Resolution 352-1992
,
James B. P't{ios-'r f"1P'
Public SafJt~bi'vihort.. "tl .
RESOLUTION NO. 352 - 1992
'92 JUL 23 P 2 :1 8
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A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF C L r
MONROE COUNTY, FLORIDA, AUTHORIZING THE SUBMISSION ~l)HRO[ I
GRANT APPLICATIONS TO THE FLORIDA DEPARTMENT OF HEALTH
AND REHABILITATIVE SERVICES, OFFICE OF EMERGENCY
MEDICAL SERVICES, TO FUND AN EMERGENCY TRANSPORT
VEHICLE PROJECT AND DIRECTING THE EXECUTION OF SAME BY
THE PROPER COUNTY AUTHORITIES.
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WHEREAS, The Florida Department of Health and Rehabilitative Services,
Office of Emergency Medical Services, is accepting applications for
Emergency Medical Services (EMS) Matching Grant funds, and
WHEREAS, the grant is for the fiscal year beginning on October 1, 1992
and ending on September 31, 1993; and
WHEREAS, the total grant application is for $ 55,000.00
~% match requirement; and
, with a
WHEREAS, the $13,750.00 match requirement is proposed for inclusion
in the County budget request for Fiscal Year 1993; and
WHEREAS, the emergency transport vehicle project will, if awarded and
accepted, be used to re-chassisjrefurbish one (1) ambulance; now therefore
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA, AS FOLLOWS:
1. That said Board has been notified of the availability of matching
grant program funds from the Florida Department of Health and
Rehabilitative Services, Office of Emergency Medical Services.
2. That the Monroe County Department of Emergency Medical Services
is hereby authorized to submit applications for grant funds to the Florida
Department of Health and Rehabilitative Services, Office of Emergency
Medical Services, to improve and expand Monroe County's EMS systems.
...;
3. That said Board hereby directs the execution of the grant
applications by the proper County Authorities.
4. That this Resolution shall become effective immediately upon
adoption by the Board and execution by the Presiding Officer and Clerk.
~ASSED AND ADOPTED by the Board of County Commissioners of Monroe
County, Florida, at a regular meeting of said Board held on the ~ day
of July , A.D. 1992.
Mayor Harvey
Mayor Pro Tern London
Commissioner Cheal
Commissioner Jones
Commissioner stormont
Yes
Yes
Yes
Not present
Yes
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
. .. d.l_
By ,\..U"l\~.~;~r ~.~ ~~
(Seal)
Attest : DANNY L KOLHAGE C
. , lerk
-L2L ~1.j)/
Cl k r
APpro~~ to form and legal
SUffi?; U-
By:
County Attorney's Office
ID Code to be Assigned by State EMS Office: MZ _ _ _
Florida Department of Health and Rehabilitative Services
Office of Emergency Medical Services (EMS)
MATCHING GRANT APPLICATION
1. Legal Name of
Agency/Organization: Board of County Cornnissioners, Monroe County, Florida
Name and Title of Mayor /Chainnan ,
Grant Signer: Wilhelmina Harvey, -
Mailing 490 63rd Street, Suite 140
Address: Marathon, Fl. 33050 County: Monroe
Telephone Number: (305) 289-6002 SunCom Number: 472-6002
2. Name and Title of
Contact Person: James R. "Reggie" Paras, Public Safety Director
Mailing 490 63rd Street, Suite 140
Address: Marathon, Fl. 33050
Telephone Number: (305) 289-6002 SunCom Number: 472-6002
3.
Legal Status of
Agency/Organization: (Check only one)
Your rlSC8l year:
10/01 9/30
Private Not for Profit (you mull provide copy of certificate)
BEGINS
ENDS
Private for Profit
.lL
Public
4. Agency/Organization's Federal
Tax Identification Number nine digits VF 2.......L --2- ~ ~ ~ L -L --2....
s. Identify the one ltate plan objective thi. project primarily addreuc.: Objective #: 13 . 6
6. Type of Project: (Check only one):
CommunicatioDl Continuing Profe..ional Education (medical director mutt .iiD Item 16a)
..x.. Emergency Tranaport Vehicle. Public Education
Syltcm Evaluation/Quality AllUraDCe Reacarch
McdicallReacue Equipment (.ignabJre. required for ItelDl 16b and 16c)
Doc. your project include the purchaac of any communicatioDl equipment?
yes
x
No
HRS Fonn 1767, March 89
1
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For both the need and outcome statements: include all available numeric data, the time frame
for the data, the data source, the number of people who will directly receive project services,
and other information which clearly identifies your need and expected outcome for this project.
7. Need Statement (use only the space below):
The vehicle maintenance reJ?Orts and records in the Monroe County EMS Office show
that one of nine ambulances operated by our service currently has an odometer
reading of 49,167. Based upon past experience and anticipated usage, the vehicle
will accumulate another 24,583 miles within the next 12 rronths. Therefore,
according to our existing vehicle maintenance program, the vehicle should be
rechassis/refurbished.
8. Outcome Statement (use only the space below):
The project will provide for an existing ambulance to be rechassis/refurbished.
The result will be increased operational reliability and decreased downtime for
repairs.
9. Improvement and Expansion of Prehospital EMS. Describe how your project improves and expands
prehospital EMS. Also, show how it builds coordination and cooperation with other EMS systems.
The project will ensure that this vehicle is operating properly and efficiently
and therefore able to respond to requests for EMS.
10. Research Projects Only:
If you are !!2! conductiDl a re_rch project, Kip thia item and '0 to Item 11.
If you are conductiDla re_rch project, attach at the end of the application concise ltatementa of the hypotheail, deliJll!method, inltrumenta, method I
to protect human IUbjecta, any lirnitationa involviDl the ltudy. research illBtnlmenta, fonnl and liltillJl of other relevant ltudiel.
11. Major Work Activities and Time Frames (Use only the space below):
Develop specifications and bid project within 6 rronths after grant begins.
Have rechassis/refurbished ambulance operational within 11 rronths after grant
begins.
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APPLICANT
State
Cash Grant
CATEGORIES Match Funds TOTAL
12. Salaries and Benefits:
TOTALSAL~andBENEnTS
13. Expenses
TOTAL EXPENSES
APPLICANT
State
Cash Grant
CATEGORIES Match Funds TOTAL
14. Equipment:
Refurbish/rechassis (1) ALS pennitted
emergency transport vehicle @$55,000.00 13,750.00 41,250.00 55,000.00
TOTAL EQUIPMENT COSTS $13,750.00 41,250.00 55,000.00
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APPLICANT
State
Cash Grant
CATEGORIES Match Funds TOTAL
15. Final Summary - Total of salaries
and benefits, expenses and equipment,
all combined
$ 13,750 $ 41,250 $ 55,000
:::===:====:: ======== =========
The above figure The above figure The above figure
must equal 25 percent mUM equal 75 mUM equal the
of the total Percent of the 111m of the
total preceding two
columna
Note: You may attach a page or pages to explain and justify as necessary the need for any and all positions, expenses, and
equipment in terms of the items, their quantities, their costs, and their roles in the project.
4
"
APPLICATION ITEM 17 (signature required)
REQUFST FOR MATCHING GRANT DISTRIBUTION (ADV ANCE PAYMENT)
EMERGENCY MEDICAL SERVICES (EMS)
Governmental Agency and Non-profit Entity ONLY
In accordance with the provisions of paragraph 401. 11 3(2)(b) , F.S., the undersigned hereby requests an EMS matching
grant distribution (advance payment) for the improvement and expansion of prehospital EMS.
Payment To:
Board of County Comnissioners , Monroe County, Florida
. Legal Name of Agency/Organization
490 63rd Street, SUlte 140
(City)
Address
FL
(State)
33050
Marathon
(Zip)
SIGNATURE: t \_~:~'1~._
Printed Name: Wilhelmina Harvey
thorized Official
DATE: July 15, 1992
itle: Mayor /Chainnan
SIGN AND RETURN WITH YOUR MATCHING GRANT APPLICATION TO:
APPROV;;;;AI;. 'fOFOl7!/f Department ofHea1th and Rehabilitative Services ATTEST: DANNY L. KOLHAGE, LERK
AND LEPlJ~C!E"CY. Office of En;~;n:a::g~::~ces (HSTM) By
f~ Deputy Clerk
~'" ._-l~ 1317 Winewood Boulevard
,.,,~~;:._.':.t:'rl~."t .0 .!",r;.....,~.
Tallahassee, Florida 32399-0700
Matching Grant Amount: $
Approved By:
For Use Only by Department of Health and Rehabilitative Service.,
Office of Eme1'lency Medical Service.
Grant ID Code:
M2
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Date:
Signature, State EMS Grant Officer
State Fiscal Year:
Amount: $
Oraanization Code
60-20-60-30-100
E.O.
HS
Obiect Code
Federal Tax IO V F:
---------
Grant Beginning Date:
Ending Oate:
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18. ASSURANCES AND APPLICATION SIGNATURE
Certification of Standards Statement
I, the undersigned, certify that if granted funds under Chapter 401, Part II, F.S.; as amended, all applicable regulations and
standards will be adhered to including: Chapter 401, F.S.; Chapter 100-66, F.A.C.; Minimum Wage Act; Title VI of the
Civil Rights Act of 1964 (42 ISC 20000 et. seg.); DHEW Regulation (45 CFR Part 80); Rehabilitation Act (Sec 504);
Developmentally Disabled Assistance and Bill of Rights of 1975 (p.L. 95-602) as amended by Title V of the
Comprehensive Rehabilitative Services Amendments of 1978: Confidentiality; Human Rights; Habilitation Plans;
Employment of the Handicapped; Services for Persons Unable to Pay.
Statement of Cash Commitment
I, the undersigned, certify that cash match will be available during the grant period and used in direct support of this grant
project. State and federal funds will not be used for matching requirements, unless specified by law. No costs or third-
party contributions count towards satisfying a matching requirement of a department grant if they are used to satisfy a
matching requirement of another state or federal grant. Cash, salaries, fringe benefits, expenses, equipment, and other
expenses as listed on this application shall be committed and used for the department's final approved project during the
grant period.
Acceptance of Tenns and Conditions
I, the undersigned, accept the grant tenns and conditions in Appendix B of the booklet, "1992 Florida EMS Matching
Grant Program", by the Department of Health and Rehabilitative Services and acknowledge this when funds are drawn or
otherwise obtained from the grant payment system.
Disclaimer
I, the undersigned, hereby certify that the facts and information contained in this application and any follow-up documents
are true and correct to the best of my knowledge, information, and belief. I further understand that if it is subsequently
determined that this is not correct, the grant funded under Chapter 401, Part II, F.S. and Chapter 100-66, F.A.C., may be
revoked, and any monies erroneously paid and interest earned will be refunded to the department with any penalties which
may be imposed by law or applicable regulations.
Notification of Awards
I, the undersigned, understand the availability of the notice of award will be advertised in the Florida Administrative
Weekly, and that 30 calendar days after this Florida Administrative Weekly advertisement I waive any right to challenge or
protest in anyway the decisions to award grants.
Maintenance of Imorovement and Expansion
I, the undersigned, agree that any improvement or expansion brought about in whole or part by grant funds, will be
maintained for five years after the project ends, unless specified otherwise in the approved application or unless the
department agrees in writing to allow a change. Any unauthorized change within the five years will necessitate the return
of grant funds involved, plus interest if any to the department.
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July 15, 1992
Date
Signature of Authorized Grant Signer
(Individual Identified in Item 1)
NOTE: Please check to insure that all required signatures have been made for Items 16, 17, and 18.
The application will not be considered for funding without any required signature.
ATTEST: ANNY L. KOLHAGE, CLERK
By
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A~r:ltl:JTO FORM
AN~ t;~cr.
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, . Attorney'& Office