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n <br />Odd <br />EACH <br />EMS COUNTY GRANT APPLICATION <br />FLORIDA DEPARTMENT OF HEALTH <br />Emergency Medical Services Program <br />Complete all items <br />ID. Code (The State EMS Program will assign the ID Code — leave this blank) C60 <br />1. County Name: Indian River County <br />Business Address: 1800 27th Street <br />Vero Beach, FL 32960 <br />Vero Beach, FL 32967 <br />Telephone: 772-226-3900 <br />Federal Tax ID Number (Nine Digit Number): VF 59-60006764 <br />2. Certification: (The applicant signatory who has authority tc4i <br />documents for the county) I certify that all information and dab; ifrthi <br />its attachments are true and correct. My signature acknowlei0s an <br />comply fully with the conditi outlined iy' e FLer• F lS tnty <br />Signature: <br />U� ti <br />corrhaP1TY�4c•'grants, and other legal <br />S cdufr,.grant application and <br />suretatthe county shall <br />cam. <br />gate: November 14 , 2017 <br />Printed Name: <br />Position Title: chairman, Board of County Commms <br />• <br />3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has <br />responsibility for the implementation of the grant activities. This person is authorized to sign project <br />reports and may request project changes. The signer and the contact person may be the same.) <br />Name: Cory S. Richter <br />Position Title: Battalion Chief <br />Address: 4225 43rd Avenue <br />Vero Beach, FL 32967 <br />Telephone: 772-226-3863 Fax Number: 772-226-3868 <br />E-mail Address: crichter@ircgov.com <br />4. Resolution: Attach a resolution from the Board of County Commissioners certifying the grant funds <br />will improve and expand the county pre -hospital EMS system and will not be used to supplant current <br />levels of county expenditures. We cannot process for funds without a current resolution. <br />5. Budget: Complete a budget page(s) for each organization to which you shall provide funds. <br />List the organization(s) below. (Use additional pages if necessary) <br />DH 1684, December 2008 <br />64J-1.015, F.A.C. <br />1 <br />