HomeMy WebLinkAbout2019-001ESD RESOLUTION NO.2019-01ESD
A RESOLUTION OF THE EMERGENCY SERVICES DISTRICT BOARD OF
COMMISSIONERS, INDIAN RIVER COUTY, FLORIDA, AUTHORIZING THE
APPLICATION FOR FUNDING COUNTY EMERGENCY MEDICAL SERVICES
(EMS) GRANT AWARDS TO BE SUBMITTED TO THE STATE OF FLORIDA
DEPARTMENT OF HEALTH, BUREAU OF EMERGENCY MEDICAL
SERVICES.
WHEREAS,The Florida Department of Health,Bureau of Emergency Medical Services announced that applications
for funding County Emergency Medical Services(EMS)Grant awards are now being accepted and a grant application
has been prepared for Indian River County;and
WHEREAS,an application for grant funds for fiscal year 2019/2020 has been prepared by the County;and
NOW, THEREFORE, BE IT RESOLVED BY THE EMERGENCY SERVICES DISTRICT BOARD OF
COMMISSIONERS OF INDIAN RIVER COUNTY,FLORIDA,that the Chairman is authorized to sign and execute
the application for EMS grant funds certifying that monies from the EMS Grant Program For Counties will improve
and expand the County's pre-hospital EMS system and that the funds will not be used to supplant existing County
EMS budget allocations.
The foregoing Resolution was offered by Commissioner Bob Solari , who moved its adoption. The
motion was seconded by CommissionerJoseph Flescherand,upon being put to a vote,the vote was as follows:
Chairman Susan Adams AYE
Vice-Chairman Joseph E. Flescher AYE
Commissioner Peter D.O'Bryan AYE
Commissioner Tim Zorc AYE
Commissioner Bob Solari AYE
The Chairperson thereupon declared the resolution duly passed and adopted this third day of December 2019.
EMERGENCY SEVICES DISTRICT
BOARD OF COMMISSIONERS ('G041ry''
INDIAN RIVER COUNTY, O:. : • :ov�� •.S%a•,
J's
BY: 4. usa n Adams,Chairman 2: •`lb, ,
c A ST:
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' I '^`g000N1�• '
Ja_L lUV
Jeffr-y R. Smith,Clerk of
Court and Comptroller
Approved as to form and legal
PP g
sufficiency:
By
William K.DeBraa
Deputy County Attorney
Instructions: County Government Application Form 2019-2020
The amount of your new grant is in the "Total" column of the county amount table at the state EMS website link.
The first application form page has five numbered items. The first three are self-explanatory.
However, note that Item 2 on the first application page is where the county's authorized person must provide his/her
signature and date.
Item 4 describes the content of the "resolution." Please provide this in your county's customary format and approval
process. The resolution must be current; or if a previous resolution has continuing authority, include a message
from a lead county official stating that the resolution is still in-effect, with a copy of it.
Item 5 of the first page of the application form asks for the name of the organization(s) to which you decide to
allocate funds from your new county grant. The second page of the application form is the budget page, and one of
these budget pages is needed for each organization listed in item 5,
The budget page for each organization must have on it specific and quantifiable items or services, with the cost for
each unit or type of item or service.
All costs combined must total to the exact amount of new funds for your grant. You can request budget changes
after the new grant begins.
Your budget totals in the application should be added for you if you place your cursor over a subtotal or total field,
right click your mouse, then left click "Update Field."
You should copy this form on your computer to use it. If you place the application in restricted editing mode, you can
use your keyboard Tab key to go from field to field.
Request for Grant Fund Distribution Form
Request for Grant Fund Distribution Form: this is the last page herein and you must complete the top part of the
form. State EMS will complete the bottom part, as indicated on the form. The address on this form must be an
address in the state MyFloridaMarketplace (MFMP) system. A mailing address you place on this form is not usable
by state finance if it is not in the MFMP system.
Ask a staff member of your organization who does cash transactions with the state for the organization name to use
on the Distribution Form, the address, and its corresponding 9-digit federal tax ID plus its 3-digit sequence code.
Otherwise, no funds can be sent to you until this situation is resolved.
If needed, you can contact MFMP customer service at 1-866-352-3776 Monday to Friday, 8 a.m. to 6 p.m., or by
email at: MyFloridaMarketPlace(a�dms.myflorida.com.
EMS COUNTY GRANT APPLICATION
FLORIDA DEPARTMENT OF HEALTH
FIT Emergency Medical Services Program
HEALTH Complete all items
ID. Code (The State EMS Program will assign the ID Code—leave this blank) C80
1. County Name: Indian River County
Business Address: 1800 27th Street
Vero Beach, FL 32960
Telephone: (772) 223-3900
Federal Tax ID Number(Nine Digit Number): VF 59-60006764
2. Certification: (The applicant signatory who has authority to sign contracts, grants, and other legal
documents for the county) I certify that all information and data in this EMS county grant application and
its attachments are true and correct. My signs re a .nowledges and assures that the county shall
comply fully with the co Lt.. outlined in t FI ,,'MS County Grant Application.
Signature: a4 �� Date: 12-03-2019
Printed Name: Adams
Position Title: I man, Board of County Commissioners
3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has
responsibility for the implementation of the grant activities. This person is authorized to sign project
reports and may request project changes. The signer and the contact person may be the same.)
Name: Stephen R. Greer
Position Title: Captain
Address: 4225 43rd Ave
Vero Beach, FL 32967
Telephone: 772-226-3864 Fax Number: 772-978-1820
E-mail Address: sgreer@ircgov.com
4. Resolution: Attach a resolution from the Board of County Commissioners certifying the grant funds
will improve and expand the county pre-hospital EMS system and will not be used to supplant current
levels of county expenditures. We cannot process for funds without this resolution.
5. Organization List: Complete a budget page(s) for each organization, which at your option you will
provide funds. List the organization(s) below. (Use additional pages if necessary)
DH 1684, December 2008(Rev. July 2018) 64J-1.015, F.A.C.
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BUDGET PAGE
A. Salaries and Benefits:
For each position title, provide the amount of salary per hour, FICA per
hour, other fringe benefits, and the total number of hours. Amount
TOTAL Salaries= $ 0.00
TOTAL FICA& Other Benefits =
Total Salaries & Benefits= $ 0.00
B. Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an
agency, such as, commodities and supplies of a consumable nature excluding expenditures classified as
operating capital outlay (see next category).
List the item and, if applicable,the quantity Amount
Total Expenses = $ 0.00
C. Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other
tangible personal property of a non-consumable and non-expendable nature with a normal expected life
of one (1) year or more.
List the item and, if applicable,the quantity Amount
Lucas 3.1 Mechanical CPR Device 16,456.00
Total Vehicles & Equipment= $ 16,456.00
Grand Total = $ 16,456.00
DH 1684, December 2008
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FLORIDA DEPARTMENT OF HEALTH
EMERGENCY MEDICAL SERVICES(EMS) GRANT UNIT
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with the provisions of section 401.113(2) (a), Florida Statutes, the undersigned hereby requests
an EMS grant fund distribution for the improvement and expansion of pre-hospital EMS.
DOH Remit Payment To:
The agency name, address, and federal ID number must be in the state MyFloridaMarketPlace (MFMP)
system. Ask a finance person in your organization who does business with the state to provide these.
Name of Agency: Indian River County Board of County Commissioners
Mailing Address: 1800 27th Street
Vero Beach, FL 32960
Federal 9-digit Identification number: VF 59-60 6 3-digit seq. code 070
Authorized County Official: ( .( _ 12-03-2019
Si• •ature Date
usan Adams, Chairman
Type or Print Name and Title
Sign and return this page with your application to:
Florida Department of Health
Emergency Medical Services Unit, Grants
4052 Bald Cypress Way, Bin A-22
Tallahassee, Florida 32399-1722
Do not write below this line. For use by State Emergency Medical Services Section
Grant Amount for State to Pay: $ Grant ID: Code: C80
Approved By:
Signature of State EMS Unit Supervisor Date
Approved By:
Signature of Contract Manager Date
State Fiscal Year: 2019 - 2020
Organization Code E.O. OCA Object Code Category
64-61-70-30-000 05 SF005 751000 059998
Federal Tax ID:VF Seq. Code:
Grant Beginning Date: Grant Ending Date:
DH 1767P, December 2008 (rev. June 8, 2018), incorporated by reference in F.A.C.64J-1.015
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