Backup Documents 09/08/2020 Item #16E5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ! 6 E
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. County Attorney Office County Attorney Office Jp,K �2
Vuo )
2. BCC Office Board of County BS 6
Commissioners at* l9.8
'02
3. Minutes and Records Clerk of Court's Office 4 /` _
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Erin Page,Accounting Supervisor Contact Information 239-252-3756
Contact/Department Administrative Services Depaitinent
Agenda Date Item was September 8,2020 Agenda Item Number 16.E.ierS
Approved by the BCC
Type of Document Grant Application,Grant Fund Distribution, Number of Original 3
Attached Resolution Documents Attached
aQ91.) No
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK EGP
2. Does the document need to be sent to another agency for additional signatures? If yes, EGP
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be EGP
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's EGP
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the EGP
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's EGP
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip EGP
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 09/8/2020 and all changes made during EGP N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. �' . this line.
9. Initials of attorney verifying that the attached document is the version approved by the / N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for e ' an option for
Chairman's signature. this line.
16E5
MEMORANDUM
Date: September 11, 2020
To: Erin Page, Accounting Supervisor
Emergency Services
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: Resolution 2020-140: Grant Application and Grant Fund
Distribution
Attached is one (1) certified Resolution and one original Application as referenced
above, (Item #16E5) as approved by the Board of County Commissioners on Tuesday,
September 8, 2020.
The Board's Minutes & Records Department has kept the original as part of the
Board's Official Records.
If you have any questions, please contact me at 239-252-8411.
Thank you.
Attachment
16E5
RESOLUTION NO. 2020 - 1 40
A 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 $63,731.00 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 8t1 day of September, 2020.
ATTEST: BOARD OF COUNTY COMMISSIONERS,
CRYSTAL K KINZEL, CLERK COLLIER COUNTY, FLORIDA
t ... 0...,,......,,,mc,
By: Ars#,,e
Attest 86 to 4e0Ame"-
Clia '"lerk Burt L. Saunders, Chairman
signature only.
I,
Item# i b —
�n
I ...r.. A.genda QI8 uJ
Appro ed s iti form and legality: Date —
:t ' Reed q 1 olio
Jeffrey la ow, County Attorney .
C uty Clerk
[19-EMS-00947/14 ' 17/1] ••• ---Y•-----
16E5
FLORIDA DEPARTMENT OF HEALTH
Emergency Medical Services Section
EMS County Grant Application
ID Code(The State EMS Program will assign the ID Code—leave this blank)
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 tr and correct. My • nature acknowledges and assures that the county shall comply
fully with the condit' out]. ' the rida EM County Grant Application.
Signature: • Date:
Printed Name: Burt L. Saunders
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: Erin Page
Position Title: Accounting Supervisor
Address: 8075 Lely Cultural Parkway, Naples, FL 34113
Telephone: 239-252-3756 Fax Number: 239-252-3298
Email Address: Erin.Page@CollierCountyFL.gov
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 this resolution.
5. Organization List: Complete a budget page(s)for each organization, which at your option you will
provide funds. List the organization(s) below. (Use additional pages if necessary)
Collier County Emergency Medical Services
DH 1684, December 2008 (Rev. July 2018) Rule 64J-1.015, Florida Administrative Code
ATTEST:
''R T;^.L K. KI ' Et., CLERI c
jy Deputy Clerk
lU 4 nairman's
sioaature only.
16E5
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
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
Tuition for Paramedic School $50,000.00
Total Expenses = $ 55,000.00
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 $8,731.00
Total Vehicles & Equipment= $ 8,731.00
Grand Total = $ 63,731.00
DH 1684, December 2008
2
16E5
FLORIDA DEPARTMENT OF HEALTH
EMERGENCY MEDICAL SERVICES(EMS) GRANT UNIT
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 county name, address, and corresponding federal ID number must be in the state MyFloridaMarketPlace
(MFMP) system. A finance person in your organization who does business with the state must provide these.
Name of County: Collier County Board of County Comissioners
Mailing Address: 3299 Tamiami Trail East, Suite 700
Naples, FL 34112-5747
Federal 9-digit Identification number. 9-6000558 3-digit seq. code
Authorized County Official: , ��a (l iroZQ
Sign ure Date
Burt L. Saunders, Chairman
Type or Print Name and Title
Sign and return this page with your application to:
Florida Department of Health
Emergency Medical Services Unit, 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 Section
Grant Amount for State to Pay: $ Grant ID: Code:
Approved By:
Signature of State EMS Unit Supervisor Date
Approved By:
Signature of Contract Manager Date
State Fiscal Year: 2020-2021
Organization Code E.O. OCA Object Code Category
64-61-70-30-000 05 SF005 751000 059998
Federal Tax ID: VF Sequence Code:
Grant Beginning Date: Grant Ending Date:
DH 1767P,,December 2008 (rev.June 8, 2018), incorporated by reference in Rule 64J-1.015, Florida Administrative Code
CRY:—AL K. . CLERK car____ 3
Deputy Clerk
Attest as to Chairman's
signature only.