04/04/2019 Grant Mission: ;; Ron DeSantis
To protect,promote&improve the health —' Governor
of all people in Florida through integrated 1�
state,county&community efforts. �1 a
HEALTH
Vision:To be the Healthiest State in the Nation
April 4, 2019
Roman Gastesi
County Administrator
Monroe BOCC
1100 Simonton Street, Suite 205
Key West, Florida 33040
Dear Sir:
It gives me great pleasure to inform you that your request for Emergency Medical Services Data Collection
funding assistance through the Overdose Prevention in States(OPTS) Cooperative Agreement has been approved
by the Bureau of Emergency Medical Oversight(BEMO).
A copy of the approved application for$43,845.60 is enclosed for your records. You are authorized by the
application and this letter to purchase the items listed in the table below. All purchases must occur after the
date of this letter.
DescrlptlonZ W11 x ,ZE�X OC ss PENSE O1..'S"S N;:, s, � a SIMMM D.AX-41i
Toughbook $ 4,384.56 10 $ 43,845.60
$ 43,845.60
Since this is a cost reimbursement program,you must first purchase the hardware, software, and/or services.
After the purchase and receipt of the commodities or services,you will have to submit a request for
reimbursement to BEMO. Due to strict requirements of the OPIS grant, all expenditure information must be
received by the bureau no later than August 31, 2019,5:00 PM EDT,to be eligible for reimbursement.
The payment request must include a copy of all purchase orders, all receiving reports,all invoices, a Non-
expendable Property Accountability Record on Operating Capital Outlay(OCO) purchases over$5,000 and
documentation of payment to the vendor for the amount of funds being requested. In addition,you must
provide a written report by August 31, 2019, detailing the actions taken to expend the funds and the progress in
implementing or improving an electronic data collection system.
Florida Department of Health
Division of Emergency Preparedness and Community Support
Bureau of Emergency Medical Oversight Accredited Health Department
4052 Bald Cypress Way,Bin A-22•Tallahassee,FL 32399-1722 ' : Public Health Accreditation Board
PHONE:850/245-4440•FAX:850/488-9408
FloridaHealth.gov
Emergency Medical Services Data Collection
Page Two
April 4, 2019
Please use the following budget codes on your Request for Reimbursement
Org EO OCA Category Object Code
64-61-70-30-000 PI OPCR9 790000 000700
CFDA Number is 93.354
The signed application acknowledges you have read, understood and will comply with all terms and conditions
of the approved and signed application. Your agency must request a budget modification to the contract before
buying anything not included in the approved contracted budget or making any change in purchases not
included in the approved contracted budget.
Thank you for your continued support and involvement in improving the Florida pre-hospital EMS system. If you
have any questions or need assistance, please contact Brenda Clotfelter, Health Information and Policy Analysis
Section at(850) 558-9510.
Sincerely,
r
Dougla oodlief
Division Director
Emergency Preparedness and Community Support
Enclosures
Grant/Al2RI a cant Information
Introduction
The Department of Health, Bureau of Emergency Medical Oversight, has received supplemental
funds from the Opioid Overdose Crisis Cooperative Agreement in support of the improvement
and/or expansion of Florida's emergency medical services field data collection efforts. The
remainder of this document contains the program and grant application guidance to request
funding through this source.
Purpose
The purpose of this program is to provide funding to Florida licensed Emergency Medical
Service (EMS) Providers to enable these agencies to participate and submit the most current
NEMSIS data standard V3.4 to the state repository. Funding will be made available for the
acquisition of hardware/software/installation and implementation services for establishing and/or
enhancing an electronic EMS data collection system to enable submission of EMS incident
related data in compliance with the Florida Data Dictionary Yj&(and consistent with the
National EMS Information System V3.4 (NEMSIS V3.4) standard) to the Bureau of Emergency
Medical Oversight Pre-Hospital System (EMSTARS-CDX).
Allowable Acquisitions
The software, hardware, communication components and installation/implementation services
that would be acquired by local EMS provider agencies can vary depending on an agency's
implementation plan.
• Most hardware consists of notebooks or tablets, desktop PC's, printerstscanners, file/
application servers, and communication components.
• All software acquired for ePCR must be certified NEMSIS V3.4 compliant and must be
Florida verified as compliant with the state system.
Disallowed Acquisitions
This grant funding does not cover the following:
• Extended warranties costs
• Maintenance costs
Application Requirements
Any licensed EMS Provider in the State of Florida, who is establishing and/or enhancing an
electronic EMS data collection system to enable consistent submission of EMS incident related
data to the Bureau of Emergency Medical Services Pre-Hospital System (EMSTARS) to be
consistent with the Florida Data Dictionary V3.4 and in compliance with the National EMS
Information System (NEMSIS) V3.4 is eligible to apply for this grant.
All applicants who are not currentlyandconsistently submitting EMSTARS data to the
Bureau of Emergency Medical Oversight Data Unit must complete Item 12 Work Activities and
Timeframes inside the application. This workplan must include details of the steps and
1
milestones to complete for submission of data to EMSTARS. Failure to include complete the
detail work activities in a disqualification for grant funds. Details for development of the
required Action Plan can be obtained from the EMSTARS Project Team. Please contact Brenda
Cloffelter @ Brenda.Cloffelter@flheat
.................................................................................................i-h-.9—ov
This is a cost reimbursement grant program. There is no matching requirement. All successful
applicants will be advised of the amount of funds they will be eligible to receive and the ending
date for expenditure of the funds. This program requires all successful applicants to purchase
and provide proof of payment for al2proved budget items resultil3a from this grant to all
vendors prior to the funds being reimbursed by the bureau. Only approved budgeted items are
considered for reimbursement. Any changes to the original approved budgeted items must be
pre-approved by the Bureau to be considered for reimbursement. Upon expenditure of any or
all approved funds or by August 31, 2019, the applicant must submit a cost reimbursement
request (invdice) totl'ie BUireati of Erneirgieriiicy M&:,:ftcal SeNicies by Atigust 3 1:, 2019 deadfirae to
a reimbuirsemer-A. The payment request must include a copy of all purchase orders,
all receiving reports, all invoices, a Non-expendable Property Accountability Record" on
Operating Capital Outlay (OCO) purchases over$5000 and documentation of payment to the
vendor for the amount of funds being requested. In addition, you must provide a written report
by August 31, 2019 detailing the actions taken to expend the funds and the progress in
implementing or improving an electronic data collection system.
By signing the applicant agreement and certification, an applicant is certifying that they meet all
requirements and other guidelines in this manual.
The Grant application signer identified in item 2 of the grant application must sign item 15 titled
"Applicant Agreement and Certification".
Reauest for GrantFund Distribution Page: this page is the last page herein and you must
complete the top part of the form. State officials will complete the bottom part, as indicated on
the form. The address on this form u'T I L s t be an exact 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 9-digit federal Tax ID plus
its 3-digit sequence code. Otherwise, no funds can be sent to you until this situation is resolved.
Tlie orgainizatitan's fied irall ta iiri rm.ist aIlso Ilse reigistir.-Yred llin SA M with a va[ld D(JNS niurrfl:)c„r
afioin:, please v�lsft htt ://www.sam., y/SAM/
prior to relcleiving fedi(:.�ira'l funds. IFbir registii,
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. M� Y FloridaMarketPlace@dms.my!!orida.com
- --,
Number ofi2ages. Each application must be no more than 15 one sided pages, including the
form and all content. Reviewers may not to read anything over 15 one sided pages. However,
you may submit a one page cover letter and letters of recommendation, and these do not count
against the 15 pages.
Fastening. If you send a paper application, do not use a booklet cover, just staple in the upper
left corner.
2,
EMS AGENCY SuBGRANT APPLICATION
, If 7
FLORIDA DEPARTMENT OF HEALTH
Health Information and Policy Analysis Section
Complete all items unless instructed differently within the application
....................................................................................................................................................................................
1D.Code(The State Bureau of EM5 will assi n the ID Code (leave this blank
...................................................................
I. Organization Name: Monroe Count BOCC
............................................................... .................... ........_................. .............................................................................................. ......................... ..................._
2.Grant Si ner: (The applicant signatory has authority sign contracts,g
rants,and a:)ffier legal&xuirni,bmts.
This individual must also sign this application)
Name: Roman Gastesi
.........................................................................................................................................................................................................................................................................................................
................................................................. y ................................................................................................................................................................................................
Position Title: Count Administrator
.........................................................................................................................................................................................................................................................................................................................................................................................................................................
Address: 1100 Simonton St
.........................................................,,,,, Suite 205,._,,.,,..............................................................................................................................................................................................
Cit Ke West Count : EF
State: Florida Zi Code:
Tele hone: Q305)292-4441 Fax Number: (305)-292-4544
..................................................................................................................................................................................................................................................................................
�E-Mail Address: astesi-roman@monroecounty-fl. ov
......... ......... ........ ......... ......... ......... ......... .........
......................................................................................................................................................................................................................_.
3.Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and responsibility for
the implementation of the grant activities.This person may sign project reports and may request project changes.
The signer and the contact person may be the same.)
...........................Name..........Je ff..M.an.n.!.n.g...............................................................................
.........................................................................................__..............................................................................................................................................................................................................
Position Title: Senior Emer enc Mana ement Planner
..............................................................
Address: 490 63`"'ST Ocean Suite 150
..............................._ ............................................................................................................................................................................................................_.._
Cit : Marathon Count . Monroe
State: Florida Zip Code: 33050
.............................................................................................................................................................................................................................................................................
Tel hone: 305 747 0690 Fax Number: 305 2S9 6'33
.........................._. g y... ..... .E Mail Address: Manning Jeff@monroecount fl. ov
3
.,�,� � -------
4. Legal Status of Applicant Organization Check onlyone res onse :
(1) ❑Private Not for Profit(Attach documentation-501 (3)01
(2) ❑Private for Profit
(3) ❑City/Municipality/TownNillage
(4) ❑X County
(5) ❑State
(6) ❑Other(specify):
5. (1) Federal Tax ID Number(Nine Digit Number. VF 59:6000749..
(2)$ ,M 't,..io v QQt',p"�i i�1iugillu rjj_ tua „Qii i N�q� ➢��i„�017387�6757
6. EMS License Number: 440:3 Type: ❑Transport ❑Non-transport ❑X - Both
7. Number of permitted vehicles by type:—BLS; 13 ALS Transport; 15 ALS non-transport.
8. Type of Service(check one): ❑ Rescue; ❑X Fire] Third Service(County or City Government,
❑nonfire); [lir ambulance❑ Fixed wit® ❑ Rotowing; Both; Other(specify),,
9. Yearly Call Volume 4784(2018)
10. EMSTARS V3.4 committed targetdate: 8/31/2019
11.Justification Summary: Monroe County's EMS grant is currently fully spent. The equipment requested via this
grant would allow Monroe County Fire Rescue to equip ten additional apparatus with laptop computers to enable
collection of patient data and NEMSIS reporting by units that currently do not possess the equipment or capabilit
Due to the unique linear geography of Monroe County, Monroe County Fire Rescue stations and units are spread
out more than 100 miles along the Overseas Highway from Key West International Airport to Tavernier in the
Upper Keys. Currently,crews from these units must physically connect with rescue units in order to transfer
patient data to be reported. This results in unnecessary delays and interruptions while crews could otherwise be
engaged in tasks to better protect residents and visitors of Monroe County. We're seeking to enhance and improv,
the efficiency of our current data collection and reporting capability for NEMSIS county-wide,as we also work t
complete the software upgrade to EMSTARS V3.4.
Additionally,as Monroe County continues the recovery process from Hurricane Irma in 2017,the slow pace of
FEMA reimbursement of hurricane related costs has presented fiscal challenges across all levels and all
departments of local government. Departments are struggling to meet normal operating costs in many cases,and
capital improvement and other projects are often delayed indefinitely. Realization of this grant project would
allow Monroe County Fire Rescue to have all units fully equipped and capable to collect and report NEMSIS
data,and to incorporate all hardware into the software upgrade process for EMSTARS V3.4.
1
Specifically, this project would provide needed hardware to equip the following units:
ARFF207(Key West International Airport)
Engine 8(Stock Island)
Engine 9 (Big Coppitt)
Tanker 10(Sugarloaf)
Engine I I (Cudjoe)
Engine 13 (Big Pine)
Engine 17 (Conch Key)
Ladder 18 (Layton)
Engine 22 (Tavernier)
Battalion I (Countywide Response)
.., ,... ..... . ,,,,,,
1
i
..._ ...... .. ............�.. .,_ _. ...............
12 Work activities and time frames: Indicate the major activities for completing the project(use only the space
provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications
project,it will take about a year. Monroe County Fire Rescue is currently reporting this data,but working
toward up rade capability and software
...._..n_....... .... .__._... _.................................................... ..... ..I..... ....... ............... .. .....__ .. . ._..._.... ......................
Work Activity Number of Months After Grant Starts
Begin End
....... ..................
Procurement and deployment of 10 Laptop Upon Award Within 60 days
Fomputers
................. w.. .......
13.Countv Governments: If this application is being submitted by a county agency,describe in the space below
why this request cannot be paid for out of funds awarded under the state EMS county grant program. Include in the
explanation why any unspent county grant funds, which are now in your county accounts,cannot be allocated in
whole or part for the costs herein. Currently Monroe County has no remaining funds in EMS grant accounts
14 Budget:
. ...... .......................... _......__................. ........ ........ ................_........_ .... ......... ....... ..................................
Salaries and Benefits; For each Costs Justification: Provide a brief justification why
position title,provide the amount of each of the positions and the numbers of hours
salary per hour,FICA per hour, fringe are necessary for this project.
benefits,and the total number of
hours.
5
TOTAL: 0.00 Right click on 0.00 then left click on"Update
Field"to calculate Total
Expenses:These are travel costs and Costs: List the price Justification:Justify why each oft e expense
the usual, ordinary,and incidental and source(s)of the items and quantities are necessary to this
expenditures by an agency,such as, price identified. project,
commodities and supplies of a
consumable nature,excludin
expenditures classified as operating
ca ita! outla (see next cafe or .
TOTAL: 0.00 Right click on 0.00 then left click on"Update
Field"to calculate Total
Vehicles,equipment,and other Costs: List the price of Justification: State why each of the items and
operating capital outlay means the item and the quantities listed is a necessary component of this
equipment, fixtures,and other tangible source(s)used to project.
personal property of a non identify the price.
consumable and non expendable
nature,and the normal expected life o
which is I year or more.
Panasonic Toughbook 33— 12" — $4384.56, based on To equip each of the following units with
Core i7 760OU — 16 GB RAM — quote provided by obi a data collection and reporting
12 GB SSD (10 Units) Strictly Tech, 5381 apability:
NW 33�d Ave, Suite ARFF207 (KWIA)
101, Ft Lauderdale, Engine 8 (Stock Island)
FL Engine 9 (Big Coppitt)
Tanker 10 (Sugarloaf)
Engine 11 (Cudjoe)
Engine 13 (Big Pine)
Engine 17 (Conch Key)
Ladder 18 (Layton)
Engine 22 (Tavernier)
Battalion 1 (Countywide)
TOTAL: 43 845.60 Right click on 0.00 then left click on "Update
Field"to calculate Total
6
?L!�na.turelbelow certifies the following.
I am aware that any omissions,falsifications,misstatements.or misrepmuntations in this application m7y
disqualify me for this grant and.if funded,may be grounds for termination at a later date,I understand that
any information I give may be investigated as allowed by law.I certify that to the best of my knowledge
and belief all of the statements contained herein and on any attachments,are true,correct.complete,and
made in good faith.
I agree that any and all information submitted in this application will become a public document pursuant
to Section 119.07,F.S.when received by the Florida Bureau of Emergency Medical Oversight.This
includes material which the applicant might consider to be confidential or a trade secret.Any claim of
confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,
F.S.,effective after opening by the Florida Bureau of Emergency Medical Oversight.
I accept that in the best interests of the State,the Florida Bureau of Emergency Medical Oversight reserves
the right to reject or revise any and all grant proposals or waive any minor irregularity or technicality in
proposals received and can exercise that right,
I,the undersigned.understand and accept that the Notice of Grant Awards will be advertised in the Florida
Administrative Weekly.and that 21 days after this advertisement is published I waive any right to challenge
or protest the awards pursuant to Chapter 120,F.S.
I certify that the cash match will be expended between the beginning and ending dates of the grant mW will
be used in strict accordance with the content of the application and approved budget for the activities
identified.In addition.the.budget shall not exceed.the department,approved funds for those activities
identified in the notification letter.No funds count towards satisfying this grant if the funds were also used
to satisfy a matching requirement of another stale grant.All cash,salaries,fringe berieri is,expenses.
equipment.and other expenses as listed in this application shall be committed And used for the activities
approved as a part of this grant.
Acceptance of Terms and Conditions: If awarded a grant,I certify that I will comply with all of�the above
also accept the attached grant terms and conditions and acknowledge this by signing below.
Signature o Authorized Grant Signer MM/DD/YY
(Individual Identified in Item 2)
7'
FLORtaA DEPARTMENT OF HEALTH
HEALTH INFORMATIONAND POLICYANALYSIS SECTION
REgUEST FOR GRANT FUND DISTRIBUTION
DOH 811mit Payment Too
The agency name,address,and federal ID number must be in the state MyFloridaMarketPlacs(MFMP)system.
Ask a finance person in your organization who does business with the state to provide these.
Name of Agency: M'0ri RD a VNTY 9.0,L L .
Mailing Address: Ca 15 p
_,CEY
Federal 9-digit Identificat' b 3-digit seq.code
Authorized Official: 03 1W In
Signature I Data
A�fc; t;s�rti�+r
Type or Print Name and Till
Sign and return this page with your application to.
Florida Department of Health
Health Information and Policy Analysis Section, Oploids
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: S........................m. ......................,............................... Grant ID: Code:
.Approved By:
Signature of Unit Su
pery isoror Date
Approved By: a .
Signature of Contract ..
Manager Date
State Fiscal Year 2018- - 2019
4tSaizatioaCodc E.Q. COCA 9hiect Code Cole&=
64-61-70-30-000 Pf OPCR9 790000 000700
Federal Tax ID:VF Oeq.Code:
Grant Beginning Date:,, . o. 0000, ._ .... .Grant Ending Date