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Ll <br />w <br />STATE OF FLORIDA <br />DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES <br />OFFICE OF EMERGENCY MEDICAL SERVICES <br />1317 WINEWOOD BOULEVARD <br />TALLAHASSEE, FLORIDA 32399.0700 <br />APPLICATION Pali .FUNDING <br />COUNTY EMERGENCY MEDICAL SERVICES (EMS) AWARDS <br />COMPLETING THE COUNTY EMS AWARD APPLICATION <br />Each Board of County Commissioners must complete this application in order for the county to <br />receive its proportionate share of the Department of Health and Rehabilitative Services (hereinafter <br />referred to as the department), Emergency Medical Services (EMS) grants program funds. Please <br />follow these instructions carefully so your application may be processed quickly and accurately. <br />The department cannot process an application which is incomplete. If there are any deficiencies in <br />the application, the Board of County Commissioners will be notified in writing, and the application <br />will be returned to the county for correction and resubmission. The corrected application must be <br />received by the department no later than 21 days from the county's receipt of the returned applica- <br />tion. <br />The Board of County Commissioners should notify the county contract manager, in writing, of <br />changes to the application prior to the contract being resubmitted. <br />INSTRUCTIONS <br />A. The Board of County Commissioners is requested to submit two identical original signature <br />copies of the typed and completed application. All completed applications must be received on <br />or before the date requested by the department. <br />B. Application package's are to be sent to the following address: <br />County EMS Award Application <br />Office of Emergency Medical Services <br />Department of Health & Rehabilitative Services <br />1317 Winewood Boulevard <br />Tallahassee, Florida 32399-0700 <br />Telephone (904) 487-1911 or SC 277-1911 79 <br />