FY2006 02/15/2006
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
February 27,2006
TO:
Fire Chief Clark Martin
Fire-Rescue Department
ATTN:
FROM:
Darice Hayes
Pamela G. Hanc~
Deputy Clerk Q
At the February 15, 2006, Board of County Commissioner's meeting the Board adopted
Resolution No. 033-2006 authorizing the Mayor to execute 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 certified copy of the subject Resolution and a duplicate original of the Grant
Application for your handling. Should you have any questions please do not hesitate to contact
this office.
cc: County Attorney
Finance
File ./
Clark O. Martin, Jr.
Fire Rescue
RESOLUTION NO. 033 -2006
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 continue to upgrade and enhance Monroe
County Fire Rescue's reporting system; will continue to upgrade area municipal fire
rescue reporting systems; will continue education to staff to improve the County's fire
rescue services; and will improve the area municipal fire rescue systems with updated
medical equipment; and therefore,
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 continue to upgrade and
enhance Monroe County Fire Rescue's reporting system; will continue to upgrade area
municipal fire rescue reporting systems; will continue education to 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 15 th day of February 3': ' 2~.
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BOARD OF COUNTY ~O
OF MONROE COUNTY'
Mayor McCoy
Mayor Pro Tern Nelson
Commissioner Spehar
Commissioner Neugent
Commissioner Rice
Yes
Yes
Yes
Yes
Yes
Mayor/Chai
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By:
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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 COpy and complete 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.
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 copies are
reQuired.
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
2. Certification: (The applicant signatory who has authori
documents for the county) I certify that all information an at
its attachments are true and correct. My signature ack wle
comply fully with the conditions outlined in the Florida MS
Si nature:
Printed Name: Charles
Position Title: Ma or
sign contracts, grants, and 0
In this EMS county grant appl
and assures that the Co un
y Grant Application.
Date:
ID. Code (The State Bureau of EMS will assign the ID Code - leave this blank) C
1. Coun Name:
Business Address:
Board of Count
9 6 0 0 074 9
3. Contact Person: (The individual with direct knowledge of the project on a day-to-day15asls e
responsibility for the implementation of the grant activities. This person is authorized to sign Pf.~NT co
reports and may request project changes. The signer and the contact person may be the~me..)
Name: Clark O. Martin, Jr.
Position Title: Fire Chief
Address: 490 63rd Street Suite 140
Marathon FL 3 050
T ele hone: (000) 000-0000
E-mail Address:abcdefg@Zyx.com
Fax Number: (000) 000-0000 305-289-6336
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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.
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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) :J:
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Monroe County Fire Rescue (MCFR)
DH Form 1684, Rev. June 2002
3
BUDGET PAGE 1 of 3 (MCFR)
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
Travel to EMSPRO Summits
$ 8,226.10
8,369.10
Administrative support costs for electronic report-
for deployment specialist for upgrade of and
ware
14 947.20
3,300.00
$3 ,
TOTAL
C. Yehicles, 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 ear or more.
power adaptors, batteries, wireless adaptors
Mapping project which includes map and grid books
$ 47,874.31
15,000.00
TOTAL $ 62,874.31
Grand Total $ 97,716.71
**
DH Form 1684, Rev. June 2002
4
BUDGET PAGE 2 of 3 (KLVAC)
A. Salaries and Benefits:
For
hour,
our, FICA per
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 excludinq expenditures classified
as ooeratinq caoital outlay (see next category).
1..i"t.he:lem~nl1;J~~pp,r~~I~e,lie .qU~J1tjtY Amount
T rave 1 c 0 s t f 0 r dep loymen t c 0 s t 0 f e Ie c t r on i c r e -
Ipo r t ing SYS t em $ 3 , 2 6 7 . 0 0
TOTAL $ 3 , 2 6 7 . 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) vear or more.
a;.i$tlie'[rtet'h'a~~i.if~n~prie~"~e~i.eqij~ijtltY AmoUnt
L ic ens ing f e e f or one-quar t er 0 f year on Re s cueNe t
proj ec t ( e Ie c t ronic repor t ing sys tern which is par t
0 f EMS PRO ) $ 9 7 5 . 00
TOTAL $ 9 7 5 00
.
Grand Total $ 4 , 2 4 2 . 00
**
DH Form 1684, Rev. June 2002
4
BUDGET PAGE 3 of 3 (ORPS)
FICA per
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 excludinq expenditures classified
as operati nQ capital outlav (see next cateQorv).
111stthfiJltem'.add, If apPlicable, theq~ant'w Amou nt
TOTAL $
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.
I1lstth~Iteman~,.lfappll(;a~I~,~~quantiW Amount
Completion of FY05 EMS patient-care reporting
system (RescueNet) already l.n progress wnl.cn l.nC.Lua es
'.:I 1 " ., "..,10 . .,.
. .~ . ~. ~
comnuters. accessories . warranty. server and server
accessories , Dell work station & work station con-
nect:l.Vlt:y $ 20 647 00
, .
TOTAL $ 20 , 647 . 00
Grand Total $ 20 , 647 . 00
**
DH Form 1684, Rev. June 2002
** $97,716.71 + 4,242.00 + 20,647.00 = $122,605.71; broke down as follows:
Includes roll-over funds in the amount of $72,417.71 ($70,220.00 with accrued
interest of $2,197.71 through September 30, 2005), and FY2006 share of $50,188.00
which equals a TOTAL OF $122,605.71. 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:
Authorized Official:
C
omml.SSl.
63rd Street Suite
FL 33050
Federal Identification number
Signature
Charles IlSonny"
Z/iSJDl,
Date
Sign and return this page with your application to:
lorida Department of Health
BEMS Grant Program
Bald Cypress Way, Bin C18
Tallahassee, Florida 32399-1738
rant 10: Code: C 50 Li '1
Oraanization Code
64-~00-000
1.(2.-10
Federal Tax 10:
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Obiect Code
750DO()
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September 30.~ ~
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Approved By :
Signature of EMS Gr
State Fiscal Year: 2 () 0 5 _ 20 () c:,
Grant Beginning Date: October 1, ? 0 fl1 Grant Ending Date:
DH Form 1767P. Rev. June 2002
5