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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 />NameofCounty: Indian River Count <br />Business Address: 1840 25th Street <br />Vera Bench, FL 32960 <br />Phone # ( 561) 567 _ 8000 SunCom # 224 _ 1444 <br />2. Certification: 1, the undersigned official of the previously named county, certify that to the best of <br />my knowledge and belief all information and data contained in this EMS County Award Application and <br />its attachments are true and correct. <br />My signature acknowledges and ensures that I have read, understood, and will comply fully with the <br />Florida EMS County Grant Manual. <br />PrintedName: Dmurlas M. Wright Title: Director <br />Signature: L" -PtkL- <br />Gate Signed: /1-30-00 <br />(Author ed 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 involve this <br />grant. <br />Tame: James A. Judge, II Title: L=UIS Chief, Inciian River County <br />Business Address: Indian River County Cmerfrency Services, 1840 25th Street <br />Vero Beach FL 32960_ <br />(City) (state) (,zip) <br />Phonefl { 561) 567 _ 2154 SunCom # { ) 224 - 1444 <br />4. County's Federal Tax Identification Number: VF 596000674 <br />DH Form 1684, Jan. 98 <br />1 <br />