Resolution 2016-211 RESOLUTION NO. 2016 - 21 1
RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,
CERTIFYING THAT THE APPLICATION FOR AND USE
OF EMS COUNTY GRANT FUNDS WILL IMPROVE AND
EXPAND PRE-HOSPITAL EMS DEPARTMENT
ACTIVITIES AND WILL NOT SUPPLANT EXISTING
COUNTY EMS BUDGET ALLOCATIONS.
WHEREAS, EMS Department Paramedics and Paramedic/Firefighters provide
basic and advanced life support care and highly technical service to the citizens and
visitors of Collier County; and
WHEREAS, the purchase of equipment and provision of training shall greatly
enhance the effectiveness of pre-hospital emergency medical care.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
The $72,971.00 in the EMS County Grant will be used to provide training and
purchase medical/rescue equipment and these funds will not be used to supplant existing
EMS Department budget allocations.
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County, Florida, this i'* #-, day of Oc.: ob , 2016.
ATTEST: BOARD OF COUNTY COMMISSIONERS,
DWIGHT E. $ROCK, CLERK COLLIER COUNTY, FLORIDA
x124.2.0
B ��,y O BY:
A f est as to G ' Clerk DONNA FIALA, Chairman
e gnature only.
Approved as to form and
legality:
iter A. Belpedio Jenn p 9.) 0
Assistant County Attorney
o.
EMS COUNTY GRANT APPLICATION
x ., FLORIDA DEPARTMENT OF HEALTH
Emergency Medical Services Program
HEALTHComplete all items
ID. Code(The State EMS Program will assign the ID Code–leave this blank) C50
1. County Name: Collier _
Business Address: 3299 Tamiami Trail East, Suite 700
— Naples, FL 34112-5747
Telephone: 239-252-3740
Federal Tax ID Number(Nine Digit Number). VF 59-6000558
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 conditions outlined in the Florida EMS County Grant Application.
Signature: Date:
— Printed Name: Donna Fiala
Position Title: Chairman
3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and has
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: Artie Bay
Position Title: Supervisor– EMS Admin
Address: 8075 Lely Cultural Pkwy,Suite 267
Naples, FL 34113
Telephone: 239-252-3756 Fax Number: 239-252-3298
E-mail Address: Artiebay@
4. Resolution: Attach a 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. We cannot process for funds without a current resolution.
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)
Collier County Emergency Medical Services
DH 1684, December 2008 64J-1.015, F.A.C.
1
0
BUDGET PAGE
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
- i
TOTAL Salaries= $ 0.00
TOTAL FICA&Other Benefits=
Total Salaries& Benefits= $ 0.00
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 excluding expenditures classified
as operating capital outlay (see next category).
List the item and, if applicable,the quantity Amount
Training 5,000.00
tE�
Total Expenses= $5,000.00
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
Medical/Rescue Equipment 52,971.00
Video Cameras for training,testing and QA 15,000.00
Total Veh.&Equipment= $ 67,971.00
Grand Total= $72,971.00
DH 1684, December 2008
2
3
FLORIDA DEPARTMENT OF HEALTH
EMERGENCY MEDICAL SERVICES(EMS) GRANT SECTION
REQUEST FOR GRANT FUND DISTRIBUTION
In accordance with the provisions of Section 401.113(2) (a), Florida Statutes, the undersigned hereby requests
an EMS grant fund distribution for the improvement and expansion of pre-hospital EMS.
DOH Remit Payment To:
The agency name and mailing address must be in the state MyFloridaMarketPlace (MFMP) system.
Name of Agency: Collier County Board of County Commissioners
Mailing Address: 3299 Tamiami Trail East, Suite 700
Naples, FL 34112-5749
Federal Identification number: .000558 .
i)
Authorized County Official: 4 , , ,c>\ `\t b
Si.nature Date
Donna Fiala, Chairman
Type or Print Name and Title
Sign and return this page with your application to:
Florida Department of Health
Emergency Medical Services Section, Grants
4052 Bald Cypress Way, Bin A-22
Tallahassee, Florida 32399-1722
Do not write below this line. For use by State Emergency Medical Services Program
Grant Amount for State to Fay: $ Grant ID: Code: C50
Approved By .
Signature of State EMS Grant Officer Date
State Fiscal Year: 2016 - 2017
Organization Code E.O. OCA Object Code Category
64-61-70-30-000 05 SF005 750000 059998
Federal Tax ID:VF
Grant Beginning.Date: Grant Ending Date:
DH 1767P, DeOenter'2008 64J-1.015, F.A.C.
3
Approved as to form anil 1et^:►►ity
DWI c WT E. 6- • K, Clerk
IS, .. r r l� Assts ant County Au�rrnr V
Attest as v Chairman's �\20 •
0
rsnat,rra Huhu