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EMS COUNTY GRANT APPLICATION <br /> FLORIDA DEPARTMENT OF HEALTH <br /> FIT Emergency Medical Services Program <br /> HEALTH Complete all items <br /> ID. Code (The State EMS Program will assign the ID Code—leave this blank) C80 <br /> 1. County Name: Indian River County <br /> Business Address: 1800 27th Street <br /> Vero Beach, FL 32960 <br /> Telephone: (772) 223-3900 <br /> Federal Tax ID Number(Nine Digit Number): VF 59-60006764 <br /> 2. Certification: (The applicant signatory who has authority to sign contracts, grants, and other legal <br /> documents for the county) I certify that all information and data in this EMS county grant application and <br /> its attachments are true and correct. My signs re a .nowledges and assures that the county shall <br /> comply fully with the co Lt.. outlined in t FI ,,'MS County Grant Application. <br /> Signature: a4 �� Date: 12-03-2019 <br /> Printed Name: Adams <br /> Position Title: I man, Board of County Commissioners <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: Stephen R. Greer <br /> Position Title: Captain <br /> Address: 4225 43rd Ave <br /> Vero Beach, FL 32967 <br /> Telephone: 772-226-3864 Fax Number: 772-978-1820 <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 /> 1 <br />