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Okaloosa County BOCC — September 16, 2014 — reading text
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Facilities} (Notes Tab on Scenario Page{s})
On‐Site Visits (for each Facility and within the Contract Period)
Site Visit Certification Form (Attached to Site Plan Tab on Facility Page) {file name must contain at minimum the SERC number if
applicable and SV – if SERC number is not available facility name and SV – additional info allowed but not required.}
Site Plan (Attached to Site Plan Tab on Facility Page) {file name must contain at minimum the SERC number if applicable and SP – if
SERC number is not available the facility name and SP – additional info allowed but not required.}
Sufficient Detail to Identify:
Location of Major Building(s)
Name and Location of Extremely Hazardous Substance(s) (if extremely hazardous materials are co‐located, noting EHS is acceptable)
Name and Location of Street(s)
Identify Pertinent Access and Egress Points
Note Additional Features Pertinent to Hazardous Materials and Medical Response
All data shall be submitted electronically via CAMEOfm version 3.0.1 in a .zip file format.
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Attachment J
FLORIDA STATE EMERGENCY RESPONSE COMMISSION FOR HAZARDOUS
MATERIALS
HAZARDS ANALYSIS SITE VISIT CERTIFICATION FORM
Facility Name (Please print)
Street Address, City & Zip Code (Please print)
_________________________
County (Please print)
Name of Facility Representative (Please print)
Facility Representative Signature Site Visit Date
Site Visit Performed by (Please print)
Signature Site Visit Date
The individuals signing above certify that a hazards analysis site visit was conducted on the
above date.
Notes:________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Check if facility representative was informed about using E-Plan (https://erplan.net/eplan/login.htm) for EPCRA
on-line filing
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Attachment K
STATEMENT OF DETERMINATION
Facility Name
Physical Address (Street only)
City County LEPC District
I have determined that this facility is / is not subject to the following section(s) of EPCRA, Title III, for the reporting year(s) indicated
(circle all applicable):
SECTION 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
302 / 303 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N
311 / 312 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N
313 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N
If “No” was indicated on any of the above, please check appropriate box(s) why:
Sections Extremely Hazardous Substances (EHSs) are / were present only in amounts less than established
302/303 Threshold Planning Quantities (TPQs).
No EHSs are Present.
No EHSs were present on-site during the year.
Sections Hazardous chemicals/EHSs are/were present only in amounts below established reporting thresholds.
311/ 312
No hazardous chemicals/EHSs are/were present.
No hazardous chemicals were present on-site during the year.
Section Not within covered SIC Codes.
313
Within covered SIC Codes, but less than ten (10) employees.
Within covered SIC Codes, but no Section 313 chemicals were present or were below Section 313 reporting
thresholds.
Other Closed facility Chemicals removed Chemicals reduced below Date Effective:
YES / NO YES / NO threshold/TPQ YES / NO
New Facility. Date chemicals brought on site meeting / exceeding TPQ:
Further explanation if necessary:
____________________________________________________________________________
________________________________________________________________________
____________________________________________________________________________
CERTIFICATION:
I understand the requirements of the law(s) circled above. I also understand that ultimate compliance
responsibility lies with me and failure to comply, if required, can result in civil and criminal penalties under federal
and state laws.
Name of owner / operator’s authorized representative (printed):
Official Title (printed):
Signature: Date signed:
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BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
DATE: September 16, 2014
TO: Honorable Chairman and Members of the Board
FROM: Dino J. Villani
SUBJECT: Amendment to Medical Examiner Agreement
DEPARTMENT: Public Safety
BCC DISTRICT: All
STATEMENT OF ISSUE: Request approval of the amendment to the Medical Examiner
Agreement, which renews the contract for one (1) additional year from October 1, 2014, through
September 30, 2015.
BACKGROUND: In compliance with Florida Statutes, Chapter 406, the Board of County
Commissioners provides an annual budget and contracts for medical examiner services with the
District I Medical Examiner’s Officer. This year’s budget approved by the Board is
$474,022.00, which is a decrease of $36,546.00 from the current year’s contract. As outlined in
the contract, the District I Medical Examiner’s Office will pay the vendor invoices directly and
then submit an invoice with the appropriate documentation to Okaloosa County for
reimbursement.
The Medical Examiner’s Office provides important services to Okaloosa County citizens and law
enforcement agencies. The District I Medical Examiner’s Office has always assured it will serve
Okaloosa County in accordance with the provisions of the pertinent statutes and applicable rules
and regulations of the Florida Department of Law Enforcement. Staff support to the Medical
Examiner’s Office at the Fort Walton Beach morgue is provided by the District I Medical
Examiner and is under her direct administration/supervision.
OPTIONS: Approve or disapprove.
RECOMMENDATIONS: Approve and authorize the Chairman to execute the amendment to
the agreement for Medical Examiner Services with Dr. Andrea Minyard, District I Medical
Examiner, for medical examiner services to Okaloosa County for Fiscal Year 2014-15.
RECOMMENDED BY:
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APPROVED BY:
Ernie Padgett, County Administrator
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BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
DATE: September 16, 2014
TO: Honorable Chairman and Members of the Board
FROM: Dino J. Villani
SUBJECT: EMS Collection Agency Selection and Contract Negotiation
DEPARTMENT: Public Safety
BCC DISTRICT: All
STATEMENT OF ISSUE: Request approval to select PennCredit as the Emergency Medical
Services (EMS) collection agency for delinquent accounts and begin contract negotiations.
BACKGROUND: The contract for the current EMS collection agency expires on September
30, 2014. Professional Adjustment Corporation has provided collections services for Okaloosa
County EMS since October 17, 2000.
The County received proposals from 5 companies to provide EMS collection services. The
selection committee ranked PennCredit as the first choice, followed by Professional Adjustment
Corporation and then LifeQuest Services. PennCredit proposes a fee of 18% for primary
collections and 25% for secondary collections. The County will have the ability to access
account activity online through PennCredit's client portal. The client portal also allows the
County to place accounts on hold for 30 days, submit a payment or adjustment to an account, and
to request cancellation of an account.
OPTIONS: Approve/Disapprove.
RECOMMENDATIONS: Approve the selection of PennCredit as the EMS collection agency
and begin contract negotiations.
RECOMMENDED BY:
APPROVED BY:
Ernie Padgett, County Administrator
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COLLECTION AGENCY SERVICES FOR EMS
OKALOOSA COUNTY BOARD OF COMMISSIONERS,
FLORIDA
RFP # EMS 63-14
PROPOSAL DUE: July 18, 2014 @ 4:00 P.M.
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NOTICE TO PROPOSERS
COLLECTION AGENCY SERVICES FOR
EMERGENCY MEDICAL SERVICES (EMS)
OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS
The Okaloosa County Board of County Commissioners under the provisions of Section 287.055, Florida
Statutes and County policy, request proposals from agencies for Collection Agency Services for EMS.
The County desires services of a qualified collection agency with proven performance as outlined in the
Scope of Services.
Agencies desiring consideration should provide an original and five (5) copies of their Request for
Proposal (RFP) with the agency’s areas of expertise identified. Submissions should be portrait
orientation, unbound, and 8 ½” x 11” where practical. All originals must be original signatures in
