My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2015-239
CBCC
>
Official Documents
>
2010's
>
2015
>
2015-239
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/31/2017 9:23:02 AM
Creation date
12/9/2015 11:16:27 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Grant
Approved Date
12/08/2015
Control Number
2015-239
Agenda Item Number
15.A.4.
Entity Name
Florida Department of Health Emergency Services
Subject
Grant Fund Application
Fiscal Year 2014-2015
Resolution 2015-01ESD
Alternate Name
EMS
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
3
PDF
View images
View plain text
FLORIDA DEPARTMENT OF HEALTH <br />EMERGENCY MEDICAL SERVICES (EMS) GRANT PROGRAM <br />REQUEST FOR GRANT FUND DISTRIBUTION <br />In accordance with the provisions of Section 401.113(2) (a), Florida Statutes, the undersigned hereby requests <br />an EMS grant fund distribution for the improvement and expansion of pre -hospital EMS. `o <br />DOH Remit Payment To: <br />Name of Agency. Indian River County Board of County Commissoners <br />Mailing Address: 1800 27th Street <br />Vero Beach, FL 32960 <br />Federal Identification number: VF 59-60006764 <br />Authorized County Official. <br />r _ <br />?o <br />i*; Sign and return this page with your application to: <br />nprPmhPr R, 7n15 <br />Signature Date <br />Bob Solari, Chairman Board of County Commissoners <br />Type or Print Name and Title <br />•........••• <br />Florida Department of Health <br />Emergency Medical Services Program, Grants <br />4052 Bald Cypress Way, Bin A-22 <br />Tallahassee, Florida 32399-1722 <br />Do not write below this line. For use by State Emergency Medical Services Program <br />Grant Amount For State To Pay: $ Grant ID: Code: C40 <br />Approved By : <br />Signature of State EMS Grant Officer Date <br />State Fiscal Year: 2015 - 2016 <br />Organization Code E.O. <br />64-61-70-30-000 05 <br />Federal Tax ID: VF <br />OCA <br />SF005 <br />Grant Beginning Date: <br />Object Code <br />750000 <br />Grant Ending Date: <br />Category <br />059998 <br />DH 1767P, December 2008 <br />64J-1 015, F.A.0 <br />3 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).