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Backup Documents 09/10/2013 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 E 3 a TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO j 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. 2. 3. County Attorney Office County Attorney Office &- q • 11 . 13 Cal 4. BCC Office Board of County fc-k.b Anj Commissioners /5/ `11(c, tr 3 5. Minutes and Records Clerk of Court's Office 011((3 ::Sze.. PRIMARY CONTACT INFORMATION I 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 Artie Bay Phone Number 252-3756 Contact/ Department ,,..- Agenda Date Item was 9210/13 Agenda Item Number 16.E.3 Approved by the BCC Type of Document Resolution,Grant Application,Distribution Number of Original 1 Each(M&R—Need Attached Form Zo(3 -- 1'18 _ Documents Attached Originals Returned) 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. (Initi. Applicable) 1. Does the document require the chairman's original signature? ,� 2. Does the document need to be sent to another agency for additional signatures? If yes, n/a 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 AI signed by the Chairman, with the exception of most letters,must be reviewed and signed �i by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's n/a 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 1 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 X- signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip should be provided to the County Attorney Office at the time th item is input into SIRE. / Some documents are time sensitive and require forwarding to llahassee within a certain a� time frame or the BCC's actions are nullified. Be aware of r deadlines! 8. The document was approved by the BCC on 9/10/13 (enter date)and all / changes made during the meeting have been incorporated in the attached document. 'IP The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the / / BCC,all changes directed by the BCC have been made,and the document is ready for t e Chairman's signature. rF' I I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2. -.; , •evised 11/30/12 16E 3 MEMORANDUM Date: September 17, 2013 To: Artie Bay, Accounting Supervisor EMS Operations From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: Resolution 2013-178, Grant Application & Distribution Form Attached for your records, is a certified copy of Resolution 2013-178, the original of the Grant Application and distribution form as referenced above, (Agenda Item #16E3) adopted by the Board of County Commissioners on Tuesday, September 10, 2013. If you have any questions, please call me at 252-7240. Thank you. 16E3 RESOLUTION NO.2013 -1 7 8 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, CERTIFYING THAT THE FLORIDA EMERGENCY MEDICAL SERVICES COUNTY GRANT FOR EMS COUNTY GRANT FUNDS WILL IMPROVE AND EXPAND PRE-HOSPITAL EMS DEPARTMENT ACTIVITIES AND WILL NOT SUPPLANT EXISTING COUNTY EMS BUDGET ALLOCATIONS. WHEREAS, Collier County EMS is applying for a Florida Emergency Medical Services Grant to benefit pre-hospital EMS Services, and WHEREAS, Collier County 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 supplies funded with grant funds shall improve and expand the effectiveness of pre-hospital emergency medical care; and WHEREAS, pursuant to the grant terms and conditions, the funds will not be used to supplant EMS Department budget allocations. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that: The $72,335.00 in the EMS County Grant will be used to purchase medical/rescue supplies/equipment and these funds will not be used to supplant existing EMS Department budget allocations. PASSED AND DULY ADOPTED by the 1Boarrd of County Commissioners of Collier County, Florida,this IL-) day of Se44-er ., 2013. ATTEST: BOARD OF COUNTY COMMISSIONERS, DWIGHT :AB. CClerk COLLIE OUNTY, FLORIDA BY: M." BY: Deputy'Cierk 1 GE G A . LER,ESQ., Chairwoman Attest as to ha rmari' ctnn:3,11'P 8111. f ove/d��a��s to form and legality: C�gC JIL0 ssistant County Attorney 1 1 16E 3 tol EMS COUNTY GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete all items ID. Code(The State Bureau of EMS will assign the ID Code-leave this blank) C 1. County Name: Collier Business Address: 3299 Tamiami Trail East, Suite 303 Naples, FL 34112 Telephone: 239-352-3740 Federal Tax ID Number(Nine Digit Number). VF_59-6000558_ 2. Certification: (The applican signatory who has authority to sign contracts, grants, and other legal documents for the co,Mnt ) I certi that all information and data in this EMS county grant application and its attachments are true on I c•rrec My signature acknowledges and assures that the County shall comply fully with the condit'o 'utl ed n the Florida EMS County Grant Application. , Signature: Date: O1 / I f 13 Printed Na e: t A. Hiller, Esq. Position Titl • hairwoman 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 Parkway, Suite 267 Naples, FL 34112 Telephone: 239-252-3740 I Fax Number: 239-252-3298 E-mail Address: artiebay @colliergov.net 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. 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 Form 1684, Decer,2008. '!;� 64J-1.015, F.A.C. 1f . 3 Approved as to form and legality MIGHT E e a oc g, '14111k Ck A, AssWant County Att A�ttest as o airl1man - ii 16E 3 NV BUDGET PAGE A. Salaries and Benefits: For each pose ion title, provide-the amount of salary per hour, FICA per hour, other fringe benefits, and the total number of hours. Amount I U I AL 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 excluding expenditures classified as operating capital outlay(see next category). List the item and, if applicable,the quantity I Amount 6,000A0 ____ TOTAL $6,000.00 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 u- Medical/Rescue Equipment 66,335.00 TOTAL '66,335.00 Grand Total $72.335.00 DH Form 1684, December 2008 4 C�,9 16E 3 FLORIDA DEPARTMENT OF HEALTH 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: Collier County Board of County Commissioners Mailing Address: 3299 Tamiami Trail East, Suite 303 Naples, FL 34112 Federal Identification number& -9-6►00 8 Authorized Official: 61 I Sig :tu'- Date Georgia A.Hiller,Esq.,Chairwoman Type Name and Title Sign and return this page with your application to: Florida Department of Health BEMS Grant Program 4052 Bald Cypress Way, Bin C18 Tallahassee, Florida 32399-1738 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 EMS Grant Officer Date State Fiscal Year: - Organization Code E.O.. OCA Object Code 64-42-10-00-000 750000 Federal Tax ID: VF Grant Beginning Date: Grant Ending Date: ,G k; T Y a ,�,� Approved as to form and legality DH 176e311berlvo6 p; 64J-1.015, F.A.C. ��� i C L E Iih AssC> irCi County Attoltey 5 ttest as 'Y I eirm5 lira Alll(J 16E3 .4,4 GENERAL CONDITIONS AND REQUIREMENTS The EMS County grant general conditions and requirements are an integral part of the county grant agreement between the agency/organization (grantee) and the state of Florida, Department of Health (grantor or department). In the event of a conflict, the following requirements shall always be controlling: FINANCIAL FUND ACCOUNTING: All state EMS grant funds shall be deposited by the grantee in an account maintained by the grantee, and assigned an unique accounting code designator for all grant deposits and disbursements or expenditures thereof. All state EMS grant funds in the account maintained by the grantee shall be accounted for separately from all other grantee funds. USE OF COUNTY GRANT FUNDS: All state EMS grant funds shall be used between the beginning and ending dates of the grant solely for activities as outlined in the Notice of Grant Award letter, its attachments if any, and the application including its budget with its revisions, if any, on file in the state EMS office. The grantee is not restricted to staying within the line item amounts within the approved grant budget. However, the grantee must adhere to the approved total grant budget. Any expenditures beyond this budget are the full responsibility of the grantee. ROLLOVERS Any unencumbered EMS county grant program funds as of September 30, of each year, including interest, remaining in the assigned grantee account at the end of a grant period shall be reported to the department. The grantee will retain these funds in the EMS County Grant account and include them in a budget revision request after receipt of approval of their next county grant application. 8 16E 3 DISALLOWED EXPENDITURES No expenditures are allowable as grant costs unless they are clearly specified as a line item in the approved grant budget, including approved change requests, or are clearly included under an existing line item. Any disallowed EMS county grant expenditure shall be returned to the EMS county grant account maintained by the grantee within 40 days after the department's notification. The costs of disallowed items are the responsibility of the county. VEHICLES AND EQUIPMENT The grantee shall own all items, including vehicles and equipment purchased with the state EMS grant funds, unless otherwise described in the approved grant application. The grantee shall clearly document the assignment of equipment ownership and usage; and maintain these documents so they are available to the department. The owner of the vehicle shall be responsible for the proper insurance, licensing and, permitting and maintenance. All equipment purchased with grant funds shall continue to be used for pre-hospital EMS or the purpose for which it was purchased throughout its useful life. When any grant-funded equipment is no longer usable, it may be sold for scrap or disposed of in the customary procedure of the receiving agency. TRANSFER OF PROPERTY A private organization owning any equipment funded through the grant program in whole or in part and purchased that equipment to provide services for a municipality, county or other public agency ceasing operation within five years of the ending date of a grant awarded to the organization shall transfer the equipment or other items to the local agency. There shall be no cost to the recipient organization. This provision is applicable when services cease operating due to a contract ending as well as any other reason. REQUESTS FOR CHANGE After a grant has been awarded, all requests for change shall be on DH Form 1684C EMS Grant Program Change Request, December 2008. The grantee shall obtain written approval from the department prior to making the requested changes. The following changes must be requested: 1. Changes in the project activities. 2. Redistribution of the funds between entities or equipment approved. 3. Establishing a new line item in the budget. 4. Changing a salary rate more than 10%. SUPPLANTING FUNDS The applicant cannot propose to use grant funds to supplant or replace any county or other funding source. Funds received under the county award grant program cannot be used to fulfill the matching requirement for the matching grant program. 9 0 16E 3 DEPOSIT OF FUNDS County grant funds provided to an applicant shall be deposited in a separate account. All interest earned shall be documented on the required reports. REPORTS Each grantee shall submit two reports to the department. The due dates for the required reports shall be specified in the letter from the department notifying the grantee of the grant award. These reports shall include, at a minimum, a narrative of the activities completed or the progress of grant activities during the reporting period. A report shall be submitted by the due date whether or not any action or expenditures have occurred. GRANT SIGNATURE The authorized individual listed on page one of the application shall sign each original application. Should this not be possible before the due date a letter shall be submitted to the department explaining why and when the signed application shall be received. RECORDS The grantee shall maintain financial and other documents related to the grant to support all revenue and expenditures. A file shall be maintained by the grantee, which includes a copy of the "Notice of Grant Award" letter, a copy of the application and department approved budget and a copy of all approved changes. FINAL REPORTS Within 120 days of the grant ending date a final report shall be submitted to the department. The final report shall at a minimum contain a narrative describing the activities conducted including any bid or purchasing process and a copy of all invoices, canceled checks relating to the purchase of any equipment and supplies. If the activity funded was for training a list of all individuals receiving the training shall be submitted along with the dates, times and location of the training. If the grant was for training to be obtained by staff then a copy of all invoices and payment documents for the training shall also be submitted. COMMUNICATIONS EQUIPMENT The grantee shall have all communications activities, services, and equipment approved in writing by the Department of Management Services, Information Technology Program (ITP). The approval shall be dated after the beginning date of the grant. Any commitment to purchase the requested equipment and service shall also be dated after the beginning date of the grant. 10 16E 3 Al EXPENDITURES No expenditures may be incurred prior to the grant starting date or after the grant ending date. Rollover funds may be used to meet expenditures prior to receipt of current year funds. CREDIT STATEMENT The grantee ensures that where activities supported by this grant produce original writing, sound recording, pictorial reproductions, drawings or other graphic representations and works of any other nature, notices, informational pamphlets, press releases, advertisements, descriptions of the sponsorship of the program, research reports, and similar public notices prepared and released by the provider shall include the statement: "Sponsored by [Your Organization's Name] and the State of Florida, Department of Health, Bureau of Emergency Medical Services." If the sponsorship reference is in written or other visual material, the words, "State of Florida, Department of Health, Bureau of Emergency Medical Services" shall appear in the same size letter or type as the name of the grantee's organization. One complimentary copy of all such materials shall be sent to the department within three weeks of their reproduction and delivery to the grantee. If the proper credit statement is not included, or if a copy of each item produced is not provided to the department within three weeks, the cost for any such materials produced shall be disallowed. Where activities supported by this grant produce writing, sound recordings, pictorial reproductions, drawings, or other graphic representations and works of any similar nature, the department has the right to use, duplicate and disclose such materials in whole or in part, in any manner or purpose whatsoever and others acting on behalf of the department. If the materials so developed are subject to copyright, trademark, or patent, legal title and every right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or application for the same, will vest in the State of Florida, Department of State, for the exclusive use and benefits of the state. Pursuant to section 286.02 (1), F.S., no person, firm or corporation, including parties to this grant, shall be entitled to use the copyright, patent or trademark without the prior written consent of the Department of State. FINANCIAL AND COMPLIANCE AUDIT REQUIREMENTS This is applicable, if the provider or grantee, hereinafter referred to as provider, is any local government entity, nonprofit organization, or for-profit organization. An audit, performed in accordance with section 215.97, F.S. by the Auditor General shall satisfy the requirement of this attachment. STATE FUNDED This part is applicable if the provider is a nonprofit organization that expends a total of $100,000 or more in funds from the department during its fiscal year, which was not paid from a rate contract based on a set state or area-wide fixed rate for service, and of which less that 11 16E 31 $300,000 is federally funded. The determination of when a provider has "expended" funds is based on when the activity related to the award occurs. The grantee agrees to have an annual financial audit performed by independent auditors in accordance with the current Government Auditing Standards issued by the Comptroller General of the United States. Such audits shall cover the entire organization for the organization's fiscal year. The scope of the audit performed shall cover the financial statements and include reports on internal control and compliance. The reporting package shall include a schedule that discloses the amount of expenditures and/or receipts by grant number for each grant with the department in effect during the audit period. Compliance findings related to grants with the department shall be based on the grant requirements, including any rules, regulations, or statutes referenced in the grant. The financial statements shall disclose whether or not the matching requirement was met for each applicable grant. All questioned costs and liabilities due to the department shall be fully disclosed in the audit report with reference to the department grant involved. If the grantee receives funds from a grants and aids appropriation, the provider shall have an audit, or submit an attestation statement, in accordance with Section 215.97, F. S. The audit report shall include a schedule of financial assistance, which discloses each state grant by number and indicates which grants are funded from state grants and aids appropriations. The grantee has "received"funds when it has obtained cash from the department or when it has incurred reimbursable expenses. The grantee agrees to submit the required reports. SUBMISSION OF AUDIT REPORTS Copies of the audit report and any management letter by the independent auditors, or attestation statement, required by this attachment shall be submitted within 180 days after the end of the grantee's fiscal year to the following, unless otherwise required by F. S.: A. Send one copy to: Florida Department of Health Contract Administrative Monitoring Unit 4052 Bald Cypress Way,BIN BO 1 Tallahassee,Florida 32399-1729 B. Submit to this address only those audits performed or attestation statements prepared in accordance with Section 215.97, F. S.: Send two copies to: Auditor General's Office Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee,Florida 32399-1450 C. Do not send this report to the state Bureau of EMS. 12 16E3 RECORDS RETENTION The grantee shall ensure that audit working papers are made available to the department, or its designee, upon request for a period of five years from the date the audit report is issued, unless extended in writing by the department. 13