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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />FLORIDA DEPARTMENT OF HEALTH <br />Emergency Medical Services Section <br />MOM EMS County Grant Application <br />HEALTH <br />ID Code The State EMS Program will assign the ID Code — leave this blank <br />1. Count Name: Indian River Count <br />Business Address: 1800 2711 St <br />Vero Beach, FL 32960 <br />Telephone: 772 226-3900 <br />Federal Tax ID Number Nine Digit Number): VF 59-60006764 <br />2. Certification: (The applicant signatory who has au , ojifi/contracts, grants, and other legal <br />documents for the county) I certify that all informatitji.an 4ata in' MS county grant application and its <br />attachments are true and correct. My signature aeknowl s an as Vires that the county shall comply <br />fully with the conditions outline the Florida ERAS. oun pption. <br />Signature: Date: December 1, 2020 <br />Printed N Jos h E. Flesc er ;�% ._ 7 <br />Position itleA hairman, Board of Countv Comm`rs4ioners• <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 reports <br />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: 772 226-3951 Fax Number: 772 978-1820 <br />Email Address: sgreer@ircgov.com <br />4. Resolution: Attach a resolution from the Board of County Commissioners certifying the grant funds will <br />improve and expand the county pre -hospital EMS system and will not be used to supplant current levels of <br />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, DeCemb &(&yi,4lly2Xi1$ <br />lGOLD <br />r " i- a TORNEY <br />Rule 64J-1.015, Florida Administrative Code <br />Attest: Jeffrey R. Smith, Clerk of <br />Circuit Court and Comptroller <br />Wal, <br />`1 <br />`� Deputy Clerk <br />