01/15/2003Clerkeflhe
CircuitCoult
Danny L. Kolhage
Clerk ofthe Circuit Court
Phone: (305) 292-3550
FAX: (305) 295-3663
e-mail: phancock®monroe-clerk.com
Memorandum
TO:
Fire Chief Clark Martin
Fire-Rescue Department
ATTN:
FROM:
Susan Hover
Pamela G. Hancc~~
Deputy Clerk
DATE: January 22, 2003
At the January 15, 2003, Board of County Commissioner's meeting the Board granted
approval to submit two (2) Grant Applications (Rural and Matching Grant Requests) to the
Florida Department of Health, Bureau of Emergency Medical Services, to fund EMS related
equipment and training and to have the applications signed by the proper County authorities.
Enclosed please find a duplicate original of each of the above-mentioned for your
handling. Should you have any questions please feel free to contact our office.
cc:
County Administrator w/o documents
County Attorney
Finance
File,/'
~Ionroe COlmtj aefk'~ ;;)~te; OrlginaU
EMS MA TCHING GRANT ApPLlCA TION
FLORIDA DEPARTMENT OF HEAL TH
Bureau of Emergency Medical Services
,
Complete all items unless instructed differently within the application
T e of Grant Re uested: D Rural [Xl Matchin
10. Code The State Bureau of EMS will assi n the 10 Code - leave this blank
1. Orqanization Name: Board of Countv Commissioners. Monroe County Florida
2, Grant Siqner: (The applicant signatory who has authority to sign contracts, grants, and other legal
documents. This individual must also sign this application)
Name: Dixie M. Spehar
Position Title: Mavor
Address: 500 Whitehead Street
City: Kev West County: Monroe
State: Florida Zip Code: 33040
Telephone: (305) 292-3440 Fax Number: (305) 292-3466
E-Mail Address: boccdis1@monroecountv-fl.com
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: Clark O. Martin, Jr.
Position Title: Fire Chief
Address: 490 63rd Street Ocean, Suite 160
City: Marathon County: Monroe
State: Florida Zip Code: 33050
Telephone: (305 ) 289-6088 Fax Number: (305) 289-6336
E-mail Address: martin-clark@monroecountv-fl.com
DH Form 1767, Rev. June 2002
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4. Leoal Status of Aoolicant Oroanization (Check only one resoonse):
(1) 0 Private Not for Profit [Attach documentation-501 (3) @]
(2) 0 Private For Profit
(3) 0 City/MunicipalityrrownNillage
(4) IiaCounty
(5) 0 State
(6) 0 Other (specify):
5. Federal Tax 10 Number (Nine Dioit Number). VF2, 3_2.. Jl_<L Q_7 4 9
6. EMS License Number: 002176 Type: KXTransport DNon-transport DBoth
7. Number of permitted vehicles by type: ~BLS -LALS Transport ~ALS non-transport.
8. Type of Service (check one): ~Rescue DFire DThird Service (County or City Government,
nonfire) DAir ambulance: DFixed wing ORotowing DBoth DOther (specify)
9. Medical Director of licensed EMS orovider: If this project is approved, I agree by signing below that I
will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all
continuino EMS educati n' this Rroject. [No signature is needed if medical equipment and
Professional EMS ed a n ar not in this project.]
I -
./
Signature:
Date:
0&/()3
t..-
PrintfType: Name of Director
Dr. Sandra Schwemmer
FL Med. Lie. No.
OS 4022
Note: All organizations that are not licensed EMS providers must obtain the signature of the medical
director of the licensed EMS provider responsible for EMS services in their area of operation for projects
that involve medical e ui ment and/or continuin EMS education.
11 your activity is a research or evaluation project, omit Items 10, 11, 12, 13, and skip to Item
Number 14. Otherwise, roceed to Item 10 and the followin items.
10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary
addressing this project, covering each topic listed below.
A) Problem description (Provide a narrative of the problem or need);
B) Present situation (Describe how the situation is being handled now);
C) The proposed solution (Present your proposed solution);
D) Consequences if not funded (Explain what will happen if this project is not funded);
E) The geographic area to be addressed (Provide a narrative description of the geographic area);
F) The proposed time frames (Provide a list of the time frame(s) for completing this project);
G) Data Sources (Provide a complete description of data source(s) you cite);
H) Statement attesting that the proposal is not a duplication of a previous effort (State that this project
doesn't duplicate what you've done on other grant projects under this grant program).
DH Form 1767, Rev. 2002
,k. ~ I'd~
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4
4. Leqal Status of Aoolicant Orqanization (Check only one resoonse):
(1) 0 Private Not for Profit [Attach documentation-501 (3) @]
(2) 0 Private For Profit
(3) 0 City/MunicipalityrrownNillage
{4} 6aCounty
(5) 0 State "
(6) 0 Other (specify):
5. Federal Tax 10 Number (Nine Diqit Number). VF2. -3_2...9 _ ~ g _7 4 9
6. EMS license Number: 002176 Type: Wransport DNon-transport DBoth
7, Number of permitted vehicles by type: ~BLS -LALS Transport -2-ALS non-transport.
8. Type of Service (check one): @Rescue DFire DThird Service (County or City Government,
nontire) DAir ambulance: DFixed wing DRotowing DBoth DOther (specify)
9. Medical Director of licensed EMS orovider: If this project is approved, I agree by signing below that I
will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all
continuinq EMS education in this project. [No signature is needed if medical equipment and
professional EMS education are not in this project.]
Signature:
Date:
Printrrype: Name of Director
Dr. Sandra Schwemmer
FL Med. lie. No,
OS 4022
Note: All organizations that are not Iicen~ed EMS providers must obtain the signature of the medical
director of the licensed EMS provider responsible for EMS services in their area of operation for projects
that involve medical e ui ment and/or continuin EMS education.
!f your activity is a research or evaluation project, omit Items 10, 11, 12, 13, and skip to Item
Number 14. Otherwise, roceed to Item 10 and the followin items.
10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary
addressing this project, covering each topic listed below.
A) Problem description (Provide a narrative of the problem or need);
B) Present situation (Describe how the situation is being handled now);
C) The proposed solution (Present your proposed solution);
D) Consequences if not funded (Explain what will happen if this project is not funded);
E) The geographic area to be addressed (Provide a narrative description of the geographic area);
F) The proposed time frames (Provide a list of the time frame{s) for completing this project);
G} Data Sources (Provide a complete description of data source(s) you cite);
H) Statement attesting that the proposal is not a duplication of a previous effort (State that this project
doesn't duplicate what you've done on other grant projects under this grant program).
OH Form 1767, Rev. 2002
4
EMS Grant Application
10. Justification Summary, Attachment Page 1 of 3
A. ITEM 1 (Universal Patient Simulator)
Monroe County Fire Rescue has been in state of constant development and change since the County started assuming the
responsibility of pre hospital patient care and transportation from the myriad of volunteer ambulance providers. From our
initial organization up to our most recent realignment; (which has brought all the EMS and Fire personnel into one
department with common goals and objectives); the "EMS" division has had a great turnover in staff and personnel. This
has made it difficult, if riot impossible, to keep a consistent level of excellence in our training program. As a consequence,
our training mannequins and training aids are of many different brands, ages and states of repair. It is almost impossible to
obtain parts or service for them, and it is certainly discouraging to try to teach a class or hold a training session using such
equipment. Many times demonstrations must be tailored to the quirks of the training aid, rather than focusing on the skill
being taught or reviewed. Because of the various states of repair of some of the units, students must sometimes deal with
unrealistic situations, which would seem to be contrary to the purpose of training.
ITEM 2 (MCS 200 UHF Radios)
The current EMS radios in the Monroe County Fire Rescue vehicles were purchased in 1988. they are starting to break
down and Motorola no longer supports this radio.
ITEM 3 (Mobile Computer Systems)
We currently have no electronic method of dispatching units. Method of obtaining accurate times for calls to service or
Sheriff Dept. incident report numbers must be done upon completion of call by telephone resulting in delays and
interruption to dispatchers.
B. ITEM 1 (Universal Patient Simulator)
Our training program has progressed by leaps and bounds recently, and we have entered into agreements with the
University of Miami SIMLAB, and MD's recognized for excellence and contributions to the field of EMS. When these
organizations or individuals teach classes, however, they still use our training aids. Many times a "Hands on" exercise
becomes more of a tabletop exercise, or discussion based scenario rather than a hands on session.
ITEM 2 (MCS 200 UHF Radios)
Currently we have had to use all of our spare radios to keep the current system operating. We now have no spare radios to
replace one that goes down.
ITEM 3 (Mobile Computer Systems)
Currently dispatched by voice radio only. Multiple verifications by voice are requested, especially given similar street
names and address ranges, thereby creating excess radio traffic.
EMS Grant Application
10. Justification Summary, Attachment Page 2 of 3
C. ITEM 1 (Universal Patient Simulator)
Monroe County Fire Rescue is proposing the purchase of a Laerdal "Sim-Man" patient simulator. This simulator
encompasses the needs of any conceivable scenario based or practical skills training. It can be used for BLS as well as
ACLS, BTLS, A TLS, and Advanced Airway classes. It will also enhance our ability for continuing education and quality
assurance of our crews in the field,
ITEM 2 (MCS 200 UHF Radios)
Purchase 9 new Motorola UHF radios to replace all of the current EMS radios.
ITEM 3 (Mobile Computer Systems)
Purchase Mobile Computer Systems with mapping capabilities to be installed on all emergency vehicles to provide written
verification of addresses, incident particulars, and unit status confirmation thereby assuring efficient responses and safety of
personnel.
D. ITEM 1 (Universal Patient Simulator)
Due to the ever increasing cutbacks in County government, the likelihood of obtaining any new training equipment outside
this grant is practically zero. If not funded we would be forced to continue to use the outdated and irreparable training aids
we have now, and the quality of our continuing education and scenario based assessment of our field crews will not be
effective.
ITEM 2 (MCS 200 UHF Radios)
If this project is not funded we will have to look for another source of financing to make sure that our EMS vehicles can
communicate with the appropriate hospitals.
ITEM 3 (Mobile Computer Systems)
E. ITEM 1 (Universal Patient Simulator)
ITEM 2 (MCS 200 UHF Radios)
ITEM 3 (Mobile Computer Systems)
Monroe County Fire Rescue provides EMS services to residents and visitors to the Florida Keys; from Mile Marker 4.5
(Cow Key Channel Bridge) to Mile Marker 113 (Miami-Dade/Monroe County line), exclusive of the municipalities of
Marathon (MM 40-56) and Islamorada (MM 73-90); although we do provide mutual aid to these cities as well as the city of
Key West. All equipment to be purchased will serve these areas.
EMS Grant Application
10. Justification Summarv, Attachment Page 3 of 3
F. ITEM 1 (Universal Patient Simulator)
Upon award of the grant, RFQ's could be issued within 30 days, with complete purchase and delivery 60 days beyond that.
A comprehensive training program to utilize the new equipment will also be developed during the same time frame, for
implementation upon delivery,
ITEM 2 (MCS 200 UHF Radios)
If the Grant is approved the Radios will be immediately ordered. They usually take 6 to 8 weeks to arrive. Once they
arrive in Monroe County they would be programmed and then installed in the Rescue Units. Installation usually takes
about 3 days per unit. Within one month of receiving the radios they should all be installed in the rescue units,
ITEM 3 (Mobile Computer Systems)
This project would be completed within 12 months of fund availability,
G. ITEM 1 (Universal Patient Simulator)
ITEM 2 (MCS 200 UHF Radios)
ITEM 3 (Mobile Computer Systems)
Not Applicable.
H. ITEM 1 (Universal Patient Simulator)
ITEM 2 (MCS 200 UHF Radios)
ITEM 3 (Mobile Computer Systems)
None of the projects we are requesting matching funds for are duplications of any previous effort or grant request, through
the State Department of Health, or any other entity or organization.
Next, only complete 2n.! of the following: Items 11, 12, Q! 13. Read all three and then select and
com lete the one that ertains the most to the recedin Justification Summa .
11. Outcome For Proiects That Provide or Effect Direct Services To Emerqencv Victims: This may
include vehicles, medical and rescue equipment, communications, navigation, dispatch, and all other
things that impact upon on-site treatment, rescue, and benefit of emergency victims at the emergency
scene. Use no more than two additional one sided, double-spaced pages for your response, Include the
following.
A) Quantify what the situation has been in the most recent 12 months for which you have data (include
the dates). The strongest data will include numbers of deaths and injuries during this time.
B) In the 12 months after this project's resources are on-line, estimate what the numbers you provided
under the preceding "(A)" should become.
C) Justify and explain how you derived the numbers in (A) and (B), above.
D) What other outcome of this project do you expect? Be quantitative and explain the derivation of your
figures.
E) How does this integrate into your agency's five year plan?
12. Outcome For Traininq Proiects: This includes training of all types for the public, first responders, law
enforcement personnel, EMS and other healthcare staff. Use no more than two additional one sided,
double-spaced pages for your response. Include the following:
A) How many people received the training this project proposes in the most recent 12 month time period
for which you have data (include the dates).
B) How many people do you estimate will successfully complete this training in the 12 months after
training begins?
C) If this training is designed to have an impact on injuries, deaths, or other emergency victim data,
provide the impact data for the 12 months before the training and project what the data should be in
the 12 months after the training.
D) Explain the derivation of all figures.
E) How does this integrate into your agency's five year plan?
13. Outcome For Other Proiects: This includes quality assurance, management, administrative, and
other. Provide numeric data in your responses, if possible, that bear directly upon the project and
emergency victim deaths, injuries. and/or other data, Use no more than two additional one sided, double-
spaced pages for your response. Include the following.
A) What has the situation been in the most recent 12 months for which you have data (include the
dates )?
B) What will the situation be in the 12 months after the project services are on-line?
C) Explain the derivation of all numbers.
D) How does this integrate into your agency's five year plan?
DH Form 1767, Rev. 2002
5
EMS Grant Application
11. Outcome For Proiects That Provide or Effect Direct Services to Emerl!encv Victims
Attachment Page 1 of 2
A. ITEM 1 (Universal Patient Simulator): In the 12 month period from 4/1/01 to 4/1/02, Monroe County Fire Rescue
delivered five major training programs to it's employees, for the basis of initial and continuing education, Most classes
were offered to both EMTs and Paramedics. Average attendance was 31. We have a staff of 42, including the Supervisors.
The breakdown of types of classes and numbers trained are as follows:
. University of Miami Acute Myocardial Infarction and 12 Lead Class
21 Employees
. University of Miami Emergency Management of Acute Stroke
21 Employees
. AdvancedJDifficult Airway management (including In service
on Pertrach Emergency Tracheotomy device, and Laryngeal Mask Airway) 31 Employees
. Basic Trauma Life Support (Advanced Class)
40 Employees
. Air Medical Core Curriculum (DOT Standard Course)
40 Employees
(We have a career staff of 42, avg. attendance = 73% career personnel)
We also trained over 253 individuals through our AHA Community Training Center to BLS skill levels, from AED through
Healthcare provider. No quantitative data is available for few scenario based skills testing/development sessions that were
conducted for field personnel. Although there is no directly identifiable relationship between patient outcomes and the
frequency/quality of training, it is a widely held belief among EMS providers and educators that more training equals better
patient care.
ITEM 2 (MCS 200 UHF Radios): N/A
ITEM 3 (Mobile Computer Systems): N/ A
B. ITEM 1 (Universal Patient Simulator): In the 12 month period after the resources become available, we would anticipate
implementation of an aggressive training and quality assurance program, which would include all of the career EMTs and
Paramedics, along with County Volunteer FireFighters (first responders and EMTs) participating as well. We would plan
for 93% participation from our career staff, and would plan on 4 major training events per year. Following is the proposed
training schedule:
. Advanced Cardiac Life Support
39 Employees
. Basic Trauma Life Support (Initial & Re-certifications)
39 Employees
. Advanced Airway / Difficult Intubation
39 Employees
. Patient Assessment Workshop
39 Employees
In addition we would also implement a skills testing/on duty skills evaluation program whereby crews would be presented
with different scenarios each month, related to the training received the month prior. This would allow for measurable
EMS Grant Application
11. Outcome For Proiects That Provide or Effect Direct Services to Emen!:ency Victims
Attachment Page 2 of 2
evaluations of teaching effectiveness, and identify areas for further training. There would be 100% participation in this
program.
ITEM 2 (MCS 200 UHF Radios): N/ A
ITEM 3 (Mobile Computer Systems): N/ A
C. ITEM 1 (Universal Patient Simulator): The figures in section (A) above were taken from training records and attendance
sheets for each of the classes taught. Section (B)'s figures are projections, based on four major training events per year,
D. ITEM 1 (Universal Patient Simulator): The overall outcome of the project should be a greater skill and comfort level
among those personnel providing Emergency care to the sick and injured of our jurisdictioIl. Secondary to this we could
expect an improved level of service and patient care, reduced on scene times, better patient assessment skills among our
staff, and improved customer service. We would near 100% participation in our training and skills review.
ITEM 2 (MCS 200 UHF Radios): N/A
ITEM 3 (Mobile Computer Systems): This project is expected to provide reduced response times by having written
confirmation of addresses available in the cab of the emergency vehicles, eliminating the mistakes of duplicate street names
with similar address ranges- a common occurrence in the Florida Keys. Attached information including milepost
references, subdivision names, near cross streets and actual key locations will eliminate the need for multiple radio
interactions with busy sheriffs dispatchers and the potential for wrong turns. The safety of crews will be enhanced by real-
time availability updates of on scene conditions as the units respond. This will give crews a "heads-up" as to the need to
coordinate more closely with law enforcement or to call in additional fire rescue resources, Future availability of mapping
and routing features, as well as GPS links will ensure closest-unit recommendations for emergencies.
E. ITEM 1 (Universal Patient Simulator): N/A
ITEM 2 (MCS 200 UHF Radios): N/A
ITEM 3 (Mobile Computer Systems): N/ A
I Skip Item 14 and go to Item 15, unless your project is research and evaluation and you have not
completed the preceding Justification Summary and one outcome item.
14. Research and Evaluation Justification Summary, and Outcome: You may use no more than three
additional one sided, double spaced pages for this item.
A) Justify the need for this project as it relates to EMS.
B) Identify (1) location and (2) population to which this research pertains.
C) Among population identified in 14(B) above, specify a past time frame, and provide the number of
deaths, injuries, or other adverse conditions during this time that you estimate the practical application
of this research will reduce (or positive effect that it will increase).
D) (1) Provide the expected numeric change when the anticipated findings of this project are placed into
practical use.
(2) Explain the basis for your estimates.
E) State your hypothesis.
F) Provide the method and design for this project.
G) Attach any questionnaires or involved documents that will be used.
H) If human or other living subjects are involved in this research, provide documentation that you will
comply with all applicable federal and state laws regarding research subjects.
I) Describe how you will collect and analyze the data.
15. Statutory Considerations and Criteria: The following are based on s. 401.113(2)(b) and 401.117, F .S.
Use no more than one additional double spaced page to complete this item. Write N/A for those things in
this section that do not pertain to this project. Respond to all others.
Justify that this project will:
A) Serve the requirements of the population upon which it will impact.
B) Enable emergency vehicles and their staff to conform to state standards established by law or rule of
the department.
C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as
required by law, rule or regulation of the department.
D) Enable the vehicles of your organization to have, at a minimum, a direct communications linkup with
the operating base and hospital designated as the primary receiving facility.
E) Enable your organization to improve or expand the provision of:
1) EMS services on a county, multi county, or area wide basis.
2) Single EMS provider or coordinated methods of delivering services.
3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other
related services. .
DH Form 1767, Rev. 2002
6
EMS Grant Application
15. Statutory Considerations and Criteria, Attachment Page 1 of 1
A. ITEM 1 (Universal Patient Simulator): WiII serve the requirements of the population by increasing the skills and quality of
EMS services delivered.
ITEM 2 (MCS 200 UHF Radios): These new radios will result in less down-time for our ambulances while repairs are
,
accomplished including parts acquisition,
ITEM 3 (Mobile Computer Systems): This project wilIlower response time averages sought by Monroe County. It will also
enhance communications to management and databases for important information and links to command and management staff.
B. ITEM 1 (Universal Patient Simulator): WiII enable staff to conform to the standards established by rule and law by enabling
them to complete require training and currency of experience requirements in a timely and cost effective manner.
ITEM 2 (MCS 200 UHF Radios): The purchase of these radios will enable emergency vehicles and their staff to continue to
conform to state standards and rules regarding emergency communications equipment.
ITEM 3 (Mobile Computer Systems): N/A
C. ITEM l(Universal Patient Simulator): N/A
ITEM 2 (MCS 200 UHF Radios): The purchase of these radios will enable the vehicles of our organization to stay within the
state requirements set forth for emergency communications equipment.
ITEM 3 (Mobile Computer Systems): N/A
D. ITEM 1 (Universal Patient Simulator): N/A
ITEM 2 (MCS 200 UHF Radios): The purchase of these radios will enhance the communications dependability between the
rescue units and the receiving facilities.
ITEM 3 (Mobile Computer Systems): N/ A
E. ITEM 1 (Universal Patient Simulator): (1) N/A: (2) N/A: (3) N/A
ITEM 2 (MCS 200 UHF Radios): (1) These updated radios will enable improved communications with other facilities while
performing services both in and out of county. (2) N/A. (3) Monroe County Fire Rescue has direct communication with related
service agencies, including local fire and police, The new radios will provide a backup to the primary radio system used for
linking these agencies, therefore improving the dependability of communications.
ITEM 3 (Mobile Computer Systems): (1) This project will improve the level of service by lowering response times as well
as provide link for on-scene information to responders or to command staff. (2) N/A. (3) By placing mobile computer systems
in command vehicles and in BLS first response apparatus, this will provide a link with the existing systems of the Sheriffs
Office and will therefore provide faster more accurate dispatching and coordination of responding units.
16. 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 win take about a year. Also, if you are purchasing certain makes of
ambulances, it takes at least nine months for them to be delivered after the bid is let.
Work Activity Number of Months After Grant Starts
:
Beqin End
1ER~-)~?!r%, of ~~fug:~A~oWfisstonar' s 1 Month Z Months
a ro a 0 ex en <n' C 1ng un s,
Rece1veRFQ s, reV1ew quotes, award Ven orZ Months 3 Months
tlace.order, await shipment, vendor 3 Months 5 Months
ra1n1ng.
DevelQp and implement training program 5 Months 10 Months
for s1mulator.
Have radios installed in rescue units. 5 Months 9 Months
Have mobile computer systems installed 5 Months 11 Months
..L.U ~"'"...u'" unlLS.
17. County 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.
The reason this request cannot be paid for out of funds awarded under the
state EMS coun~y grant program is because we have already allotted those
funds for the purchase and implementation of a pen-based EMS field data
collection and reporting system.
DH Form 1767, Rev. 2002
7
18. BudQet:
Salaries and Benefits: For each Costs Justification: Provide a brief justification
position title, provide the amount of why each of the positions and the numbers
salary per hour, FICA per hour. of hours are necessary for this project.
fringe benefits, and the total .
number of hours.
N/A
TOTAL:
Expenses: These are travel costs Costs: list the price Justification: Justify why each of the
and the usual. ordinary, and and source(s) of the expense items and quantities are
incidental expenditures by an price identified. necessary to this project.
agency. such as, commodities and
supplies of a consumable nature.
excludinQ expenditures classified
as operating capital outlay (see
next cateQorv).
N/A
TOTAL: $
DH Form 1767. Rev. 2002
8
LE: Life Expectancy
Vehicles, equipment, and other Costs: List the price Justification: State why each of the items
operating capital outlay means of the item and the and quantities listed is a necessary
equipment. fixtures, and other source(s) used to component of this project.
tangible personal property of a non identify the price.
consumable and non expendable
nature, and the normal expected I
,
life of which is 1 year or more.
(1) Universal Patient $ 28,980* Base unit of patient simulator,
Simulator LE: 7 years Laerdal Sim Mart.
(1) Portability/Power :ji 990* Allows simulator to be used outdo r
Adapter Kit LE: 7 years during training, added realism.
(1) Trauma Module ~ 1 ;360* Added realism: to simulator in
LE: 7 years emergency trauma management.
(1) Regulator :ji 490* Allows for running simulator throlg
LE: 7 years connection to wall outlet or port b
(10) MCS 200 UHF Radios $ 24,950 u2 source. in neec
We have 9 ALS rescue units
LE: 8 years Notorola "'h~-- --~.;"C' ....1n" ~-~
(27) Nobile Computer Systerrs $ 167,400** 9 ALS Ned Units, 2 ALS Engines,
LE: 8 vears 6 BLS Resnonse Eneines. 6 Dent Co un;
Vehicles, 4 Staff Vehicles.
TOTAL: $ 224,170
s
h
le
of
and
*Simulator costs quoted are from the manufacturer, and reflect list prices.
** '
State Amount
(Check applicable program)
IX] Matching: 75 Percent $ 168,127
o Rural: 90 Percent $
Local Match Amount
(Check applicable program)
IX] Matching: 25 Percent
$ 56,043
o Rural: 10 Percent
$
Grand Total
DH Form 1767, Rev. 2002
$
9
19. Certification:
My signature below certifies the following.
I am aware that any omissions, falsifications, misstatements, or misrepresentations in this
pplication may 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 Jaw. I
certify that to the best of my knowledge and belief all of the statements contained herein and on
ny 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 EMS. 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 EMS.
I accept that in the best interests of the State, the Florida Bureau of EMS 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 Matching Grant Awards will be
dvertised 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
rant and 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,
pproved funds for those activities identified in the notification letter. No funds count towards
atisfying this grant if the funds were also used to satisfy a matching requirement of another
tate grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as
listed in this application shall be committed and used for the activities approved as a part of this
rant.
cceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the
bove and also accept the attached grant terms and conditions and acknowledge this by signing
below.
D I / 15" /. '3
MM / DO / YY
10
FLORIDA DEPARTMENT OF HEAL TH
EMS GRANT PROGRAM
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with the provisions of Section 401.113(2)(b), F, S" the undersigned
hereby requests an EMS grant fund distribution for the improvement and expansion or
continuation of pre-hospital EMS,
DOH Remit Payment To:
Name of Agency: Board of County Commissioners. Monroe County. Florida
Mailing Address: 490 63rd Street. Marathon. Florida 33050
Federal Identification Number: 596000749
Authorized Aaencv Official: ~. ifi'<~. >n ~A~
i,,!'PROVED"AS TO' FORM S '
,:,ND LEGAL SUFFI Ie. 19 a re
DI/'~/.5
Date
Zij;~ft J~O~_ ~~eeN~~~:~j~j;:;.vor
Sign and return this page with your ap~~~''':':<'. ;
l":,(';/ ~~;<\~1; ,r,:....,:, -.,'~Li':'.'~/i~',
;... i ,,/\'tl ~'l ..1, ..;\
Florida Department of HeaHf)!,,/, , ~\.~')~ .....
BEMS G 1. ',' ..:.'." \ . '. 1;
rant Program \'.' ;:~ + ;. i,~ .' < \ /' ...,
,,, t '. ", , ?;;,
4052 Bald Cypres.s Way, Bin~~~i~"';'<'0)\\'b;v" ..
Tallahassee, Flonda 32399-1~?::,~-,:.""~y;/,, >c.
....;~~~,-~~\
Do not write below this line. For use by Bureau of Emergency"Medical Services
personnel only
Grant Amount For State To Pay: $
Grant ID Code:
Approved By:
Signature of EMS Grant Officer
State Fiscal Year:
Date
Oraanization Code
64-25-60-00-000
E.O.
N_
OCA
N2000
Obiect Code
7
Federal Tax ID:
VF_________
'-"
Grant Beginning Date:
"
Grant Ending Date:
'.."
DH Form 1767P, Rev. June 2002