Backup Documents 01/08/2019 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 4 C
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT�TRY L 7
Print on pink paper. Attach to original document. 1 he completed routing slip and original documents are to be tot marded to the tounth.Attorney Office
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 routinpzlines#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. County Attorney Office County Attorney Office �� 2 ,\ `\g
4. BCC Office Board of County
Commissioners \rt• :::> L,t \kc
5. Minutes and Records Clerk of Court's Office
tiq 19
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 Phone Number 252-3622
Contact/ Department Kathy Heinrichsberg
Agenda Date Item was January 8,2019 V Agenda Item Number 16E5
Approved by the BCC
Type of Document CoPCN Certificate,Permit Number of Original 1 ��.x��� �r .—
Attached Documents Attached t C`"
PO number or account
number if document is �+��..
to be recorded
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?
2. Does the document need to be sent to another agency for additional signaturEs? If yes, N/A
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 KH
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 KH NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the KH
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 KH
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip KH
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 January 8,2019 and all changes made KH N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the NLA is not
BCC,all changes directed by the BCC have been made,and the document is ready forth anption for
Chairman's signature. this line.
Please return to Kathy Heinrichsberg,Emergency Management
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WINS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
Ann P. Jennejohn
16Ey ,
From: Ann P.Jennejohn
Sent: Friday, January 11, 2019 7:56 AM
To: HeinrichsbergKathy
Subject: RE: CoPCN Certificate & Permit (1-8-2019 BCC Meeting Item#16E5)
Sounds good
Avtvt Jennejohn, Sr. Deputy Clerk
Board Minutes & Records Department
Collier County Value Adjustwtevtt Board
239-252-8406
From: HeinrichsbergKathy<Kathy.Heinrichsberg@colliercountyfl.gov>
Sent:Thursday,January 10, 2019 5:28 PM
To:Ann P.Jennejohn <Ann.Jennejohn@collierclerk.com>
Subject: Re: CoPCN Certificate & Permit(1-8-2019 BCC Meeting Item#16E5)
Happy new year Ann! I will come by& pick it up.Thank you.
Sent from my iPhone
On Jan 10, 2019, at 4:43 PM,Ann P.Jennejohn<Ann.Jennejohn@collierclerk.com>wrote:
Hi Kathy,
We have your North Collier Fire Control and Rescue District's
(COPCN) for Collier County Emergency Medical Services,
in our office. (Item *1-6E5) from Tuesday's Meeting.
Would you like vete to hold on to this for pickup
or would you prefer I send it via inter-office mail?
Just let vine know what's the most
convenient for you.
Thank you!
Ann Jennejohn, Sr. Deputy Clerk
Board Minutes & Records Department
Collier County Value Adjustwtevtt Board
239-252-8406
1
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16E5
COLLIER COUNTY FLORIDA
Renewal of Class "3" COCPN
This Permit is effective March 30,2019 and
Expires March 29,2020
Name of Service: North Collier Fire Control and Rescue District
Name of Owner: North Collier Fire Control and Rescue District
Principle Address of Service: 1885 Veterans Park Drive,Naples, FL 34109
Business Telephone: 239-597-3222
Description of Service: Non-Transport Advanced Life Support
Number of Ambulances: 23 Ground Units available.
See Application for Description of Vehicles
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Non-transport ALS Service to operate within the North Collier Fire Control and
Rescue District response boundary and pursuant to the Collier County Fire Chiefs Local
Mutual Aid Agreement 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 North Collier Fire Control and Rescue District.
Issued and approved this 8th day of January , 2019
ATTEST: BOARD ! CPI tt�TY C Y .IONERS
't
CRYSTAL K. KIN'Z- L, CLERK COLL ' ' C� �� '1 ►�'
est as to Cha
c" • _ Jerk ANDY SOLIS , Chairman
signature only.
Approved as to form and legality:
Item# 1,(J2
Jerldifer A. Belped Qj
Assistant County Attorney CY" ,��� Agenda `_8_,1
u \"3-
� Date
• Date ri
r:ec'd
OLUA
7 .[18-EMG-00422/1451242/1] '^��