Resolution 129-1987
James R. Pa Director
Emergency M~u~~al Services
RESOLUTION NO. 129-1987
A RESOLUTION AUTHORIZING THE MAYOR AND
CHAIRMAN OF THE BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA, TO EXECUTE A
CONTRACT BY AND BETWEEN THE STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES AND THE MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS.
WHEREAS, Monroe County is in need of consultant services to
study the County's Emergency Medical Services, and
WHEREAS, such services will improve and expand Monroe
County's prehospital Emergency Medical Services system, and
WHEREAS, the State of Florida has made funds available for
such consultant services, and
WHEREAS, use of the State funds will not be used to supplant
the existing Monroe County Emergency Medical Services budget
allocation, now, therefore,
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, as follows:
1. Monroe County hereby certifies that the monies received
from the County Emergency Medical Services award will improve and
expand the County's prehospital Emergency Medical Services system
and will not be used to supplant the existing Emergency Medical
Services budget allocations.
2. That the Mayor and Chairman of the Board of County
Commissioners of Monroe County, Florida, is hereby authorized to
execute a Contract by and between the State of Florida Department
of Health and Rehabilitative Services and the Monroe County Board
of County Commissioners, a copy of same being attached hereto.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on this 3rd day of March, A.D. 1987.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA,
(SEAL)
At tes t: DANNX L. KOLHAGE, Clerk
W~~L
airman /7-'.
d..L ,/JtlbkA 1, [).~
,.1PP 0 ED AS TO FORM
A LEGAL SUFfIC.'fE(t~C . l'
2Y ~............. (J .... L /
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OTHER GOVERNMENTAL AGENCIES
GENERAL REVENUE I FEDERAL FUNDS
CONTRACT BETWEEN
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
AND
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I J 1,ldO
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Rt-H "till IT 'fl\ 1- ~t-R\.\ , -
Monroe County Board of County Commissioners
THIS CONTRACT is entered into between the State of Florida, Department of Health and Rehabilitative
Servij::es, ,hereinafter referred to as the "department", and MonroP' rrmnt-y Rt"'\~rQ OF Countv
Comnussloners , hereinafter referred to as the "provider",~
The parties agree:
I. The PnMder AgrMe:
A. To provide services according to the conditions specified In Attachment I
B. Federal and State Laws and Regulations
1. If this contract contains federal funds, the provider shall comply with the provisions of 45 CFR,
Part 74, and other applicable regulations If specified in Attachment N/A .
'.
2. If this contract contains federal funds and is over $100,000, the provider shall comply with all
applicable standards. orders, or regulations issued pursuant to the Clean Air Act as amended (42 USC 1857
et seq.) and the Water Pollution Control Act as amended (33 USC 1368 et seq.).
C. Audita and Records
1. To maintain books. records and documents in accordance with accounting procedures and
practices which sufficiently and properly reflect all expenditures of funds provided by the department
under this contract.
..\
2. To assure that these records shall be subject at all times to inspection, review, or audit by
state personnel and other personnel duly authorized by the department, as well as by federal personnel.
3. To maintain and file with the department such progress,' fiscal, inventory and other
reports as the department. may require within the period of this contract.
4. To include these aforementioned audit and record-keeping requirements in all approved
subcontracts and assignments.
5. To allow publiC access to all documents, papers, letters or other material subject to the
provisions of Chapter 119, F.S., and made or received by the provider in conjunction with this con-
tract. It is expressly understood that substantial evidence of the provider's refusal to comply with
this provision shall constitute a breach of contract.
D. Retention of Records
1. To retain all financial records, supporting documents, statistical records, and any other
documents pertinent to this contract for a period of five (5) years after termination of this contract. or
if an audit has been initiated and audit findings have not been resolved at the end of five (5) years.
the records shall be retained until resolution of the audit findings.
2. Persons duly authorized by the department. and federal auditors, pursuant to 45 CFR.
Part 74.24(a), (b), and (d), shall have full access to, and the right to examine any of said records and
documents during said retention period.
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Rev; sed E. Monitoring
1, To provide progress reports, including data reporting requirements as specified in
Attachment I. These reports will be used for monitoring progress or performance of the con.
tractual services as specified in Attachment I
2. To provide access to, or to furnish whatever information is necessary to effect this
monitoring.
3. To permit the department to monitor the aforementioned service program operated by
the provider or subcontractor or asignee according to applicable regulations of the state and federal
governments. Said monitoring will include access to all client records.
F. Insurance
If the provider is a county or municipality, the provider shall furnish the department written
verification of liability coverage in accordance with Section 768.28, F.S.
G. Safeguarding Information
The provider shall not use or disclose any information concerning a recipient of services
under this contract for any purpose not in conformity with the state regulations and federal regula-
tions (45 CFR, Part 205.50), except upon written consent of the recipient, or his responsible parent or
guardian when authorized by law.
H. Client Information
The provider shall submit to the department as specified in Attachment N fA manage-
ment and program data, including client identifiable data, for inclusion in the HRS Client Informa-
tion System.
I. Assignments and Subcontracts
The provider shall neither assign the responSibility of this contract to another party nor sub-
contract for any of the work contemplated under this contract without prior written approval of the
department. No such approval by the department of any assignment or subcontract shall be deem-
ed in any event or in any manner to provide for the incurrence of any obligation of the department in
addition to the total dollar amount agreed upon in this contract. All such assiQnments or subcon.
tracts shall be subject to the conditions of this contract and to any c~nditions of approval that
the department shall deem necessary.
J. Financial Reports
To provide financial reports to the department as specified in Attachment I
K. Return of Funds
The provider agrees to return to the department any overpayments due to unearned funds or
funds disallowed pursuant to the terms of this contract that were disbursed to the provider by the
department. Such funds shall be considered department funds and shall be refunded to the depart-
ment. The refund shall be due within 45 days following the end of the contract or at the time
the overpayment is discovered unless otherwise authorized by the department in writing and attach-
ed to this contract.
L Unusual Incident Reporting
If services to clients will be provided under this contract, the provider and any subcontrac-
tors shall report to..the department unusual incidents in a manner prescribed in HRSR 0-10-1,
M. Transportation. Disadvantaged
If clients will be transported under this contract, the provider will subcontract with the
designated Community Coordinated Transportation Provider, or otherwise comply with the provI-
sions of Chapter 427, Florida Statutes. The provider shall submit to the department the reports reo
quired pursuant to Volume 10, HRS Accounting Procedures Manual.
2
;'r1/86
N. Civil Rights C~ tlon
The provider gives this assurance in consideration of and for the puroose ~f ::::talr:~t;
r=gaeral grants. loans, contracts (exceot contracts of insurance or guaranty), property, :::sc~Lr~s, :-
Jther t:gaeral financial assistance to programs or activities recel'lIng or Denetitlng ;'cr = ~C::':;.
financ:al assistance.
The provider assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended. 42 U.S.C. 2000d et seq..Nnlc:; :;r:-
hibits discrimination on the basis of race, color, or national origin in programs and activities recel'l'
ing or benefiting from Federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prOhIbits
discrimination on the basis of handicap in programs and activities receiving or benefiting from
Federal financial assistance.
3. Title IX of the Education Amendments of 1972. as amended. 20 U.S.C. 1681 et sea.. Nnici'1
prohibits discrimination on the basis of sex in ~ducation programs and activities receiving ::r
benefiting from Federal financial assistance. '
4, The Age Discrimination Act of 1975, as amended. 42 U.S.C. 6101 et seq., whlC:; oronlcl:s
discrimination on the basis of age in programs or activities receiving or benefiting from r=eaeral
financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97.35, which prohibits discrimlna.
tion on the basis of sex and religion in programs and activities receiving or benefiting from Feaeral
financial assistance.
6. All regulations, guidelines, and standards lawfully adopted under the above statutes.
The pro'Vider agrees that compliance with this assurance constitutes a condition of con.
tinued receipt of or benefit from Federal financial assistance, and that it is binding uoon ~he orc.
vider, its successors, transferee. and assignees for the period during which such assistance IS :)ro-
vided. The provider further assures that all contractors. subcontractors, subgrantees or otherSNl:h
whom it arranges to provide services or benefits to participants or employees in connection 'N1th an~1
of its programs and activities are not discriminating against those participants or emoloyees n
Violation of the above statutes, regulations, guidelines, and standards. In the event of 'aliue ~::
comply, the provider understands that the Grantor may, at its discretipn. seek a court order -ecuw ~~
compliance with the terms of this assurance or seek other appropriate judicial or admlnlstrat:'/e
relief, to include assistance being terminated and further assistance being denied.
11. The Department Agrees:
A. Contract Amount
To pay for contracted services according to the conditions of Attachment I n ::n
amount not exceed $25.878. l~ subject to the availability of funds. ihe State of FlOrida s cer'cr.
mance and obligation to pay under this contract is contingent upon an annual appropriation DY ~~e
Legislature.
B. Contract Payments
Pursuant to section 215.422. F,S., on receipt of an invoice and receipt. insoec:!cn, "r,c ::c-
proval of the goods or services. the department shall file the invoice with the Comptroile, m:r.lr. '::
days. If the payment of the invoice is not mailed by the department to the vendor Within ..l: sa~/s s."e:
:ecelpt of the Invoice and receipt. inspection, and approval of the goods and services. ~-e :ec::-~'
ment 'NIII pay the vendor, in addition to the amount of the invoice, interest at a rate of i :ec::r: :~:
month or portion thereof on the unpaid balance from the expiration of sucn .15 day perlce Jr.,11 S,,::-
time as the warrant is mailed to the vendor, Exceptional circumstances as aefinec n see::-
215.422(2), F,S., may permit the deadline for payment to be revised.
3
'7/1/86 .
III. The Provider anct ....."'_. tment Mutually Agree:
A. Effective Date
1. ThiS contract shall begin on Der.pmhpr 1 C; , 986
c:ate on Nnlch the contract has been signed by both .:Janies. whichever IS ~ater.
or :~s
2. This contract shall end on
December 14, 19B7
B. Termination
1. Termination at Will
This contract may be terminated by either party upon no less than thirty (30) days notice,
without cause. Said notice shall be delivered by certified mail, return receipt requested, or in person
with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to fInance this contract become unavailable, the department may ter.
minate the contract upon no less than twenty-four (24) hours notice in writing to the proviaer. Said
notice shall be delivered by certified mail, return receipt requested, or in person With proof::;f
delivery. The department shall be the final a\jthority as to the availability of funds.
3. Termination for Breach
Unless the provider's breach is waived by the department in writing, the department may
by written notice to the provider, terminate this contract upon no less than twenty-four (24) hours
notice. Said notice shall be delivered by certified mail, return receipt requested, or In person With
proof of delivery. If applicable, the department may employ the default provisions in Chaeter 13A-.1,
Florida Administrative Code. Waiver of breach of any provision of this contract shall not be deemea
to be a waiver of any other breach and shall not be construed to be a modification of the terms of this
contract. The provisions herein do not limit the department's right to remedies at law or to damages.
C. Notice and Contact
The contract manager for the de~artment for this contract is Jaime S. Ca 1 dwe 11
..\
The representative of the provider responsible for the administration of the program uncer
this contract is James R. (Re~qie) Paras
In the event that different representatives are designated by either party after execution at ~hls :;:;n.
tract. notice of the name and address of the new representative will be rendered In Writing to :1e
other party and said notification attached to originals of this contract.
D. Renegotiation or Modification
1. Modifications of provisions of this contract shall only be valid when they have been
reduced to writing and duly signed. The parties agree to renegotiate this contract if federal and/or
state revisions of any applicable laws,or regulations make changes in this contract necessary.
2. If this contract contains a fixed-price method of payment section, and the rate of :::ay.
ment is determined through the appropriations process, then this contract may be amenaec :0
reflect the new rate established through the appropriations process retroactive to the effec~lve ca,e
of this contract.
3. If tlJ.e contract co'ntalns either a cost-reimbursement or a fixed-price methoa :::f ;:lay~en:.
the rate of payment and the total dollar amount may be adjusted prosDectlvely to reflec :::rlce,'e'/8i
Increases determined through the appropriations process and subsequently Identified in tne deoar~.
ment's operating budget.
~
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E. Name and Ac
of Payee
The name and address of the official payee to whom the payment shall be made:
Monroe County Board of County Commissioners
Post Office Box 1980
Key West, Florida 33040
F. All Terms and Conditions Included
This contract and its attachments as referenced, ( I, II, III, IV, V and VI
),
contain all the terms and conditions agreed upon by the parties.
IN WITNESS THEREOF, the parties hereto have caused this 22
executed by their undersigned officials as duly authorized.
page contract to be
NAME:
STATE OF FLORIDA DEPARTMENT OF
HEALTH AND
REHABILITATIVE SERVICES
PROVIDER
SIGNED
SIGNED BY:
TITLE:
Chairman
TITLE:
E. CHARLTON PRATHER, M.D.,M.P.H.
Acting Deputy Assistant Secretar
for Health
and State Bealth Officer
NAME:
DATE:
3.3"<{7
DATE:
.,'
FEDERAL 10 NUMBER:
59-6000-749
AtJ9'~ANNY. 4 KOLHAGE, Clerk
~~pL;
DVED AS TO FORM
/
GAL SUFFICIENCY.
(l
BY
Attorney's Office
5
ATTACHMENT I
A. SERVICES TO BE PROVIDED:
The department will contract with the provider to:
(1) improve the existing quality of prehospital emergency
medical service (EMS) activities, services, or to have a positive
impact on patient mortality and morbidity; and (2) expand the
extent, size, or number of existing prehospital EMS activities or
services. The Activities and services to be provided are
described in the County A~ard Application, Attachment VI.
B. MANNER OF SERVICE PROVISION:
Services will be provided in' a manner consistent wi th Florida
Statutes Chapter 401 and the work plan which is included in the
County Award Application, Attachment VI.
C. METHOD OF PAYMENT:
Pursuant to Florida Statutes 401.113(2) (a), the department agrees
to advance payment of $ 25,878.15 , in full, to the
provider within thirty days of the effective date of the
contract.
The provider shall submit quarterly documentation of
accomplishments and expenditures to the department in accordance
with the Reports and Documentation requirements described in the
special provisions section of this attachment. All reports and
documentation are to be submitted to the contract manager at the
following address:
Jaime S. Caldwell
Department of Health and Rehabilitative Services
Office of Emergency Medical Services
1317 Winewood Boulevard
Tallahassee, Florida 32399-0700
..~
D. SPECIAL PROVISIONS:
1. The provider agrees to implement prOViSions of this contract
in accordance with federal, state, and local laws, rules,
regulations and policie~ that pertain to emergency medical
services.
2. The provider assures that EMS funds will not be . used to
supplant or replace any other funds.
3. The e~ovider will have an annual financial and compliance
audit per~ormed, by an independent auditor per specifications
outlined in Attachment IV.
6
4. The Provider agrees that all communications d<": 1..1vi ties and
equipment shall be approved by the State of Florida, Department
of General Services, Division of Communications pr ior to
implementation, as required by Chapter 401.024, Florida Statute.
Any expenses involving communications activities and equipment
not receiving this prior approval shall be disallowed.
5. The Provider agrees that evaluation and research activi ties
will comply Iii th U. S. Department of Health and Human Services
Regulations for Protection of Human SUbjects (45 CFR, as amended)
regarding the protection of human research subjects.
6. Facilities and Equipment
Both Parties Agree:
a. responsibility for proper insurance, licensing, permitting
and maintenance of facili ties and equipment purchased wi th the
County Award funds shall be the Providers.
. .
b. Ownership of all facilities and equipment purchased by
County Award funds shall be the providers.
c. Facilities and equipment purchased by County Award funds
shall be used solely for Improvlng and expanding prehospital
emergency medical ~ervices as described in Attachment VI, County
Award Application.
7. County Award Funds
Both Parties Agree:
a. all County Award funds to be expended by the Provider shall
be deposited in a separate account maintained,by the Provider.
.\
b. all County Award funds
Provider shall be accounted
Provider funds.
in the account maintained by the
for separately from all other
c. all County Award funds shall be used solely for activities
and services as described in Attachment VI, County Award
Application.
d. any unused County Award funds remaining in the separately
maintained Provider Account at the end of the contract, including
accrued interests, shall ~e reported to the department and remain
in the Provider account and be applied toward the next year's
County Award funding requirements.
e. there shall be no transfer or assignment of County Award
funds bet~~en the Provider and any other party without a written
sub-contract. All such sub-contracts shall be subject to the
conditions of this contract and must have prior approval of the
department.
7
f. exclusive of personnel salaries and fr_..:>_ benefits
categories, the provider is not restricted to staying within the
line item amounts reflected in the budget. However, the provider
must stay within the total combined amount budgeted for all other
categories.
g. no budget change can be made which will increase the
budgeted salary line item or any Provider staff person, unless
such an increase was projected in the original contract budget,
wi thout pr ior approval of the contract manager and the Central
Finance Contract Administration Office. The Provider will amend
the appropriate line items and submit appropriate justification
for the change using the Contract Budget Revision Request,
Attachment V. Any salary or fringe benefit increase made by the
provider without an approved line item budget amendment will be
disallowed.
h. no change may be made which will add a line item to the
original contract line item budget, without prior approval of the
contract manager and the Central Finance Contract Administration
Office. The Provider will amend the original contract line item
budget and submit appropriate justification for the change. Any
line i terns added by the Provider wi thout an approved line item
budget amendment will be disallowed.
i. The provide;- shall be solely responsible for any amount
reflected in the' budget \4hich is in excess of the amount
specified in Section II. A. of the model contract and the method
of payment Section C. of this attachment.
8. Reports and Documentation:
The Provider agrees to submit 1 original and 3 copies each of the
following reports and documents to the department on a quarterly
basis: ,,,
a. The Program Performance Report, Attachment II,
indicate measurable progress toward meeting stated
services, objectives, actions and time-frames.
which shall
activities,
b. The Expenditure Report, Attachment III, which shall indicate
all agreed upon budget expenditures.
c. Signed invoices which clearly indicate the service or
product delivered, date delivered, date paid, i tern cost, total
cost, condition or quality, and identification of person
receiving the service or product.
d. The required deadline for providing the department with
Program Performance Reports, Expenditure Reports and invoices is
as follows:
,'-
1.
~larch 15, 1987
for the period December 15, 1986
through February 28, 1987;
8
2. June 15, 1987 for the period March 1, 1987 through
May 31, 1987;
3. September 15, 1987 for the period June 1, 1987 through
August 31, 1987;
4. December 31, 1987 for the period September 1, 1987
through December 14, 1987.
9. OBJECTIVE TIME FRAMES:
Both parties agree that county award funds shall be used solely
for activities, services, or expenses incurred during the agreed
upon contract period, irregardless of time frames specified in
Attachment VI. The Provider shall revise time frames specified
in Attachment VI accordingly.
..',
9
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ATTACHMENT IV
Financial and Compliance Audit
The provider agrees to have an annual financial and compliance
audit performed, by independent auditors in accordance with
Standards for Audit of Governmental Organizations, Programs,
Activities, and Functions dev~loped by the Comptroller General of
the United States, dated Febr'~ary 27, 1981 (also referred to as
the "yellow book" and generally accepted governmental auditing
standards). State and local governments shall comply with Office
of Management and Budget (OMB) Circular A-128, "Audits of State
and Local Governments" dated April 15, 1985. Universities,
hospitals and other nonprofit prov~ders shall comply with OMB
Circular A-IIO, "Grants and Agree~ents with Institutions of
Higher Education, Hospitals, and Other Nonprofit Organizations".
Such audits shall cover the entire organization for the
organization's fiscal year.
Sections 5.f., 6., 7., 8., 12., 13., 14. and 15. of OMB 'Circular
A-128 shall apply to all audits. The provider shall assure that
audit workpapers and reports are retained for a minimum of five
years from the date of the audit report, unless the auditor is
notified in writing by the department to extend the retention
period. The provider shall also ensure that audit workpapers are
made available upon request to the department or its designee.
The scope of Standards for Audit of Governmental Organizations,
Programs, Activities, and Functions (the "yellow book") includes
(1) financial and compliance, (2) economy and efficiency and (3)
program results. For purposes of this attachment, the scope of
audits performed should include only financial ~nd compliance.
~
Contracts containing federal funds shall be audited for fiscal
years beginning after June 30, 1985. For example, the first
audit required by this attachment for contracts ending June 30,
1986 is for the period July 1, 1985 through June 30, 1986. All
contracts beginning after June 30, 1986, whether containing
federal funds or not, shall be audited in accordance with these
provisions.
A copy of the audit report must be submitted to the Office of
Audit and Quality Control Services, Audit Administrator, 1317
Winewood Boulevard, Tallahassee, Florida 32399-0700 within 120
days after the end of the provider's fiscal year unless otherwise
required by Florida statutes. If a management letter or any
other reports or correspondence relating to the audit findings or
recommendations are issued in connection with the audit, copies
must accompany the audit report.
13
~rnm"=HMENT V
?ROVIDER'S NAME
DATE
:::ONTRACT #
REQUESTED EFFECTIVE DATE OF THIS AMENDMENT
CURRENT REQUESTED PROPOSED
\'PPROVED CATEGORY/LINE I 'C'EME BUDGET CHANGES NEW BUDGET EXPLANATION
.
. .
.
,
It'
"
.
,
/
';RAND TOTAL ,"
~equested by
/
Date
\pproved by HRS Contract Manager
Date
.pproved by HRS Contract Administrator
(ASCAF)
Date
14
ATTACHMENT VI
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
OFFICE OF EMERGENCY MEDICAL SERVICES
1317 WlNEWOOD BOULEVARD
TALLAHASSEE, FLORIDA 32301
APPLICATION FOR FUNDING
COUNTY EMERGENCY MEDICAL SERVICES (EMS) AWARD
COMPLETING THE COUNTY EMS AWARD APPLICATION
Each Board of County Commissioners must complete this application in order
for the county to receive its proportionate share of the EMS grants program
funds. Carefully follow these instructions so your application may be
processed quickly and accurately.
We will not process an application which is found to be incomplete. The
Board of County Commissioners will be notified, in writing, of any
deficiencies in the ap~lication and it shall be returned to the county for
correction and resubmission. The corrected application shall be received
by the department no later than 21 days from the county's receipt of the
returned application.
The Board of County Commissioners shall notify the contract manager, in
writing, of changes to the application prior to a contract being awarded.
..\
INSTRUCTIONS
A. The Board of County Commissioners must submit two original signature
and three copies of the typed and completed application. All completed
applications must be submi tted to us so as to be rece~ved no later than
October 1. '.
B. Application packages are to be addressed as follows:
Larry S. Jordan~' Contract Manager
County EMS Award Application
Department of Health & Rehabilitative Services
Office of Emergency Medical Services
1317 Winewood Boulevard
Tallahassee, Florida 32301
HRS Form 1684, Ju1 86
15
1. County Identification:. Give county identification in[orm~tlon a~ it
uppears on contracts.
Name:
M.:mroc C:mnty Board of County Camussioncrs
Business Address:
P.o. Box 1980
Key west, Fl. 33040
(CITY)
Phone: (305 ) 294-4641
(AREA CODE)
(ZIP CODE)
-172-9000
( SUNCOl\1)
2. County Official(s) Authorized to Sign Contract: Attach a copy of
official county documents that clearly authorize individual(s) to si0n
contracts for the county.
Name: _ Je~ry Hernandez
Title: Chairman, Board of County Commissioners
Name: ~ne l.ytton.
Title:
Mayor Pro tem
Name:
I"
Title:
J. ~uthocizcd Contact Person: This is the person who has full authority
~Ild responsibility for providing us with information and documentation on
all activities, services and expenditures involving county EMS award
;nonie$ .
Name:
James R. (Reggie) Paras
'l'i tIe:
Director, Emcrqcncy Services
Business Address:
MonrO-~ COlU1ty l~ncrgcncy Services
lOGOO Aviation Blvd.
t-t1rathoI1, FI. 33050
(CITY)
(ZIP CODE)
P!101W: -1 305 ) 743-G~i19
(ARE1\ CODE)
472=-.C) 1 55
{ SUNCGr-n
I Ill::. Form 168t1, .Jlll 86
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5. Proposed County Expenditure plan: !'\ttach a line item budget that
identifies providers, designated. recipients, subcontractors, s,c>rvices,
equipment to be purchased, and other expenditures involving county EMS
award mO:1 ies.
6. Total Amount of County Award Funds Requested:
$ 25,878.15
Note: You are not eligible for more than the amount generated when we
apply the allocation formula specified in 40l.ll3(2((a) (F.S.)
7. Resolution: Attach a signed resolution from the Board of County
Commissioners certifying that monies from the county EMS award will improve
and expand the county's prehospital EMS system and that the funds will no~
be used to supplant existing county EMS budget allocations.
8. Certification: I, the undersigned representative of the above named
county, certify that to the best of my knO\lledge all statements contained
in this application and in the attachments thereto are true and correct.
Signature:
n
Printed Name
Date Signed:
Notary Seal
.~ l, ...
,71uk,-,- /ll. ~
Notary Signature .
Not!!ry PuHt. S!lltc of ~;::d<'l
My Commis~icr. E::,:::c:; S"pt. ~).';' 1738
_ .._ __~~d"d, ]h(q Jl0:l f..J.ill:.: In:";jJ""'.;"'1 ~.l':~
-:5-t/-tf1
Date
M)NROE; . COUNty EMS AWARDS PRCX:"..RAN
. ....-.... -.
','
, I
,
}lu1CtlOri/Act~v~ty
Account Department No.
'. i' ,
. EXecutive~laries.(Elected_OfflC~als)
=~__ SalarIes' U Wages 'other emps.., ,
Uther Salarles Q-wages
FICA Taxes
-- Ret~rement COntrlbutlons
Grouo !nsurance
- 1'lorlciilenTsCOmpensatlon -
__ GasoTme. Oil & Lubr~cants .: .
- MlsceTlaneous -SupPI~es,& ilimeiises-
_ ?ff~ce SuppIles- mC!~dmg Prlllfing
rag-Is & Siliall Implements , '
Mecbcme lfl.1fugs ' , " " "
t~dica1 '& Surglcal SUPPlies,
ClothinR._& .!~earing ~arel
Food & DIetary
AUto Allowance & Travel
- Ltics Q~ershIp--
-- Tnsurance & BondS
H.entaTs
Subscrlbers
~vertls Ul.ll
Commlsslons Q Fees .
ComnUJIUcatlons
t.1amt. of BICfiis.. Imorovements & Grounds
Maintenance ox ~uipment
1ranspOrtatlOns
UtlIltles I
Contractual -ServJ.ceslConsUI tant ServlceS
DUila-mg &. Other Structures
Cap-i tal Olltlay- !:.gtllpment
Caoltal CUtlar:tand
& EXpenses
:-
I
, I
\\t
(Masteri'ranr-
--
TOT AI.. Rf;QUEST
Amount
'C
--
--~
=]
-:-----
$25,878.1..5_
$25,878.15
James R. Paros, Director
Emergency Services
RESOLUTION NO. 276 -1986
A RESOLUTION PROVIDING THAT MONROE COUNTY
APPLY FOR STATE FUNDS FOR EMERGENCY MEDICAL
SERVICES CONSULTANT SERVICES AND AUTTIORIZING
THE HAYOR AND CHAIRMAN OF THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA, TO
EXECUTE THE STATE OF FLORIDA DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES G.RANT
APPLICATION AND ALL APPLICABLE DOCUMENTATlON.
... -
WHEREAS, Monroe County is in need of consultant services to
s~uJy the County's Emergency Medical Services, and
WHEREAS, such services will improve and expand Monroe
County's pre-hospital Emergency Medical Services system, and
WHEREAS, the State has made funds available for such
consultant services, and
WHEREAS, use of the State f~nds will not be used to
supplant the existing Monroe County Emergency Medical Services
budget allocation, now, therefore,
BE IT RESOLVED BY THE BOARD OF COUNTY. COMMISSIONERS OF
MONROE COUNTY, FLORIDA, as follows:
1. Monroe County shall apply for State funds for Emergency
Medical Services consultant services, and
2. The Mayor and Chairman of the Board of County
Commissioners of Monroe County, Florida, is hereby authorized to
execute the State of Florida Department of Health and Rehabilita-
tive Services grant application, a copy of same being attached
hereto, and all other applicable documentation.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on the 5th day of September, A.D. 1986.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
l.........t\..... ~
BY: -~~~.'-'-.
MAYOR/CHAIRMAN "
(SEAL)
Attest:
---/2.L ~~ ~f
rL
.
BY