJ�aaaa
�Mp � �Mp Ccp� (M�pp tD <D f0 O t[f fG tD S b N
— - —
r r r r r r r r r r r
IT
O
M
W
CL