HomeMy WebLinkAbout2024-119A TRUE COPY
CERTIFICATION ON LAST PAGE
RYAN L. BUTLER, CLERK
EMS COUNTY GRANT APPLICATION
FLORIDA DEPARTMENT OF HEALTH
Emergency Medical Services Program
HEALTH
Complete all items
ID. Code The State EMS Program will assign the ID Code — leave this blank
1. Count Name: Indian River Count
Business Address: 1801 27"' St
Vero Beach, FL 32960
Telephone: 772-226-3900
Federal Tax ID Number Nine Digit Number): VF 59-60006764
2. Certification: (The applicant signatory who has autho.' *... Fg pts, grants, and other legal
documents for the county.) I certify that all information atd to icounty grant application and
its attachments are true and correct. My signature acktiail s as rets that the county shall
comply fully with the co 'tions outlined in th FI S ant r�pj�lication.
Si nature: o Date: June 4 2024
Printed Nam : S an Adams ; o,
Position Title: hairman, Board of County C is i' ' . d
'•v,'vRIV.RC� .
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: Assistant Fire Chief of EMS
Address: 4225 431 Ave
Vero Beach, FL 32967
Telephone: 772-226-3900 Fax Number: 772-978-1820
E-mail Address: s reer indianriver. ov
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)
Lim ioo4, uecemer zuuzs (rtev. uuiy zuits) 64J-1.015, F.A.C.
A TRUE COPY
CERTIFICATION ON LAST PAGE
RYAN L. BUTLER, CLERK
BUDGET PAGE - When the budget form is in your computer, the budget totals below should be added
for you if you place your cursor over a subtotal or total field, ri ht click your mouse, then left click "Update
Field" on the resulting menu.
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
mai outia see next category).
List the item and, if applicable, the quantity Amount
Total Expenses = 1 $ 0.00 1
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
OT one year or more.
List the item and, if applicable, the quantity Amount
Strategic Operations TCCC Instructor Kit Advanced Tier 3 1 18,251.42
Total Vehicles & Equipment = I $ 0.00 I
I Grand Total = I $ 18,251.69 I
DH 1684, December 2008
STATE OF FLORIDA
INDIAN RIVER COUNTY
THIS IS TO CERTIFY THAT THIS 15 A TRUE AND CORRECT
COPY OF THE ORIGINAL ON FILE IN THIS OFFICE
�.,, RYAN L BUTLER. CLERK
FLORIDA DEPARTMENT OF HEALTH DATE 0
EMERGENCY MEDICAL SERVICES (EMS) GRANT IIIA
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 Pavment To:
The county name, address, and corresponding federal ID number used herein must be in the state
MyFloridaMarketPlace (MFMP) system. A finance person in your organization who does business with the
state can provide these.
Name of County: Indian River County Board of County Commissioners
Mailing Address: 1800 271h St
Vero Beach, FL 32960
O�y�phSMlSSjn�✓,�3
Federal 9 -digit Identification number: 59-60006764 -digit seg, code 070
Authorized County Officia *Siature
' ' '*`�
June 4. 2024
slate
_ Susan Adams Chairman�TAP.
6Y iqT;
Type or Print Name and Title •.9y �'
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 Emeraencv Medical Services Section
Grant Amount for State to Pay: $
_Approved By:
Approved By:
Signature of State EMS Unit Supervisor
Grant ID: Code:
Date
Signature of Contract Manager Date
State Fiscal Year: 2023 - 2024
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.
3
RESOLUTION NO. 2024- 024
A RESOLUTION OF THE EMERGENCY SERVICES DISTRICT BOARD
OF COMMISSIONERS, INDIAN RIVER COUNTY, 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 2023/2024 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 Flescher who moved its
adoption. The motion was seconded by Commissioner Earman and, upon being put to a
vote, the vote was as follows:
Chairman Susan Adams
Vice -Chairman Joseph Flescher
Commissioner Joseph H. Earman
Commissioner Deryl Loar
Chairman Laura Moss
AYE
AYE
AYE.
AYE
-AYE
The Chairman thereupon declared the resolution duly passed and adopted this fourth day of June 2024.
ATTES")"C��f�Q-
Ryan L. Butler, Clerk of Oodrt and Comptroller
Approved as to form and legal
sufficiency -
By: I - a i — I
William K. l5ebra
County Attorney
"h1MISSj'
EMERGENCY SEVICES DISTRICT B� s*
OF COMMISSIONERS;:
RIDA
CO T LO
BY: o
Susan Adams, hairman oe:'
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