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Resolution 2012-149 RESOLUTION NO. 2012 - 1 4 9 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 $74,895.00 in the EMS County Grant will be used for training and 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 Board of County Commissioners of Collier County, Florida, this 1 f h day of&P+e m h er, 2012. ATTEST: BOARD OF COUNTY COMMISSIONERS, DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA r ,t its • a • gC BY ti°' �, D pu Cl k FRED W. COYLE, Chai 1r ►tgna t •:11t-.4 Approved as to form and legal sufficiency: Je jr. Wright As stant County Attorney 1 EMS COUNTY GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH Bureau of Emergency Medical Services Complete all items i 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 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 co y signature acknowledges and assures at the County shall comply fully with the conditions outiin e Fl r1 Signature: w. nty r Application. Date:C'j I J I I I°2- Printed Name:Fred W.Coyle Position Title:Chafrman 3. Contact Person: (The individual with direct knowledge of the protect on a day-to-day basis and has reports and may requesttp project cchhanges. grant he signer activities. nd the contact e authorized to sign project person may be the same.) Name: Waiter Kopka Position Title: Assistant Chief Address: 8075 Lely Cultural Parkway, Suite 267 Naples, FL 34113 Telephone: 239-252-3740 Fax Number. 239-252-3298 E-mail Address:WaiterKopka©colliergov.ned 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 OH Form;1884,Dec emt:44608 64J-1.015,F.A.C. 3 ATTEST: App 'veil as to forms and I- •. sufficiency DWIGHT E.BROCK CLERK Allis Je , E. right,Assistant County Attorney t wi..,. A ta ::' 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 10 I AL Salaries TOTAL FICA Grana lotal-Salaries and pICR 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 Medical Equipment/Supplies 34,805.00 Training �._._.�. _,.....___.___._...__. 10 000.00 TOTAL $44,895.00 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 IVIe�IcalTfFescue lcqu prnen��' ,��----�---�—°------ __._.. TOTAL $30,000.00 Grand Total $_74,895.00 DH Form 1884,December 2008 4 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�59-6000558 Authorized Official: ILA_ IA), 9l / ) ) Signature Date Fred W.Coyle,Chairman 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,Q, ocq OOb(ed code 64-42-10-00-000 750000 Federal Tax ID: VF Grant Beginning Date: Grant Ending Date: , App • as to form and lega= fficiency AlQ 11 7P, DedetbF4 o08 64J-1.015,F.A.C. itS Jeff :. Wight,Assistant County Attorney DWI T E.BRO C CLERK ,Crav1/4.1,vo 5 A*,Le PtIlIFititi941 trum