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Backup Documents 12/14/2021 Item #16E3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 3 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 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 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. County Attorney Office County Attorney Office I Z ���� 1 2. BCC Office Board of County Qj !;: Commissioners l+�'r5/ 2, // 3. Minutes and Records Clerk of Court's Office ►aIail a► �( t.►�r� C©/. af ei(ec'L Ci**i 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 Tabatha Butcher, EMS Chief Contact Information 239-252-3780 Contact/Department County Manager Operations Agenda Date Item was December 14,2021 Agenda Item Number 16.E.3 Approved by the BCC Type of Document EMS COPCN Certificate Number of Original Attached EMS Permit Documents Attached PO number or account 4-1 number if document is to be recorded • INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column •chever is Yes N/A (Not appropriate. Initial) Applicable) 1. Does the document require the chairman's original signature TAMP OK ; 2. Does the document need to be sent to another agency for additional signa . f yes, TB 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 TB 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 Attomey's TB 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 TB 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 TB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip TB 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 1.2/14/21 and all changes made during TB N/A is not 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. 19. Initials of attorney verifying that the attached document is the version approved by the N/A is not 1-iCC. all changes directed by the BCC have been made,and the document is ready for the �'►J an option for 1 1 Chairman's signature. this line. 1 E3 Ann P. Jennejohn From: Ann P.Jennejohn Sent: Wednesday, December 29, 2021 11:45 AM To: ButcherTabatha Subject: EMS COPCN & Permit Item #16E3 (12-14-21 BCC Meeting) Attachments: Backup Documents 12_14_2021 Item #16E3.pdf Hi Tabatha, Please see the attached for your records. Thavtk you! Ann Jennejohn I3MR Sevtior Deputy Clerk II { ,,, Clerk to the Value Adjustment Board Office: 23 9-252-8406 Fax: 239-252-8408 (if applicable) Ati.K.Jenvtejohm.@CollierClerk.com Office of the Clerk of the Circuit Court `k``K,,,t,tt, & Comptroller of Collier County 3299 Tawtiavvti Trail, Suite #401 Naples, FL 34112-5324 www.CollierClerk.cowt i 16E3 COLLIER COUNTY FLORIDA Renewal of Class 1 COPCN This Permit Expires December 31, 2022 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: 26 ground units (ambulances) Number of Ambulances on 12- hour duty: 2 ground units (as needed during season taken from reserve fleet). Number of reserve Ambulances: 17 Number of non-transport ALS vehicles 13 Number of Medivac helicopter: 2 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 /1th day of QQ(',eut.k.Qf , 2027 �•� : . ATifST1,.� B COUNTY CO MISSSIONERS Crtal ` �n'zel, CI ELK C COUNTY, F D tft*aS f0 f»i ty Clerk Penny Tayl , Chairman SignatareVOIV Approved as to form & legality: Jennifer Be�io Assistant County Attorne C EXHIBIT Pam ‘_ ..._L_. 16 E 3 T m Permit# A 1. Year Make Model VIN Assigned 1453 T 1999 EUROCOPTER EC135 N911CK MHQ 2022 T 2019 AIRBUS H135 N911CB MHQ 22340 T 2019 FORD F550 1 FDUF5GT9KDA04460 Truck 41 23189 T 2020 FORD F550 1 FDUF5GT9LDA03369 Truck 7 23192 T 2020 FORD F550 1 FDUF5GT9LDA03372 Truck 22 23190 T 2020 FORD F550 1 FDUF5GT5LDA03370 Truck 8 17255 T 2012 FORD F550 1FDUF5GT8CEB23691 Truck 1 17256 T 2012 FORD F550 1FDUF5GTXCEB23692 Truck 25 17257 T 2012 FORD F550 1FDUF5GT10EB23693 Truck 27 17258 T 2012 FORD F550 1 FDUF5GT3CEB23694 Truck 37 18087 T 2013 FORD F550 1FDUF5GTODEA35168 Truck 38 18088 T 2013 FORD F550 1FDUF5GT7DEA35166 Truck 24 18089 T 2013 FORD F550 1FDUF5GT2DEA35169 Truck 15 18090 T 2013 FORD F550 1 FDUF5GT9DEA35167 Truck 6 18866 T 2015 FORD F550 1 FDUF5GT7FEA64024 Truck 14 18867 T 2015 FORD F550 1 FDUF5GT9FEA64025 Truck 31 18868 T 2015 FORD F550 1 FDUFSGTOFEA64026 Truck 39 18869 T 2015 FORD F550 1 FDUF5GT2FEA64027 Truck 40 23191 T 2020 FORD F550 1 FDUF5GT7LDA03371 Truck 18 19044 T 2015 FORD F550 1 FDUF5GT8FEC82389 Truck 4 19046 T 2015 FORD F550 1FDUF5GT6FEC82391 Truck 43 19047 T 2015 FORD F550 1 FDUF5GT8FEC82392 Truck 30 19048 T 2015 FORD F550 1FDUF5GTXFEC82393 Truck 42 20437 T 2015 FORD F650 3FRWF6GZ1FV675309 Truck 33 20443 T 2016 FORD F550 1FDUF5GT8GED28644 Truck 3 20444 T 2016 FORD F550 1FDUF5GT6GED28645 Truck 11 20445 T 2016 FORD F550 1FDUF5GTXGED28643 Truck 19 20548 T 2015 FORD F550 1 FDUF5GT4FEC82390 Truck 20 20549 T 2019 FREIGHTLINER M2EC 2FZACFDJ18AZ51747 Truck 35 20550 T 2007 STERLING ACETERA 2FZACFCS17AY33965 Truck 34 22299 T 2019 FORD F550 1 FDUF5GT1 KEE37245 Truck 44 22298 T 2019 FORD F550 1FDUF5GTXKEE37244 Truck 9 21169 T 2017 FORD F550 1 FDUF5GT5HDA02856 Truck 21 21170 T 2017 FORD F550 1FDUF5GT9HDA02858 Truck 16 21171 T 2017 FORD F550 1FDUF5GT7HDA02857 Truck 36 22300 T 2019 FORD F550 1FDUF5GT3KEE37246 Truck 17 22301 T 2019 FORD F550 1 FDUF5GT5KEE37247 Truck 10 21405 T 2017 FORD F550 1 FDUF5GT1 HEF21218 Truck 5 21403 T 2017 FORD F550 1FDUF5GT1HEF21221 Truck 32 21404 T 2017 FORD F550 1FDUF5GT3HEF21219 Truck29 21709 T 2017 FORD F550 1 FDUFSGTXHEF21220 Truck 12 21861 T 2019 FORD F550 1FDUF5GT4KDA01138 Truck 02 21862 T 2019 FORD F550 1 FDUF5GT6KDA01139 Truck 23 21863 T 2019 FORD F550 1 FDUF5GT2KDA01140 Truck 26 21864 T 2019 FORD F550 1 FDUF5GT4KDA01141 Truck 28 20438 N 2017 FORD EXPLORER 1FM5K8AROHGB64925 CC2-1628 20439 N 2017 FORD EXPLORER 1FM5K8AR2HGB64926 CC2-1630 20440 N 2017 FORD EXPLORER 1FM5K8AR4HGB64927 CC2-1629 20441 N 2017 FORD EXPLORER 1FM5K8AR6HGB64928 CC2-1632 _ 19797 N 2016 FORD EXPLORER 1 FM5K8ARXGGAO8079 CC 1130 19303 N 2015 FORD EXPLORER 1FM5K8AROFGC26952 CC2-1076 19304 N 2015 FORD EXPLORER 1FM5K8AR2FGC26953 CC2-1085 21084 N 2013 FORD EXPLORER 1 FM5K8R8DGA18380 CC2-668 21085 N 2016 FORD EXPLORER 1FM5K8AR2GGA46941 CC2-1135 21086 N 2017 FORD EXPLORER 1 FM5K8AR7HGC57022 CC2-1631 21087 N 2017 FORD EXPLORER 1FM5K8AR3HGA36372 CC2-1401 21088 N 2016 FORD EXPLORER 1 FM5K8AR5GGC07850 CC2-1314 21089 N 2020 FORD EXPLORER 1FM5K8AWOLGC13670 CC2-2547 .0 C lr>. ;;:a •l f? { "......P.,r,,.•?. ••:\t.,p1,,. i.: +.: ,�f•,, 1?'r'. 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