Backup Documents 12/14/2021 Item #16F2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE 1 6 1'c
2
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.
2.
3. County Attorney Office County Attorney Office
4. BCC Office Board of County ,CJ` 4.29
Commissioners /WV is/ 2//,J
•
5. Minutes and Records Clerk of Court's Office N, '
labSID071 a!aSik.
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 December 14,2021 k/ Agenda Item Number q-
Approved by the BCC
Type of Document Certificate, Permit Number of Original 2
Attached Documents Attached _
PO number or account
number if document is IL`f 11
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? Th.\rt1 (] V iv/4
2. Does the document need to be sent to another agency for additional signatures? IV yes, KH 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 o1/4.)(3
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's 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 December 14,2021 and all changes made (�
during the meeting have been incorporated in the attached document. The County (J
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the n n
BCC,all changes directed by the BCC have been made,and the document is ready for the b�
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16F2 '
MEMORANDUM
Date: December 16, 2021
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Certificate of Public Convenience and Necessity (COPCN) for
Collier County Emergency Medical Services to provide Class 1
Advanced Life Support Transport (ALS)
Attached is the original COPCN referenced above (Item #16.E3'f and certified copy
of the associated document, approved by the Board of County Commissioners on
December 14, 2021.
A copy of the COPCN and the original accompanying document will be held in
the Minutes and Records Department for the Board's Official Record.
If you have any questions, please call me at 252-8406.
Thank you.
Attachment
1 6 F 2 -
COLLIER COUNTY FLORIDA
Class "2" COPCN
BLS Transport
Name of Service: Care Med Transportation. LLC.
Name of Owner: Nerlyne Saintyl-Agenor
Principle Address of Service: 740 Goodlette Frank Road
Ste 240
Naples. FI_ 34102
Business Telephone: 239-599-5606
Description of Service: Interfacility and out-of.county Basic Life Support (BLS)
transport for Collier County
Number of Ambulances: Three 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 interfacility and out-of-county Class 2 Basic Life
Support transports for a fee or charge for the following area(s): Collier County for one
year from 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 �-1 day of , 2021
ATTEST: BOA OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL COL IE )UNTY. FLOR DA
*.;CLERK
kbQ@5 Ala . ; Jerk Penny Tayl CHAIRMA
A }MRl ?form and legality:
ill ofrA.Belpe ��,N
Assistant County A rney •9-N
I 19-EMG-00436 1510051/I J 04.
0
16F2
Care Med Transportation, LLC
// ri
Attachment ti
A
Permit Number Type Year Make Model V!N
6053 BLS 2007 Ford E450 1FDXE45P37DA69129
6054 BLS 2010 Ford E450 1FDXE4FP6ADA09370
6460 BLS 2021 Dodge RAM Promaster 3C6LRVDG6ME540223
Page 4
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