FY2005 01/19/2005
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
January 20, 2005
TO:
Fire Chief Clark Martin
Fire-Rescue Department
ATTN:
FROM:
Darice Hayes
Pamela G. Hanc&
Deputy Clerk
At the January 19, 2005, Board of County Commissioner's meeting the Board adopted
Resolution No. 013-2005 authorizing the Mayor to execute an EMS County Grant Application
and related request for grant distribution to the State of Florida Department of Health, Bureau of
Emergency Medical Services.
Enclosed is a duplicate original of the Application Packet and a certified copy of the
subject Resolution for your handling. Once the State has completed the Request for Grant
Fund Distribution please forward a copy to our office for the record. Should you have any
questions please do not hesitate to contact this office.
cc: County Administrator w/o document
County Attorney
Finance
File .I
Oark O. Martin, Jr.
Fire Rescue
RESOLUTION NO. 013-2005
A RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA
AUTHORIZING MAYOR TO EXECUTE AN EMS COUNTY
GRANT APPLICATION AND RELATED REQUEST FOR
GRANT DISTRIBUTION TO THE STATE OF FLORIDA
DEPARTMENT OF HEALTH, BUREAU OF EMERGENCY
MEDICAL SERVICES
WHEREAS, an EMS County Grant will improve and expand the County's pr~ ~
hospital EMS system to include the area municipal fire rescue systems; will cotit!~e
to upgrade MCFR's reporting system; will continue education of staff to improv~:the
County's fire rescue services; and will improve the area municipal fire rescue sy~tems ~_r:
with updated medical equipment; now therefore,
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BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, as follows:
1. The Mayor is hereby authorized to execute an EMS County Grant
Application and related Request for Grant Distribution to the State of Florida Department of
Health, Bureau of Emergency Medical Services, and copies of same being attached hereto.
2. The monies from the EMS County Grant will improve and expand the
County's pre-hospital EMS system to include the area municipal fire rescue systems; will
continue to upgrade MCFR's reporting system; will continue education of staff to improve the
County's fire rescue services; and will improve the area municipal fire rescue systems with
updated medical equipment.
3. The grant monies will not be used to supplant existing County EMS
budget allocations.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the 19 th day of January , 2005.
Mayor Spehar
Mayor Pro Tern McCoy
Commissioner Nelson
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BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By tI~~< hJ.~.
ayor/Chairma -
MONROE COUNTY ATTORNEY
ROVED AS TO
FLORIDA DEPARTMENT OF
HEALT
FLORIDA DEPARTMENT OF HEALTH
BUREAU OF EMERGENCY MEDICAL SERVICES
EMS COUNTY GRANT PROGRAM
APPLICATION PACKET
Revised: June 2002
DESCRIPTION OF PROGRAM
OVERVIEW:
The Department of Health, Bureau of Emergency Medical Services (EMS) is authorized by
Chapter 401, Part II, F. S., to dispense grant funds. Forty-five (45) percent of these funds are
made available to the 67 boards of county commissioners (BCCs) to improve and expand
prehospital EMS systems in their county.
On-going costs for EMS and replacement of equipment cannot be funded under this grant
program. These costs remain the responsibility of the counties and EMS agencies and
organizations.
ELIGIBILITY:
EMS County grants are awarded only to BCCs. However, each BCCs is encouraged to
assess its countywide EMS needs and establish priorities before submitting a grant
application. The assessment should be coordinated with area EMS councils, when available.
COUNTY GRANT PROCESS
APPLICATION FORM:
BCCs must coov and comolete the form titled "EMS County Grant Application, DH Form 1684,
June 2002". The BCCs will return the county grant application and resolution ( item 5 on the
application) to the department.
NOTICE OF GRANT AWARD:
The Department shall send a Notice of Grant Award letter to the BCCs. This is the BCCs
official notice that its grant application has been approved for funding. The letter and its
attachments will include the amount of the award, the beginning and ending dates of the grant,
due dates for required reports, the approved budget, and additional grant conditions, if any.
1
APPLICATION SUBMISSION:
The BCCs must submit:
1. A completed application (DH Form 1684, June 2002) with original signatures of the
authorized county official.
2. A county resolution certifying the EMS county grant funds received shall be used to
improve and expand prehospital EMS and that the funds will not be used to supplant
existing county EMS budget allocations (item 4 in the application).
A complete EMS County Grant packet consists of the above two items. No cooies are
reauired.
Mail the application to:
County Grant
Emergency Medical Services
4052 Bald Cypress Way, Bin C18
Tallahassee, Florida 32399-1738
Retain this application packet because it contains the grant conditions and requirements, and
other information and forms needed.
2
EMS COUNTY GRANT ApPLlCA TION
FLORIDA DEPARTMENT OF HEAL TH
Bureau of Emergency Medical Services
Complete all items
ID. Code (Tile State Bureau of EMS will assign the ID Code - leave this blank) C
2. Certification: (The applicant signatory who has authority to sign contracts, grants, and other legal
documents for the county) I certify that all information and data in this EMS county grant application and
its attachments are true and correct. My signature acknowledges and assures that the County shall.
comply fully with the condo iqns outlined in th Florida EMS County Grant Application. .
Si nature: · Date: 1/11/.~. i
Printed Name:
Position Title:
Tele hone:
Federal Tax ID Number
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 is authorized to 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: 4 0 63rd Street 140
4. Resolution: Attach a current resolution from the Board of County Commissioners certifying the grant
funds will improve and expand the county pre-hospital EMS system and will not be used to supplant
current levels of county expenditures.
5. Budget: Complete a budget page(s) for each organization to which you shall provide funds.
List the organization(s) below. (Use additional pages if necessary)
Monroe Count
Ocean Reef Public Safety CORPS)
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DH Form 1684, Rev. June 2002
BUDGET PAGE
1 of 3 (MCFR)
A. Salaries and Benefits:
For eachP0$iti9n title, provide the amount of salary per hour, FICA per
hour, other fringe benefits, and the total number of hours. Amount
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
Amount
Trainin . which includes salary reimbursement for
employees on new version of pen-based system
Travel to Rural Health EMS Consortium meetings and
State Advisory Council meetings
Travel to EMS Pro (EMS reporting system) Summit and
$
13 ,200 .00
2,160.00
Conference
TOTAL $
3,392.00
18 752.00
C. Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other
tangible personal property of a non consumable and non expendable nature with a normal expected life
of one (1) year or more.
list the Item and, if appllcable,thequanttty Amount
.. ..
Enhancements and replacement equipment for pen-based
EMS patient care reporting system $ 14,590.32
EMS billing extract software program (for sending of
medical reports electronically from EMS reporting
system) 7,500.UU
Completion of FY03 and FY04 projects already in
progress with the EMS patient care reporting system 27,315.34
TOTAL $ 49,405.66
Grand Total $68,157.66
**
DH Form 1684, Rev. June 2002
4
BUDGET PAGE 2 of 3 (KLVAC)
A. Salaries and Benefits:
For each poeittQn title. provide the amount of salary per hour, FICA per
hour, other fringe benefits, and the total number of hours. Amount
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
Amount
Training which would include salary reimbursement
for employees
$
12,500.00
TOTAL $
12 500.00
C. Vehicles, eqUipment. and other operating capital outlay means equipment. fixtures, and other
tangible personal property of a non consumable and non expendable nature with a normal expected life
of one (1) year or more.
LIst the ft4tm and, If aPPlicable,. the quantity Amount
.. ...., '.:'.! T,:.?.,>",;, . ~, ..'
Pen-based EMS field data collection and reporting
system $ 57,444.04
TOTAL $ 57,444.04
Grand Total $69,944.04
**
DH Fonn 1684, Rev. June 2002
4
BUDGET PAGE 3 of 3 (ORPS)
A. Salaries and Benefits:
For each position title. provide the amount of salary per hour, FICA per
hour, other fringe benefits, and the total number of hours. Amount
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
B. Expenses: These are travel costs and the usual, ordinary, and incidental expenditures by an
agency, such as, commodities and supplies of a consumable nature excludino expenditures classified as
ooeratina caoital outlav (see next cateoorv).
List the item and, if applicable, the quantity Amount
Training which would include salary reimbursement
of employees $ 8,000.00
TOTAL $ 8,000.00
C. Vehicles, equipment, and other operating capital outlay means equipment, fixtures. and other
tangible personal property of a non consumable and non expendable nature with a normal expected life
of one (1) year or more.
List the item and, if applicable, the quantity Amount
Pen-based EMS field data collection and reporting
system $ 40,630.04
TOTAL $ 40,630.04
Grand Total $ 48,630.04
**
DH Form 1684, Rev. June 2002
** $68,157.66 + 69,944.04 + 48,630.04 = $186,731.74; broke down as follows:
Includes roll-over funds in the amount of $126,574.08 ($125,640.83 with accrued
interest of $933.25 through September 30, 2004), and FY2005 share of $60,157.66
which equals a TOTAL OF $186,731.74.
4
FLORIDA DEPARTMENT OF HEAL TH
EMS GRANT PROGRAM
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with the provisions of Section 401.113(2)(a), F. S., the undersigned hereby
requests an EMS grant fund distribution for the improvement and expansion of pre-hospital
EMS.
DOH Remit Payment To:
Name of Agency: Board of County Commissioners, Monroe County, FL
Mailing Address: 490 63rd Street, Suite 140
Marathon, FL 33050
Federal Identification number 59-6000-749
Authorized Official: Ai;J'~ 7n. . {,,</-'. ~ --.(~
I 7 Signature ~
~J/t(1/o5
" Date
Dixie M. Spehar, Mayor
Type Name and Titfe
Sign and return this page with your applicatlQfi to:
Florida Department of Health
BEMS Grant Program
4052 Bald Cypress Way, Bin e18
Tallahassee, Florida 32399-1738
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
Date
State Fiscal Year:
Oraanization Code
64-25-60-00-000
E.O.
N_
OCA
N2000
Obiect Code
7
Federal Tax ID:
VF_________
Grant Beginning Date: October 1,
Grant Ending Date: September 30,
DH Form 1767P, Rev. June 2002
5