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go <br />f' <br />99- 3j <br />Emergency Medical Services (EMS) County Grant Application <br />State Of Florida <br />Department of Health <br />Bureau of Emergency Medical Services <br />Grant No. C <br />1 Board of County Commissioners (grantee) Identification: <br />Name of County: Indian River County <br />Business Address: 1840 25th Street <br />Vero Beach, Florida 32960 <br />Phone # (561) 567-8000 <br />1 SunCom # 224-1444 <br />2. Certification: I, the undersigned official of the previously named county, certify that to the <br />best of my knowledge and belief all information and data contained in this EMS county Award <br />Application and its attachments are true and correct. <br />My signature acknowledges and ensures that I have read, understood, and will comply fully <br />with the Florida EMS County Grant Manual. <br />Printed Name.- Douglas M. Nyright Title: Director of Emergency Services <br />Signature: ` .,, ate Signed: <br />(Authorized County Official) <br />3. Authorized Contact Person: Person designated authority and responsibility to provide the <br />department with reports and documentation on all activities, services, and expenditures which <br />involve this grant. I <br />Name; James A. Judge, II Title: EMS Chief, Indian River County <br />Business Address: Indian River County Emergency Services, 1840 25th Street <br />Vero Beach, Florida 32960 <br />4 County's Federal Tax Identification Number: VF596000674 <br />H Form 1684. Jan. 98 <br />