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EMS COUNTY GRANT APPLICATION 2022 - 2023 <br />FLORIDA DEPARTMENT OF HEALTH <br />Emergency Medical Services Program <br />Honaa <br />I or A ■ulll� ■ <br />Complete all items <br />State EMS Program will assign the ID Code - leave this <br />1. Count Name: Indian River Count <br />Business Address: 180027 th St. <br />Vero Beach, FL 32960 <br />Telephone: 772-226-3900 <br />Federal fax ID Number (Nine Di it Number), VF,59,.69006764 <br />2. Certification: (The applicant signatory who has;�pfh to sig► ntracts, grants, and other legal <br />documents for the county) I certify that all informatirin a ata 1 tlai SMS county grant application and <br />its attachments are true and cor t. My signatdre:ackn �ar�ssures that the county shall <br />comply fully with the c nditi ou ne i rI�rida E ;5 Qnty meant Application. <br />Signature: i °' Date: /Z- /3� 2OZ <br />Printed Name: Jo h E r a <br />Position Title: Chairman, Board of Count (,Gdmtfii4*k'nnprc <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: Bureau Chief of EMS <br />Address. 4225 43rd Ave. <br />Vero Beach, FL 32960 <br />Telephone: 772-226-3951 Fax Number: 772-978-1820 <br />E-mail Address: igreer@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 />Attest: Jeffrey R. Smith, Clerk of <br />DH 1684. Decemhar 9nnR tpo., i' d on10% rte:,... * _-4— <br />1 <br />Deputy Clerk <br />=ORM <br />Y <br />b4J-1.u1 A.N/ <br />By _. <br />^0UNTY t\TT0RN <br />