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Agenda 01/10/2017 Item #16E 1 16E.1 01/10/2017 EXECUTIVE SUMMARY Recommendation to approve submittal of an EMS Matching Grant application to the Florida Department of Health for the purchase of 20 power stretchers for a total of $275,416 (Match $68,854). OBJECTIVE: To alleviate stretcher-related injuries to personnel and patients by replacing manual ambulance stretchers with power models. CONSIDERATIONS: Each year the Florida Department of Health provides the opportunity for the improvement and/or expansion of EMS services through a matching grant program. This year the grant period runs from October 1, 2016 through February 1, 2017. The State EMS Matching Grant was previously identified as a possible funding source to replace manual ambulance stretchers with powered models and in June 2015, Collier County was awarded $104,475. Those grant funds, along with a $34,825 match, purchased 11 power stretchers. An award for this submission would outfit the remaining front line ambulances with powered stretchers. With the exception of the 11 new powered stretchers, EMS uses "H-Framed" manual stretchers. The H- Frame design requires gravity and the proper angle to allow the support legs of the stretcher to swing down into place. Depending on the height of the rescue worker and the terrain on which the vehicle is parked, the proper angle can be difficult to maintain with a heavy load. EMS covers a vast rural area and staffs only 2 personnel on each ambulance; requests for additional personnel for lifting assistance can take a considerable amount of time and delays patient care. This puts responders in a situation where they may attempt to lift a load heavier than they should and places them at risk for injury. Over the last six years, 23 personnel have been injured as a direct result of bending and lifting patients on a stretcher, while another 21 were injured from loading and unloading a patient from an ambulance. While routine maintenance to the stretchers and annual training on proper lifting techniques are in place to mitigate injuries,use of power stretchers will improve patient care and enhance worker safety. FISCAL IMPACT: There is no Fiscal Impact at this time. The total funds requested for this project are $275,416; $206,562 to be funded by the grant and a match of 25%, $68,854 to be funded by EMS Fund 490. If awarded, staff will request Board acceptance at a future meeting. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board approval. -JAB GROWTH IMPACT: There is no Growth Management Impact resulting from this action. RECOMMENDATION: That the Board of County Commissioners approves the submittal of an EMS Matching Grant application to fund the purchase of power stretchers for Emergency Medical Services. PREPARED BY: Artie Bay, Supervisor,Emergency Medical Services Admin. ATTACHMENT(S) 1.Application-Power Stretchers (PDF) Packet Pg. 640 16.E.1 01/10/2017 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.1 Item Summary: Recommendation to approve submittal of an EMS Matching Grant application to the Florida Department of Health for the purchase of 20 power stretchers for a total of$275,416 (Match $68,854). Meeting Date: 01/10/2017 Prepared by: Title: Supervisor-Accounting—Administrative Services Department Name: Artie Bay 12/08/2016 11:16 AM Submitted by: Title: Department Head -Administrative Svc—Administrative Services Department Name: Len Price 12/08/2016 11:16 AM Approved By: Review: Administrative Services Department Pat Pochopin Level 1 Division Reviewer Completed 12/08/2016 11:19 AM Emergency Medical Services Tabatha Butcher Additional Reviewer Completed 12/15/2016 10:33 AM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 12/15/2016 3:37 PM Grants Edmond Kushi Level 2 Grants Review Completed 12/19/2016 2:15 PM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 12/19/2016 3:56 PM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 12/20/2016 8:37 AM County Attorneys Office Jeffrey A.Klatzkow Level 3 County Attorneys Office Review Completed 12/20/2016 11:11 AM Office of Management and Budget Laura Wells Additional Reviewer Completed 12/20/2016 6:29 PM Grants Therese Stanley Additional Reviewer Completed 12/28/2016 12:20 PM County Managers Office Nick Casalanguida Level 4 County Manager Review Completed 12/28/2016 3:59 PM Board of County Commissioners MaryJo Brock Meeting Pending 01/10/2017 9:00 AM Packet Pg. 641 (saayo;aaag Jerrod - uogeoilddy luejD Bulgolew : zLpz) siegol.a.us Jerrod - uogeoilddy :luawgoefy W co tD a1 Y d EMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH } c Emergency Medical Services Program HEALTHComplete all items unless instructed differently within the application Type of Grant Requested: ❑ Rural Matching ID. Code(The State Bureau of EMS will assign the ID Code leave this blank) 1. Organization Name: Collier County Board of County Commissioners-EMS 2. Grant Signer: (The applicant signatory who has authority to sign contracts, grants, and other legal documents. This individual must also sign this application) Name: Position Title: Chairman Address: 3299 Tamiami Trail East Suite 303 City: Naples County: Collier State: Florida Zip Code: 34112 Telephone: 239-252-8097 j Fax Number: 239-252-362 E-Mail Address: 3,cContact Person: (The individual with direct knowledge of the project on a day-to-day basis and ;+,;r+, for the implementation of the grant arfi.nfio¢ This narcnn may Ginn nrnieca reports and may i c�pvit�wuuy' u.u�nr - �.. ..r..,..�....�� ....� -..�.. r'.—- reports request project changes. The signer and the contact person may be the same.) Name: Artie R. Bay Position Title: Supervisor—EMS Admin. Address: 8075 Lely Cultural Pkwy Suite 267 City: Naples County: FL State: Florida Zip Code: 34113 Telephone: 239-252-3740 Fax Number: 239-252-3298 E-Mail Address:Artiebay(�colliergov.net DH FORM 1767[2013] 64J-1.015,F.A.C. 1 ATTEST: Approved as to form and legality DWIGHT E. BROOK, Clerk By: ` Assistant County Attorney (Z ' 1 111 — (siagoiaais Jarrod - uolieollddV TUeJO 6ulyoiew : ZLPZ) siagoiaJis Jarrod - uogeollddy :ivawtpeiiV � cn ui a, cc G. d V C6 C. 4. Legal Status of Applicant Organization (Check only one response): (1)D Private Not for Profit[Attach documentation-501 (3)©j (2) ❑Private For Profit (3) ❑City/Municipality/Town/Village (4)1Z County (5)❑State (6) ❑Other(specify): 5, Federal Tax ID Number(Nine Digit Number). VF 59_76000050__ 6. EMS License Number: 3886 Type: ❑Transport ❑Non-transport ®Both 7. Number of permitted vehicles by type: BLS; 40 ALS Transport; 10 ALS non-transport. 8. Type of Service(check one): ❑ Rescue; ❑ Fire; ®Third Service(County or City Government, nonfire); ❑Air ambulance; ❑ Fixed wing; ❑ Rotowing; ❑ Both; Other(specify) 9. Medical Director of licensed EMS provider: If this project is approved, I agree by signing below that I will affirm my authority and responsibility for the use of all medical equipment and/or the provision of all continuing EMS education in this project. [No signature is needed if medical equipment and professional EMS education are not in this project.] Signature: Date: Print/Type: Name of Director Robert Boyd Tober, MD, FACEP FL Med. Lic. No. ME 30891 Note: Ail organizations that are not licensed EMS providers must obtain the signature of the medical director of the licensed EMS provider responsible for EMS services in their area of operation for projects that involve medical equipment and/or continuing EMS education. If your activity is a research or evaluation project,omit Items 10,11,12,13,and skip to Item Number 14. Otherwise,proceed to Item 10 and the following items. 10. Justification Summary: Provide on no more than three one sided, double spaced pages a summary addressing this project, covering each topic listed below. A) Problem description(Provide a narrative of the problem or need); B) Present situation (Describe how the situation is being handled now); C) The proposed solution (Present your proposed solution); D) Consequences if not funded (Explain what will happen if this project is not funded); E) The geographic area to be addressed (Provide a narrative description of the geographic area); F) The proposed time frames (Provide a list of the time frame(s)for completing this project); G) Data Sources(Provide a complete description of data source(s)you cite); H) Statement attesting that the proposal is not a duplication of a previous effort(State that this project ! doesn't duplicate what you've done on other grant projects under this grant program). DH FORM 1767(2013] 2 k9 f1 1 (sia140}aa1S Jannod - uoi;eoiiddy;ue.a9 6ui4o4eiN : ZLt'Z) si014o1aJ1S aannod - uoneoilddy :;uawyoe4v yr ui co c) a C.) c6 a Next, only complete one of the following: Items 11,12,or 13. Read all three and then select and complete the one that pertains the most to the preceding Justification Summary. Note that on all three,that before-after differences for emergency victim data are the highest scoring items on the Matching Grants Evaluation Worksheet used by reviewers to evaluate your application form. 11. Outcome For Projects That Provide or Effect Direct Services To Emergency Victims: This may include vehicles, medical and rescue equipment, communications,navigation, dispatch, and all other things that impact upon on-site treatment, rescue, and benefit of emergency victims at the emergency scene. Use no more than two additional one sided, double-spaced pages for your response. Include the following. A) Quantify what the situation has been in the most recent 12 months for which you have data(include the dates). The strongest data will include numbers of deaths and injuries during this time, B) In the 12 months after this project's resources are on-line, estimate what the numbers you provided under the preceding"(A)"should become. C) Justify and explain how you derived the numbers in (A)and (B), above, D) What other outcome of this project do you expect? Be quantitative and explain the derivation of your figures, E) How does this integrate into your agency's five year plan? 12. Outcome For Training Projects: This includes training of all types for the public,first responders, law enforcement personnel, EMS and other healthcare staff. Use no more than two additional one sided, double-spaced pages for your response. Include the following: A) How many people received the training this project proposes in the most recent 12 month time period for which you have data(include the dates). B) How many people do you estimate will successfully complete this training in the 12 months after training begins? C) if this training is designed to have an impact on injuries, deaths, or other emergency victim data, provide the impact data for the 12 months before the training and project what the data should be in the 12 months after the training. D) Explain the derivation of ail figures. • E) How does this integrate into your agency's five year plan? 13. Outcome For Other Projects: This includes quality assurance, management, administrative, and other. Provide numeric data in your responses, if possible,that bear directly upon the project and emergency victim deaths, injuries, and/or other data. Use no more than two additional one sided, double- spaced pages for your response. Include the following. A) What has the situation been in the most recent 12 months for which you have data (include the dates)? B) What will the situation be in the 12 months after the project services are on-line? C) If this project is designed to have an impact on injuries, deaths, or other emergency victim data, provide the impact data for the 12 months before the project and what the data should be in the 12 months after the project. D) Explain the derivation of all numbers. E) How does this integrate into your agency's five year plan? DH FORM 1767[2013] 3 • __ I (sJego}aa;s aamod - uol;eollddy;ue.eo 6ulyo}e/ : ZLt ) siayola.us aaMod - uo!Jeollddv :;uawgoepv1.0 co ui a, cti cc G m a Skip Item 14 and go to Item 15, unless your project is research and evaluation and you have not completed the preceding Justification Summary and one outcome item. 14. Research and Evaluation Justification Summary, and Outcome: You may use no more than three additional one sided, double spaced pages for this item, A) Justify the need for this project as it relates to EMS. B) Identify (1)location and (2)population to which this research pertains. C) Among population identified in 14(B)above, specify a past time frame, and provide the number of deaths, injuries, or other adverse conditions during this time that you estimate the practical application of this research will reduce(or positive effect that it will increase). D) (1) Provide the expected numeric change when the anticipated findings of this project are placed into practical use. (2) Explain the basis for your estimates. E) State your hypothesis. F) Provide the method and design for this project. G) Attach any questionnaires or involved documents that will be used. H) If human or other living subjects are involved in this research, provide documentation that you will comply with all applicable federal and state laws regarding research subjects. I) Describe how you will collect and analyze the data. ALL APPLICANTS MUST COMPLETE ITEM 15. 15. Statutory Considerations and Criteria: The following are based on s. 401.113(2)(b)and 401.117, F.S. Use no more than one additional double spaced page to complete this item. Write N/A for those things in this section that do not pertain to this project. Respond to all others. Justify that this project will: A) Serve the requirements of the population upon which it will impact. B) Enable emergency vehicles and their staff to conform to state standards established by law or rule of the department. C) Enable the vehicles of your organization to contain at least the minimum equipment and supplies as required by law, rule or regulation of the department. D) Enable the vehicles of your organization to have,at a minimum,a direct communications linkup with the operating base and hospital designated as the primary receiving facility. E) Enable your organization to improve or expand the provision of. 1) EMS services on a county, multi county, or area wide basis. 2) Single EMS provider or coordinated methods of delivering services. j 3) Coordination of all EMS communication links,with police, fire, emergency vehicles, and other related services. I z DH FORM 1767[2013] 4 (saago;aa;s Jarrod - uoi;eo fiddv lueao Buigole j : ZLbZ) siiayolaals aamod - uolleouddv :;uawgoellyto to w (n ca a CD U 10. Justification Summary a A) Problem Description Collier County EMS Depaikcnent (CCEMS) is the sole provider of 9-1-1 emergency care and transportation for the second largest county in the state of Florida. These rescue units utilize a combination of manually operated stretchers and a total of 11 hydraulic assistance stretchers,which we were grateful to have been awarded through an EMS Matching Grant in June 2015. Manually operated stretchers require the entire load to be lifted by personnel, regardless of how much the patient weighs. As the problem of obesity continues to grow, it puts our first responders in a situation that will eventually lead to a personal injury or an injury to a patient. The manually operated stretchers currently in use have locking mechanisms that are intended to prevent collapse(patient drops). However, even with routine maintenance performed to manufactures recommendations, these events still occur. Without a standardized fleet of stretchers throughout the department confusion can exist on operation procedures of the stretcher when patient care should be the main focus of rescue workers,particularly when being assisted by our partner agencies. B) Present Situation CCEMS employs over 150 employees and uses a combination of 34 Ferno 93H PROFlexx "H-Framed" manual stretchers and I I Stryker PowerPros. The H-Frame design of the Ferno requires gravity and the proper angle to allow the support Iegs of the stretcher to swing down into place. Depending on the height of the rescue worker and the terrain the vehicle is parked on,the proper angle can be difficult to maintain with a heavy load.Due to the fact that CCEMS covers a vast rural area and staffs only 2 personnel on each rescue truck, the request for an additional unit for Iifting assistance can take a considerable amount of time and delays patient care. This puts responders in a situation where they may lift a load heavier than they are capable, causing injury to themselves so that the patient condition is not compromised due to lack of manpower. Over the last six years, 23 of our personnel have been injured as a direct result of bending and lifting patients on a stretcher, while another 21 were injured from Ioading and unloading a patient from a rescue vehicle. Of the 44 total injuries, 21 of them resulted in back injuries and the others involved shoulder, neck (cervical), abdomen (umbilical hernia), and chest injuries. With the routine maintenance to the stretchers and annual training on proper Iifting techniques, many injuries are avoided however more injuries can be prevented with the proposed change in equipment. ca (sJago;aa;g Jarrod - uo!;eollddy;ueJo 6uigo;ew : ZLt'Z) siago;ai;g Jarrod - uol;eouddy :;uawgoe;;y �- cn w � a to 10. Justification Summary a C) Proposed Solution Based on the research done on our current manual lift stretchers,we feel the injuries to our rescue workers can be greatly reduced with the purchase of powered stretchers with hydraulic lifting assistance.This research includes a 2008 field study by Century Ambulance who had 10 patient drops from 2003 —2005 and 0 in 2005—2007 after switching to powered stretchers. Since switching, Charleston County EMS (a department similar in size and annual call volume)has reduced employee injury days by 84%.In 2010,EMSStat Ambulance service reported 39 injuries related to stretcher lifting and since switching from manual stretchers there have been 0 injuries. Dr. Tycho Fredericks conducted a study on the "Evaluation of Medical Cot Design Considering the Biomechanical Impact on Emergency Response Personnel". Six combinations from three stretcher designs and three fastener systems were evaluated, and the results show the addition of powered mechanisms decreases compression forces on the I_l/L5 disc up to 50%over a manual stretcher designs. D) Consequences If this grant is not funded, there will continue to be a risk to our patients and personnel each time a manual stretcher is used to care for those in their greatest time of need. With the findings of the research into powered stretchers it was our intent to employ these in the future through the budgeting process. Unfortunately, due to the necessity to replace radios to bring our communications up to P25 compliance and a backlog in our ambulance replacement program, which resulted from the past recession, we were unable to budget for the purchase of powered stretchers to standardize our rescue vehicles, thus continuing inconsistencies in equipment. Due to the nature of work performed by our personnel daily/nightly, it can lead to more injuries to patients and rescue workers. E) Geographic Area Collier County covers 2,026 square miles and provides care for 350,514 full time residents that include the city of Naples. At times of peak season, population can increase by an additional 100,000 people (US Census Bureau 2010). Naples is also home to a large retirement community and many nursing homes that contribute to the 40,000 responses in FY16 and growing at a rate of over 9% over the past three years. With major highways such as I-75 and US 41 running through Collier County there is always the potential for vehicle accidents that could 112, (siago;aa;s aamod - uognoHddv lueio 6uigo;ew : ZLt'Z) siago;a.i;s Jarrod - uoi;eo!Iddy :;uawgon;;y co ui co cc d) a m 10.Justification Summary co become large-scale incidents. The need for mutual aid from neighboring departments is a regular practice in these cases and all of them use powered stretchers. On the scene of a Mass Casualty Incident is not the time to delay patient care while teaching another rescue worker how to work equipment they have not used before. F) Proposed Time Frame Once notified of award the purchase/procurement process would be 90 days. Delivery and installation in emergency vehicles will take place in 60-90 days. Training our personnel on the use of the equipment is currently done on both styles of stretchers but would be focused on one style if awarded this grant. Once in service, continued quality control and monitoring of injury will be a continuous process with no end date. G) Data Sources Collier County Government Comprehensive Planning and Risk Management Divisions. United States Census Bureau. McGill Study, The Biomechanics Of Low Back Injury 1997. NAEMT. "NAEMT. Four in Five Medics Injured on the Job."EMSWorld.com.Perry,Nancy. 19 Nov.2005.EMS World. 10 Sept.2012. Statement Attesting To No Duplication This grant application is not a duplication. While Collier EMS was grateful to receive partial funding toward the purchase of power stretchers in 2015, an award for this submission would complete the critical need for this equipment. ® E (saayo}aa}s aamod - uoiieoi0ddv lue.e9 6ulyo}ew : ZLt7Z) siayolaa;s Jarrod - uol}eollddy :}uawyoe}}y �- cc ui a, co o_ r y 11. Outcome For Projects That Provide or Effect Direct Services To Emergency Victims n. A) The Most Recent 12 Months Over fiscal year 2016 CC EMS responded to 39,698 emergency medical calls of which 28,619 patients were transported to the hospital. During this period, seven of our personnel experienced stretcher-related injuries, four of which were a direct result of loading/unloading patients from the rescue unit, and three that were due stretcher collapse or malfunction.Thankfully there were no patient injuries as a result of these stretcher collapses however the risk still exists with the continued use of manual stretchers. These injuries not only resulted in substantial medical claims and lost days,but also are a detriment to our responders'future health and welfare. 12 Months Following Project It is hard to predict the exact outcome with a mixed fleet of manual and hydraulic assisted stretchers there is a chance for confusion due the drastic differences in operation of each.The repetitive lifting of a heavy load and its negative effects on the spine is well documented.Additionally with the growing problem of obesity and the use of hydraulic assisted stretchers one can hypothesize the chance for injury will be significantly decreased. Given the claims from the manufacture and studies done by other departments similar to ours, there has been nearly 100% elimination of workers compensation claims since implementation. B) Justification The numbers from A) and B)in this section are derived from numerous agencies that perform similar emergency responses and have significantly reduced their injuries related to manual lift stretchers. Furthermore, these agencies were standardized in the type and brand of equipment they used to reduce the chance for injury. The McGill Study documents that the spine is at greater risk for injury early in the morning and shortly after rising from bed. Due to the nature of work performed by our department on 24-hour shifts, hydraulic assist stretchers will reduce this risk.EMSStat Ambulance service and Fairfield County EMS have reported 0 injuries and 0 days of work missed due to injuries respectfully since the switch. There have been 0 injuries at Superior Ambulance Service and they have reported 15%decrease in insurance premiums as a result. C) Other Outcomes Improved patient care is another indirect outcome that we foresee in the long term after the change from manual stretchers. In the emergency medicine field the more experience a rescue worker has, the better the potential outcome for the patient. By reducing and eliminating injuries to our personnel they will remain in the field longer (saago;a.J;s JaMod - uoE eo!iddy;ueJo 6uigo;e j : ZLtiZ) siayo;aa;s Jarrod - uoneouddv :;uatuipe;;v ui tD Co c� a m C.) 11. Outcome For Projects That Provide or Effect Direct Services To Emergency Victims a and pass on their knowledge to other rescue workers. CC EMS personnel are not always scheduled at the same station or on the same truck year round, That being said, responders who are accustomed to operating hydraulic assisted stretchers may get relocated to a truck that has a manual stretcher that they have not used in quite some time. These are more examples of the benefit of standardizing the department to hydraulic assisted stretchers, D) Agency's five year plan Implementation of the hydraulic assisted stretchers aligns with our agencies 5 year plan because we try to provide the best care and safest environment to our employees,residents and those that visit Collier County. The proposed equipment can accommodate larger/heavier patients and reduce the risks for further injury to our patients and personnel. Additionally, we anticipate a boost in moral amongst the employees. The purchase of theses stretchers conveys a message to the employees that the department cares about the longevity of their careers and backs.This creates a work environment where employees are less focused on the possibility of injuring themselves and more on providing quality patient care,which is always a main priority. (siago;a.i;s aamod - uol;eoilddv;ueael 6uigo}eW : ZLVZ) sJago;aals Jarrod - uoi;eoIlddv :;uawgoe;;v I ui co co d a) 15. Statutory Considerations and Criteria a A) Serve the Requirement of the Population This project will provide a higher standard of care for the population of Collier County through the reduction in risk factors associated with manual stretchers. Mitigation of these risk factors will enable rescue workers to have longer careers so that their knowledge may be passed down. Additionally,this project will reduce the chance for secondary injury to patients from stretcher collapse. B) Conform to State Standards This grant will specifically aid CCEMS in its goal to reduce the number of on the job injuries in the field to its personnel. The propose change in equipment conforms to all the minimum requirements under Florida Administrative Code 64J-1 and meets all FDA, state and local requirements for safe loading and unloading of patients. C) Minimum Equipment This stretcher design should only increase safety to both the patients that are transported and the rescue workers providing the care.There will not be any need to modify the current storage capabilities of CCEMS rescue units. Therefore, all the required equipment currently on the emergency vehicles will remain in the same locations and available for patient care. D) Communications n/a E) Enable your Organization to Improve or Expand This project will improve services on a multi county level in the event of a mass casualty incident. All departments that neighbor Collier County currently use hydraulic assistance stretchers. In the event of a mass casualty incident, patients will be loaded into vehicles faster and arrive at the hospital safer if there is uniformity in the equipment used by all departments responding to the incident. There will not be a delay in patient care on scene while teaching emergency responders how to use equipment they are not familiar with. (-&; 17 (saayo;aa;s.49nnod - uol;eoliddv;ueao 6ulyo;eW : ZLi7Z) saayo;aa;s aannod - uol;eollddd :;uawyoe;;y t!7 W cn 4. a, U f4 a 16. Work activities and time frames: Indicate the major activities for completing the project(use only the space provided). Be reasonable, most projects cannot be completed in less than six months and if it is a communications project, it will take about a year. Also, if you are purchasing certain makes of ambulances, it takes at least nine months for them to be delivered after the bid is let. Work Activity Number of Months After Grant Starts Begin End Procurement 1 3 Delivery/Installation 4 6 Training 5 Continuous 17. County Governments: If this application is being submitted by a county agency, describe in the space below why this request cannot be paid for out of funds awarded under the state EMS county grant • program. Include in the explanation why any unspent county grant funds,which are now in your county accounts, cannot be allocated in whole or part for the costs herein. Creating a standardized fleet of stretchers will ensure the safest working conditions for our personnel and patients. Confusion and risks can arise if there is not uniformity in the equipment used by rescue workers that sometimes operate on little sleep while caring for the sick or injured. At this time the number of stretchers that need to be purchased to ensure safety will exceed the funds awarded to Collier County. DH FORM 1767(2013) 5 0;..2 (1 (saayo}aa}g aannod - uol}eoilddy}ueio 6uigo}evil : ZL'6Z) saayo}aa}g aannod - uol}eollddy :}uowgoe}}y ui c, a _ d t4 d 18. Budget: Salaries and Benefits: For each Costs Justification: Provide a brief justification position title, provide the amount of why each of the positions and the numbers salary per hour, FICA per hour, of hours are necessary for this project. fringe benefits, and the total number of hours. TOTAL: $ 0.00 Right click on 0.00 then left click on "Update Field"to calculate Total Expenses: These are travel costs Costs: List the price Justification: Justify why each of the and the usual, ordinary, and and source(s)of the expense items and quantities are incidental expenditures by an price identified. necessary to this project. agency, such as, commodities and supplies of a consumable nature, excluding expenditures classified as operating capital outlay(see next category). TOTAL: $ 0.00 Right click on 0.00 then left click on "Update Field'to calculate Total DH FORM 1767[2013] 6 C� , ca (siago;ai;s Jarrod - uogeollddy;ueao 6u14o;e j : ZLvZ) siago;ai;s Jarrod - uol;eoilddy :;uawgoe;;y e uD u l CD co a, a Si C.) a) al Vehicles,equipment,and other Costs: List the price Justification: State why each of the items operating capital outlay means of the item and the and quantities listed is a necessary equipment,fixtures, and other source(s) used to component of this project. tangible personal property of a non identify the price. consumable and non expendable nature, and the normal expected life of which is 1 year or more. 20 hydraulic assist stretchers 275,416.00 1 stretcher per truck as required by code 64J-1 • TOTAL: $275,416.00 Right click on 0.00 then left click on "Update Field"to calculate Total State Amount (Check applicable program) Right click on 0.00 then left click on ® Matching: 75 Percent $206,562.00 "Update Field"to calculate Total Right click on 0.00 then left click on ❑ Rural: 90 Percent 50.00 "Update Field"to calculate Total Local Match Amount (Check applicable program) Right click on 0.00 then left click on ® Matching: 25 PercentU date Field"to calculate Total $68,854.00 p Right click on 0.00 then left click on ❑ Rural: 10 Percent $ 0.00 "Update Field"to calculate Total Grand Total S275,416.00 Right click on 0.00 then left click on DH FORM 1767[2013] 7 (siiago;ails Jarrod - uogeollddV;ueJD 6u!go4e1A1 : ZLt7Z) siago;aa;s Jannod - uol;eoliddy :;uawgoe;;y LO LO co ui di LC; d m 0 f4 19. Certification: My signature below certifies the following. I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for this grant and, if funded, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. I agree that any and all information submitted in this application will become a public document ,pursuant to Section 119.07, F.S. when received by the Florida Bureau of EMS. This includes material which the applicant might consider to be confidential or a trade secret. Any claim of confidentiality is waived by the applicant upon submission of this application pursuant to Section 119.07,F.S., effective after opening by the Florida Bureau of EMS. I accept that in the best interests of the State,the Florida Bureau of EMS reserves the right to reject or revise any and all grant proposals or waive any minor irregularity or technicality in proposals received, and can exercise that right. I, the undersigned, understand and accept that the Notice of Matching Grant Awards will be advertised in the Florida Administrative Weekly, and that 21 days after this advertisement is published I waive any right to challenge or protest the awards pursuant to Chapter 120, F.S. I certify that the cash match will be expended between the beginning and ending dates of the grant and will be used in strict accordance with the content of the application and approved budget for the activities identified. In addition, the budget shall not exceed, the department, approved funds for those activities identified in the notification letter. No funds count towards satisfying this grant if the funds were also used to satisfy a matching requirement of another 'state grant. All cash, salaries, fringe benefits, expenses, equipment, and other expenses as listed in this application shall be committed and used for the activities approved as a part of this grant. Acceptance of Terms and Conditions: If awarded a grant, I certify that I will comply with all of the above and also accept the attached grant terms and conditions and acknowledge this by signing below. / / Signature of Authorized Grant Signer MM /DO/YY (Individual Identified in Item 2) DH FORM 1767[2013] 8 THE TOP PART OF THE FOLLOWING PAGE MUST ALSO BE COMPLETED AND SIGNED. ATTEST: Approved mi to farm and legality DWIGHT E. BROCK, Clerk R,.�: Assistant County Attorney (siayo;aa;s Jarrod - uogeollddy;ueio 6ulyo;ew : ZLbZ) siayo;aa;s Jarrod - uol;eollddy :;uewyoe;;y m r � U.1 tO C15 o� a. rts a. FLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM REQUEST FOR GRANT FUND DISTRIBUTION In accordance with the provisions of Section 401.113(2)(b), 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:Collier County Board of County Commissioners Mailing Address: 3299 E. Tamiami Trl Suite 700 Naples, FL 34112 Federal Identification Number 59-60000558 Authorized Agency Official: Signature Date Type Name and Title Sign and return this page with your application to: DOH Bureau of Emergency Medical Oversight EMS Section, Grants Unit 4052 Bald (Jypress Way, Bin A-22 Tallahassee, Florida 32399-1722 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 State EMS Grant Officer Date State Fiscal Year: 2016 - 2017 Organization Code E.O. OCA Object Code Category 64-61-70-30-000 03 SF003 750000 059999 Federal Tax ID: VF Grant Beginning Date: Grant Ending Date: DH FORM 1767P[2013] 9 - ATTST: DWIGHT E. CROCK, Clerk Approved as to form and legality By: .416'sistant Count .aJ,cneY cS7