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• ,: EMS COUNTY GRANT APPLICATION <br /> 1. <br /> :- FLORIDA DEPARTMENT OF HEALTH <br /> ori • a Emergency Medical Services Program o <br /> o <br /> HEALTH Complete all items w <br /> 0 <br /> ID.Code(The State EMS Program will assign the ID Code—leave this blank) C70 _ x <br /> .°) <br /> 1. County Name: .:Indian River County 1 <br /> Business Address:. 1801 27th Street ..•N <br /> Vero Beach, Fl 32960 ti \ <br /> Telephone: 772-226-3900 �` <br /> Federal Tax ID Number(Nine Digit Number): VF 59-60006764 a x <br /> h <br /> 2. Certification: (The applicant signatory whohas authority to sign contracts, grants, and other legal (4-1`:i 51 <br /> documents for the county) I certify that all information and data in this EMS county grant application and ' <br /> its attachments are true correct. My sig ature acknowledges and assures that the county shall 1-3 L <br /> comply fully with the con. if .a•utli d i arida EMS County Grant Application. 1` • <br /> Signature: H lb <br /> ene..n„n� <br /> gDate: 10/02/2018 <br /> issio,; w <br /> Printed Name: Peter D. O'Bryan. 174/4 ,+••••j�M,,.......6'c.. . <br /> Position Title: : Chairman, Board of County Commissit le s : , P <br /> rQ <br /> 3 Contact Person (The individual with direct knowledge of the 5r. k.u nt'-i day-td•�ay basis and has. <br /> responsibility for the.implementation of the grant activities. This; .fson ice' "'6.,:ze¢ sign project <br /> reports and may request project changes. The signer and the contact per-'yi',4,- y.f ..the same.) <br /> %Name: Steve Greer �ti,•,.(4 •.-:••��*. <br /> Position Title: Training Captain �`'NrtivEa"" <br /> Address: 4225 43rd Avenue_ <br /> Vero Beach,FL 32967 <br /> Telephone: 772-226-3864 . . Fax Number: 772-226-3868 <br /> E-mail Address: sgreer@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 this resolution. <br /> 5. Organization List: Complete a.budget page(s)for each organization, which at your option you will <br /> provide funds. List the.organization(s) below. (Use additional pages if necessary) <br /> DH 1684, December 2008(Rev.July,2018) 64J-1.015, F.A.C. <br />