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Home My WebLink About1999-069C) q-061 City :Vero Beach State :Florida Zip :32960 Telephone (5611 567-2154 (SC): Email Address :irces'psuner net 3. Legal Status of EMS Organization (Check only one response). ('I) ❑ Private Not For -Profit (attach copy of IRS's 501 (c)(3) letter or other legal documentation of this status) (2) ❑ Private For -Profit (3) ❑ City/Municipality (4) ® County (5) ❑ State 4. Federal Tax ID Number: VF 596000674 5. Medical Director t hereby affirm my authority and responsibility for the use of all medical equipment and continuing education in this activity. MediDid (ctor Roger J Nicosia, Jr. D0__LnS ))5396 Date: Printed Name and FL Medical License No. FLORIDA DEPARTMENT OF HEALTH EMS MATCHING GRANT APPLICATION yI (BEMS ID. Code) Total Grant Amount 1. BCC or EMS Organization :Indian River ount�Board of County (bmmissioners Authorized Official :Kenneth R. Macht Title :Chairman Mailing Address :1840 25i1 Street - City :Vero Beach State :Florida Zip :32960 County: Indian River Telephone :(561) 567-8000 ext 490 (Sc): Email Address 2. Contact Person :Jim Judge Title :GMS Chief Mailing Address :1840 25i1 Street City :Vero Beach State :Florida Zip :32960 Telephone (5611 567-2154 (SC): Email Address :irces'psuner net 3. Legal Status of EMS Organization (Check only one response). ('I) ❑ Private Not For -Profit (attach copy of IRS's 501 (c)(3) letter or other legal documentation of this status) (2) ❑ Private For -Profit (3) ❑ City/Municipality (4) ® County (5) ❑ State 4. Federal Tax ID Number: VF 596000674 5. Medical Director t hereby affirm my authority and responsibility for the use of all medical equipment and continuing education in this activity. MediDid (ctor Roger J Nicosia, Jr. D0__LnS ))5396 Date: Printed Name and FL Medical License No. 40 40 PROJECT DESCRIPTION AND JUSTIFICATION A 12 POINT FONT MUST BE USED OR LEGIBLE HAND PRINTING State Plan: Brief synopsis and relationship to state plan goal, if applicable. Not Applicable per Matching Grant Instruction Booklet. Project Description/Justification: This is the NEED STATEMENT. Describe and justify the project. Include (1) all available numerical data, time frame for the data, data source: (2) number of people directly impacted by the grant(s); (3) whether the project will serve single municipality, county, multi county, or regional area (4) whether the project will coordinate with other EMS organizations. NEED STATEMENT: (use only the space provided) The Indian River County Department of Emergency Services. Division of Emergency Medical Services would be utilizing the matching grant to improve and expand EMS within Indian River County by increasing existing levels of EMS by adding two licensed ALS ambulances into service. This would expand the existing level of EMS service and reduce response times as well as increasing ambulance coverage ratios county wide. One ALS unit would be located on the North Barrier Island. The zones within this area are primarily residential with heavy recreational use areas with 2,900+ residents. The population is diverse with a wide variety of calls and an emphasis in respiratory and cardiac emergencies. From 1/98 through 12/98, the zones located in this area experienced 632 EMS calls with an average response time of 8.53 minutes. By locating a new station with a licensed ALS unit on the island, the response time will decrease to a 5.00 minute average response time. The other ALS unit would be located in the Western area of the City of Sebastian. These zones are primarily residential interspersed with commercial areas and would serve a population of 11,950+ residents. It receives a wide variety of EMS calls from 1/98 through 12'98 experienced 609 EMS responses with an average time of 8.64 minutes. By placing a licensed ALS unit in an existing area fire station, the response time will be decreased to a 5.00 minute average EMS response time. Data Source: EMS Run Reports, 911 Communications Center CAD system, and EMS Pro Run Report Data Collection System. Time Frame: 1/98 through 12/98 Outcome: Will improve and expand EMS services by increasing EMS resources and reducinL responw times county %vide Outcome measurable: Degree to which need will be met or changed. (Use only the space provided) By increasing the number and location of EMS Stations and ALS transport Ambulances available, Indian River County Emergency Medical Services will be able to provide the citizens in these two locations with improved response times while providing an increased level of EMS on a county wide basis. By reducing the coverage zones of the ambulances, response times will drop overall and multiple zone emergencies will have quicker responses with the two additional ALS licensed transport ambulances. Additionally, the provision of licensed ALS ambulances in these locations will increase the level of service from BLS first responder aid to an ALS level service with transport capabilities. 9. Work activities and time frames: Indicate procedure for delivery of project. (use only the space provided) The Architectural firm hired by Indian River County is nearing completion of the construction drawings for the building of station I1 and renovations to station 8 including obtaining permit applications and site plan approval. July 1, 1999 Place order for ambulances (5 months) December 1, 1999 Receive Ambulances for service December 1, 1999 Complete Station 8 Renovations March 31, 2000 Complete Station 11 Both units will be placed into active service prior to the end of the matching grant cycle. A► 40 1U. bUUUt:I CATEGORIES APPLICANT STATE I TOTAL MATCH FUNDS Expenditures $ $ $ TOTAL EXPENDITURES $ $ $ Equipment (2) ALS 158" Wheelbase Ford E350 $ 40,000.00 $ 120.000.00 $ 160,000.00 Super Duty Ambulances TOTAL EQUIPMENT COSTS $ 40,000.00 $ 120,000.00 $ 160,000.00 GRAND TOTAL $ 40,000.00 $ 120,000.00 $ 160,000.00` —" �51'ercenl 7'i Percont TOTAL do Item 11 FLORIDA DEPARTMENT OF HEALTH EMS MATCHING GRANT PROGRAM REQUEST for ADVANCE PAYMENT (Governmental Agency and Not -for -Profit Entity Only) In accordance with the provisions of Section 401.113(2)(b), Florida Statutes, the undersigned hereby request an EMS matching grant distribution (advance payment) for the improvement, expansion and continuation o prehospital EMS. Remit Payment To: Name of EMS Organization :Indian River County Board of County Commissioners Address .1840 25" Street I City :Vero Beach State: Florida Zip: 32960 Authorized Official Signature ate Kenneth R. Macht. Chairmal Lt- 2 2 Type Name and Title Sign and return this page with your application to: Florida Department of Health SEMS Rural Matching Grants Program 2002 - D Old St. Augustine Road Tallahassee. Florida 32301-4881 Do not write below this line For use by BEMS personnel only Matching Grant Amount for State to Pay: Grant ID. Code: M Approved By: Signature & Title of BEMS Grant Officer Date State Fiscal Year:-- Organization ear: Organization Code E. 0. Obiect Code 64-25-60-00-000 13U 7 Federal Tax ID: VF_ _ DH Form 1767P, Fffective Jan. 99, Revised Feb. 99 do ASSURANCES Item 12 PAYMENT FOR GRANT PROJECT: The grantee certifies, understands and accepts that due to state cash flow and activity priorities, the grantee may not receive payment from the state for this activity until several months after announcement of awards. The work activity time frames will be adjusted based on the date payment is received, except the ending date of the grant will remain as specified in the Notice of Grant Award letter. STATEMENT OF CASHCoMMITMENT: The grantee certifies thatthe cash match will be expended between the beginning and ending dates of the grant and will be used in strict accordance with the content of the application and approved budget for this activity. No costs count towards satisfying a matching requirement of a department grant if also used to satisfy a matching requirement of another state orfederal grant. Cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the department's final approved activity during the grant period. ACCgrantee ts the s and ons nthe EMS Matching Grant Program Application ppl cat oneManual", andpacknowledges this whenflulnds rare drawn or EMS Matching Grant Pro ram App otherwise obtained from the grant payment system. DISCLAIMER: The grantee certifies that the facts and information contained in this application and any attached documents are true and correct. A violation of this requirement may result in revocation of the grant, return of all funds and interest to the Department and any other remedy provided by law. NOTIFICATION OFAWARDS: The grantee understands and accepts that the notice of award will be advertised in the FAW, and that 21 days after this advertisement the grantee waives any right to challenge or protest pursuant to Chapter 120, F.S. MAINTENANCE OF IMPROVEMENT AND EXPANSION: The grantee agrees that any improvement, expansion or other effect brought about in whole or part by grant funds, will be maintained for five years after the activity ends, unless specified otherwise in the approved application or unless the department agrees in writing to allow a change. Any unauthorized change within five years will necessitate the return of grant funds, plus interest. NATURE OF AD OFFIC UTHORIZEIAL (Individual Identilied in Item t) DATE I ChairmanBoard of County.Commissioners TITLE ri+f, I '--7A U' '- in t IFet 'D 40 ESD RESOLUTION NO. 99- 05 4 A RESOLUTION OF THE EMERGENCY SERVICES DISTRICT BOARD OF COMMISSIONERS, INDIAN RIVER COUNTY, FLORIDA, AUTHORIZING THE APPLICATION FOR FUNDING COUNTY EMERGENCY MEDICAL SERVICES (EMS) MATCHING GRAN -r AWARDS TO BE SUBMITTED TO THE STATE OF FLORIDA DEPARTMENT OF HEALTH, BUREAU OF EMERGENCY MEDICAL b) SERVICES. WHEREAS, The Florida Department of Health, Bureau of Emergency Medical Services announced that applications for funding County Emergency Medical Services (EMS) Matching Grant awards are now being accepted and a matching grant application has been prepared for Indian River County; and WHEREAS, an application for matching grant funds for fiscal year 1999/2000 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 matching grant funds certifying that monies from the EMS Matching 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 Stanbridge who moved its adoption. The motion was seconded by Commissioner Ginn _ and, upon being put to a vote, the vote was as follows: Chairperson Kenneth R. Macht Vice -Chairperson Fran B. Adams Commissioner Caroline D. Ginn Commissioner Ruth Stanbridge Commissioner John W. Tippin Aye Absent Aye Aye Ave The Chairperson thereupon declared the resolution duly passed and adopted this 16 day of March 11999 ATTEST: EMERGENCY SERVICES DISTRICT BOARD OF COMMISSIONERS INDIAN RIVER COUNTY, FLORIDA BY 2 Jeffrey arton, Clerk r Y�► Kenneth . Macht, Chairperson -, A•. nY.'i 41y1