Resolution 2022-134 RESOLUTION NO. 2022- 1 34
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, IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
The $72,756.00 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.
THIS RESOLUTION PASSED AND DULY ADOPTED by the Board of County
Commissioners of Collier County, Florida, this 13th day of September 2022.
ATATT'E'ST: BOARD OF COUN Y COMMISSIONERS
�'vi:.-'C:RYSTAL Ks. KINZEL,CLERK COLLIER CO + - • - 4 •
e, : 4S,4' l'(11' , ', ai:, C ). /7i,
# '
_ By: _.►fir
t e - Glerk Will',.m L. McDaniel, Jr., Chain an
,siga:whire only(
Appr v i ., . nn and legality:
-,t%A�
Jeffre I . Kl kow, County Attorney
ili
EMS COUNTY GRANT APPLICATION 2022- 2023
FLORIDA DEPARTMENT OF HEALTH
Emergency Medical Services Program
t..t. A,P,II Complete all items
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 s's : •• ho has authority to sign contracts, grants, and other legal
documents for the county) I ce ' 4j-t all in o --tion a • data in this EMS county grant application and
its attachments are tr a cv -- , signature :c owle • :nd assures that the county shall
comply fully with the o ou l,t cr3 t - FI• id. t1!• • y Grant Application.
Signature: �,�- •+r Date: yfr3/22.
Printed Name: / liam McDaniel
Position Title: ' hairman
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: Cherie DuBock
Position Title: Accounting Supervisor
Address: 8075 Lely Cultural Parkway, Suite 267
Naples, FL 34113
Telephone: 239-252-3756 Fax Number: 239-252-3298
E-mail Address: cherie.dubock@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
AtTEST'
cmisiU.K.KUVZEL,CLERK
BY (ill dJOC c
A es#�a ad 's
signature on y.
DH 1684, December 2008 (Rev.July 2018) 64J-1.015, F. C.
1
(CAC»
BUDGET PAGE -When the budget form is in your computer, the budget totals below should be
added for you if you place your cursor over a subtotal or total field, right click your mouse, then left
click"Update Field" on the resulting menu.
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
Total Expenses = $ 0.00
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 $72,756.00
Total Vehicles & Equipment= $ 0.00
Grand Total = $ 72,756.00
DH 1684, December 2008
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(CA))
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 used herein must be in the state
MyFloridaMarketPlace (MFMP) system. A finance person in your organization who does business with the
state can provide these.
Name of County: Collier County Board of County Commissioners
Mailing Address: 3299 Tamiami Trail East. Suite 700
Naples, FL 34112-5747
Federal 9-digit Identification n mb.. : 1110 58 Affik di•it se•. code
Authorized County Official: - N/ 9II22-
Sig,:ture Date
William McDaniel, Chairman
Type or Print Name and Title
Sign and return this page with your application to: ATTEST
Appro Florida Department of Health CRYSTAL K.KINZEL,CLERK
o^form and legality:
Emergency Medical Services Unit, Grants BY: , pt.
4052 Ba
Jeffrey A.xlatzkow ld Cypress Way, Bin A-22
County A omey tot
Tallahassee, Florida 32399-1722 ._` tt:A' as C rina S
-.sigq ure'only.
Do not write below this line. For use by State Emergency Medical Setrvic' s Section
Grant Amount for State to Pay: $ Grant ID: Code: e .••
<Zt L'e�`�
�
_Approved By:
Signature of State EMS Unit Supervisor Date
Approved By:
Signature of Contract Manager Date
State Fiscal Year: 2022 - 2023
Organization Code E.O. OCA Object Code Category
64-61-70-30-000 05 SF005 751000 059998
Federal Tax ID:VF Seq. Code:
Grant Beginning Date: Grant Ending Date:
DH 1767P, December 2008(rev. June 8,2018), incorporated by reference in F.A.C. 64J-1.015.
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