Backup Documents 01/12/2021 Item #16E4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E 4
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County 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 routingylines#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
4. BCC Office Board of County `� 1
Commissioners
5. Minutes and Records Clerk of Court's Office
LZQ(a-i l(159
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 Kathy Heinrichsberg/EMS Phone Number 239-252-3622
Contact/ Department
Agenda Date Item was January 12,2021 Agenda Item Number 16E4
Approved by the BCC
Type of Document COPCN Number of Original 1 Certificate
Attached Documents Attached 1 Permit
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? Sq- 1 O✓ N/A
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 N/A
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 k
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 1/12/21 and all changes made KH
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 the Ir
BCC,all changes directed by the BCC have been made,and the document is ready for the ,
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2. - I , evised 11/30/12
16E4
MEMORANDUM
Date: January 20, 2021
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: COPCN w/Care Med Transportation, LLC
Attached is an original of the document as referenced above, (Item #16E4) as approved
by the Board of County Commissioners on Tuesday, January 12, 2021.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
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16E4
COLLIER COUNTY FLORIDA
Class "2" COPCN
BLS Transfer
•
Name of Service: Care Med Transportation, L.L.C.
Name of Owner: Nerlvne Saintyl-Agenor
Principle Address of Service: 3510 Kraft Road
Ste 200
Naples. FL 34105
Business Telephone: 239-599-5606
Description of Service: Interfacility and out-of-county Basic Life Support (BLS)
transport for Collier County
Number of Ambulances: Two Ground Units
See attachment "A" for description of vehicles.
This permit, as provided by Ordinance No. 2004-12. as amended, shall allow the above
named Ambulance Service to operate interfacilit and out-of-county Class 2 Basic Life
Support transports for a fee or charge for the following area(s): Collier County until
February 24. 2022 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 application to the provisions of
Emergency Medical Services.
Issued and approved this_ t _day of_ nu . 2021
ATTEST: BOARD OF COI NTY COMMISSIONERS
CRYSTAL. K. KINZI.I. COI.I. :R I '\TY. FLOR )A
CI.I. ZK
• 011-1
to Ch311'lttalir3)cput) Clerk
signature Only. Penny Taylor,Chairperson
Approved as to form and legality:
J fifer A. Belpedi3O.9 f,Q
Assistant County Attorney `s \.L�
16E4
IA „
Care Med Transportation, LLC At H c�c lel vvi e v-, j'
Permit Number Type Year Make Model VIN
6053 BLS 2007 Ford E450 1FDXE45P37DA69129
6054 BLS 2010 Ford E450 1FDXE4FP6ADA09870