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2 /-0 3 <br /> i <br /> Emergency Medical Services (EMS) County Grant Application <br /> State Of Florida of <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 # (772) 567.8000 SunCom # 224-1444 <br /> 2. Certification: I,the undersigned official of the previously named county,certify that to the best <br /> 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 with <br /> the Florida EMS County Grant Manual. <br /> Printed Name: John King Title: Director of Emergency Services <br /> Signature: Date Signed: <br /> (Autho iz d Cou 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. <br /> Name: Brian S. Burkeen Title: EMS Chief, Indian River County <br /> Business Address: Indian River County Emergency Services, 1840 25th Street <br /> Vero Beach, Florida 32960 <br /> Phone# (772) 567-2154 SunCom# 224-1444 <br /> 4 County's Federal Tax Identification Number: VF596000674 <br /> DH Foran 1684, an.98 <br />