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Last modified
12/9/2019 3:43:20 PM
Creation date
12/9/2019 3:43:18 PM
Metadata
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Template:
Resolutions
Resolution Number
2019-01ESD
Approved Date
12/03/2019
Agenda Item Number
15.A.2.
Resolution Type
ESD Grant
Entity Name
Emergency Services District (ESD)
Subject
Medical Services (EMS) Grant Award Application
to the State of Florida Department of Health, Bureau of Emergency Medical Services
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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 />
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