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HomeMy WebLinkAboutBack-Up DocumentsFUND TITLE RESOURCES: EMS Matching Grant Award - M0037 State of Florida Department of Health Florida EMS Grant Program City Matching Grant from Account No. 11000.184010.481000.0000.00000 $263,663.00 APPROPRIATIONS: $351,550.00 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Vision: To be the Healthiest State in the Nation May 02, 2022 Lillian Blondet City of Miami Department of Fire Rescue 444 SW 2"d, 5th Floor Miami, Florida 33130 Dear Blondet: Ron DeSantis Governor Joseph A. Ladapo, MD, PhD State Surgeon General The Florida Department of Health (DOH) is pleased to award an Emergency Medical Services (EMS) Matching Grant, ID Code M0037 in the amount of $263,663.00 to City of Miami Department of Fire Rescue. This grant program is funded by the DOH, EMS Trust Fund. There are no federal funds involved. The purpose of this grant is to improve and expand EMS by assisting your organization with purchase of Automated CPR Devices. The grant begins the date of this letter and ends June 30, 2023. Your required local cash match is $87,887.00 with a total budget of $351,550.00. You are required to report grant activities and purchases to the state pursuant to section 401.113 (2) (b), Florida Statutes, and in compliance with the Florida Catalog of State Financial Assistance, program number 64.003. The reports are due the third week of October 2022, February 2023, and the final report by the grant ending date of June 30, 2023. Your signed grant application affirms you have read, understand, and will comply with the conditions and requirements in the "Florida EMS Matching Grant Program Application Packet, December 2008." You may obtain a copy of the grant application packet from your identified state contact person. Thank you for participation in this state EMS grant. If you need assistance, please contact the Bureau of Emergency Medal Oversight, EMS Section, EMS Grants Program Manager, Lorrianna Jean -Jacques at (850) 558-9500. Sincerely, Douglas H. Woodlief Division Director Emergency preparedness and Community Support cc: Christian Guzman Florida Department of Health Division of Emergency Preparedness and Community Support Accredited Health Department 4052 Bald Cypress Way, Bin A-22 • Tallahassee, FL 32399 :Public Health Accreditation Board PHONE: 8501245A864 • FAX: 850/921-8162 FlorldaHealth.gov Applicant Information and Form for 2021-2022 Matching Grant Requests Optional: In your application package cover letter, you may request to be, or recommend a person to be, a reviewer of matching grant applications during this grant cycle. If selected, reviewers will only evaluate applications that are not associated with them. Request for Grant Fund Distribution Page: this page is the last page herein and you must complete the top part of the form. State EMS will complete the bottom part, as indicated on the form. We need this to obtain state funds for awards. A staff member of your organization who has cash transactions with the state for your organization must provide the address on the top part of this Distribution Page because the address on this page is not a normal mailing address. It must exactly be the same address as in the state financial system for your organization's corresponding nine -digit ID code and the additional three -digit sequence code of the address, for any funds to be provided. Number of pages. Each application must be no more than 15 one sided pages, including the form and all content. Reviewers may not read any pages beyond 15 one sided pages. However, you may submit a one -page cover letter and letters of recommendation, and these do not count against the 15 pages. Fastening. If you send a paper application, do not use a cover or folder, just staple in the upper left corner, with the first page of the application form the first of the stapled pages. EMS MATCHING GRANT APPLICATION FLORIDA DEPARTMENT OF HEALTH MOTHEmergency 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: City of Miami Department of Fire -Rescue 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: Lillian Blondet Position Title: Director, Office of Grants Administration Address: 444 SW Tid Ave, 511 Floor City: Miami County: Miami -Dade County State: Florida Zip Code: 33130 Telephone: 305-416-1536 Fax Number: E-Mail Address: lblondet ,miami ov.com 3. Contact Person: (The individual with direct knowledge of the project on a day-to-day basis and responsibility for the implementation of the grant activities. This person may sign project reports and may request project changes. The signer and the contact person may be the same.) Name: Christian F. Guzman, BSN Position Title: Assistant Fire Chief Management Services Division Address: City of Miami Department of Fire Rescue 1151 NW 7 Street City: Miami County: Miami -Dade County State: Florida Zip Code: 33136 Telephone: 305-416-5422 Fax Number: 305-400-5327 E-Mail Address: C uzman miami ov.com DH FORM 1767 [2013] 64J-1.015, F.A.C. 4. Legal Status of Applicant Organization (Check only one response): (1) ❑ Private Not for Profit [Attach documentation-501 (3) ©] (2) ❑ Private for Profit (3) ® City/Municipality/Town/Village (4) ❑ County (5) ❑ State (6) ❑ Other (specify): 5. Federal Tax ID Number (Nine Digit Number). VF 596000375 _ _ _ _ _ 6. EMS License Number: 1315 Type: ®Transport ❑Non -transport ❑Both 7. Number of permitted vehicles by type: 0 BLS; 28 ALS Transport; 26 ALS non -transport. 8. Type of Service (check one): ® Rescue; ❑ Fire; ❑ Third Service (County or City Government, non -fire); ❑ 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: January 20, 2022 Print/Type: Name of Director: Paul Joseph Adams D.O., M.A., FACOEP FL Med. Lic. No. OS 7893 Note: All 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. 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] ITEM 10. Justification Summary 3 Pages A) Problem Description: Miami Fire Rescue (MFR) uses automated cardiopulmonary resuscitation (ACPR) devices on every cardiac arrest patient. Current national guidelines in CPR require a consistent rate, depth of compression, and force when providing chest compressions. These factors are more easily and effectively obtained through mechanically (automated) assisted compression versus provider (human) assisted compressions. Hence, the more consistent compressions are delivered during CPR, the greater the chance for survivability and return to normal life functions. The ACPR device relieves responders from manual CPR, reduces their fatigue' and allows them to provide other critical care needed by these acute patients. Rescuer fatigue reduces the effectiveness of chest compressions requiring the frequent change of MFR responders, interrupting the compressions, and as a result, reducing further the effectiveness of the resuscitation'. MFR rescuers sometimes have to perform CPR in moving ambulances in Miami's precarious traffic conditions. Members and patients are placed at risk of injury. ACPR devices can be used to perform safe, successful, uninterrupted CPR when the ambulance is in motion'. These machines are often more effective than manual CPR, especially when seconds count. They are critical in providing effective, prompt, and high -quality resuscitation. Unfortunately, MFR's devices are beyond their serviceable lifespan. Their age creates several issues, which include increased cost of repairs ($99,571 from January 2019 to January 2022) and less effective CPR when devices are inoperable. Because they are old, the ACPR's sometimes malfunction in the midst of treating cardiac arrest patients. Responders transition to manual CPR while waiting for the arrival of a replacement, interrupting effective treatment, causing loss of precious time and endangering lives. These issues compromise MFR's ability to provide the highest level of care to the citizens and visitors of Miami, cause delays in patient transport, and result in decreased chances of survivability2. Further, this reduces overall healthy patient outcomes and decreases their likelihood of returning to normal life functions. More than 356,000 people suffer an out -of -hospital cardiac arrest in the U.S. annually, nearly 90% of them fatal according to the American Heart Association. Further, survival rates remain low'. In 2021, MFR treated 577 cardiac arrests. MFR responders are critical in the survivability of patients by their rapid assessment, triage, scene treatment and transport of the voluminous patients served in Miami and in the other Miami -Dade County municipalities where it provides mutual aid and automatic aid. Miami has a disturbingly high mortality rate, due to high poverty levels, an abundance of ill stricken residents, and elderly, which makes it critical to transport patients expeditiously. B) Present Situation: MFR provides both fire and EMS services, consisting of 27 fully staffed ALS rescue transport units, one fully staffed ALS transport capable Fireboat, and 26 ALS non -transport units . CPR is one of the most important life-saving procedures. Members often have to perform CPR in adverse locations and environments, including a moving ambulance, cramped spaces or amid poor weather conditions. Alone, these unfavorable conditions create possible delays in hospital arrival, decreases in patient survivability and decreased efficiency in MFR care. In 2021 MFR transported 40,236 patients to hospital emergency departments and responded to over 100,000 calls. An automated CPR device was used on 99% of the cardiac arrests treated by MFR. When a device malfunctioned, an MFR spare had to be delivered to responders. At times, the spare was not available, and responders had to wait for the arrival of a second spare. This required a transition from ACPR device assisted compressions to human assisted compressions back to the ACPR device. Current national guidelines in CPR require a consistent rate, depth of compression, and force when providing chest compression. This breech in CPR protocols, compromised care and created additional challenges for rescuers such as decreasing the chances of return of spontaneous circulation. Also, the broken device had to be shipped out for repair and a loaner mailed to MFR. C) Proposed Solution: It is critical that MFR provides effective lifesaving treatment and improves its ability to care for the more than 1 million people traversing through Miami daily. We are requesting financial assistance to purchase 25 automated CPR devices to ensure MFR is able to successfully perform CPR and avoid endangering patients' lives and safety. Without the ACPR devices, rescuers may have trouble providing CPR to the many people treated during MFR's over 100,000 EMS calls. The ACPR devices minimize challenges experienced when performing CPR in the field. Minimal training is required to be skilled at using these devices. Using them will significantly increase accuracy in lifesaving care and survivability of all of our residents and visitors. D) Consequences If Not Funded: Without this grant, MFR will not be able to fund this project, patients' lives will be endangered, and members and patients will be at risk of injury. MFR members will continue to experience fatigue resulting in the frequent alternating of MFR responders, interruption of compressions, and reduction of the effectiveness of the resuscitation. Rescuers will face challenges providing other critical care needed by acute patients and maybe compromised in their ability to perform safe, successful, uninterrupted CPR when transporting patients. When seconds count, members will have to rely on current devices, which need repair and sometimes malfunction while treating cardiac arrest patients. Thus, MFR's ability to provide effective care to Miami's citizens and visitors will be unfortunately and inevitably compromised and there may be delays in hospital arrival and potential poor patient outcomes. Unfortunately, MFR does not have the funds to purchase this equipment without grant assistance. E) The geographic area to be addressed: The City of Miami is comprised of 34 square miles with about 442,241 residents. Daily, the population swells to over 1 million during working hours. Current vulnerabilities are: 1) High rate of ill -health due to poverty: Miami has a 23% poverty rate3 and in 2014 had the nation's second -lowest median income4; 2) Mutual Aid Obligations: MFR provides automatic aid to the Village of Key Biscayne and mutual aid to Miami -Dade County, the cities of Miami Beach, Coral Gables and Hialeah. F) The proposed time frames: Months 1 to 5: present award to the City of Miami Commission for approval and procure equipment. MFR anticipates units will arrive in four to six weeks from the date ordered; Month 6 to 9: training of 700 plus firefighters/paramedics and; Month 10-12: implementation of the equipment into service and record and evaluate the positive effects of the automated cardiopulmonary resuscitation devices. G) Data Sources: (1) https://Oournals.sagepub.com/doi/pdf/10.1177/1687814017748749 (2) Miami Department of Fire Rescue; (3) U.S. Census; (4) http://www.npr.org/ 2014/11/29/367268973/foreign-dollars-fuel-a-new-condo- boom-in-miami; (5) https://iournals.sagepub.com/doi/pdf/l0.1177/1687814017748749. H) Statement of Non -Duplication: With this funding, MFR will obtain 25 automated cardiopulmonary resuscitation devices to improve the response of members. In FY2019 the City of Miami received funding for 10 ACPR devices from the Florida EMS matching grant program. This grant request is for 25 additional devices, which were not funded, and does not duplicate any other grant funded initiative. Next, only complete one of the following: Items 11, 12, 13 or 14. Read all four and then select and complete the one that pertains the most to the preceding Justification Summary. Note that on all, that credible 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? DH FORM 1767 [2013] ITEM 11. Outcome for Projects That Provide or Effect Direct Services to Emergency Victims: (2 PAGES) A) Quantify Situation in Last 12 Months: From January 1, 2021 through December 31, 2021, MFR responded to over 100,000 incidents. There were 577 cardiac arrests and automated CPR devices were used 99% of the time and sometimes malfunctioned and a spare was required. During critical moments of care, this required a transition from ACPR device assisted compressions to human assisted compressions back to the ACPR device. Miami also has a high level of obese individuals who are at increased risk of cardiac arrest. Automated CPR devices are an integral component of treatment. In 2021, three ACPR devices malfunctioned during care of cardiac arrest patients and in all five, return of spontaneous circulation was not obtained, resulting in negative outcomes including death. The failure of the devices interrupted the continuity of treatment, resulted in less effective CPR and placed victims in danger. Further, the age of the ACPR's results in increased cost of repairs, specifically $99,571 from January 2019 to Jan 25, 2022. B) Data Change with Project Implementation: Equipping MFR members with new automated CPR devices will result in fully functioning devices that can be counted on to operate properly 100% of the time resulting in an increase in successful CPR. During critical moments of care, the devices will not breakdown and force an interruption in life saving CPR, due to responders transitioning from ACPR device assisted compressions to human assisted compressions back to the ACPR device. MFR will be able to perform CPR effectively and efficiently on the over 100,000 calls members respond to annually. The expected goal is to achieve return of spontaneous circulation on 99% of patients. Victims' lives will not be endangered, and the possibility of healthy outcomes will be increased. Also, the cost of repairs will be eliminated and savings from these expenses will result in more funding available for EMS equipment and training to save lives. Yearly, MFR's calls and population served increase significantly. This project is critical to MFR's efforts in serving our community and in decreasing mortality in Miami. Residents and visitors will be better protected; there will be an extensive increase in quality of care and increased survivability. There will be more expeditious lifesaving treatment as delays in CPR will be eliminated through more efficient and accurate performance with the new automated CPR devices. C) Justification and Explanation of Above Data: Information given in questions (A) and (B) was obtained using data from the Miami Fire -Rescue Department data collection system. D) Additional Outcomes: MFR estimates that the funding of this project will result in more than a 97% reduction of malfunctions as it relates to the age of the equipment. There will be more expeditious administration of CPR and improved outcomes of patients. Responders will be able to better perform CPR under adverse circumstances such as moving ambulances in Miami's precarious traffic conditions. It will improve MFR's ability to provide mutual aid. MFR morale and confidence will improve as the devices will reduce issues members encounter while responding to over 100,000 calls. MFR will also be able to provide citizens and visitors with consistent state of the art treatment. E) Integration into Agency's Five Year Plan: MFR's five year plan includes a complete review of our current treatment protocols and equipment needs and the impact of AHA guidelines. The ACPR devices address equipment needs included in the five-year plan. Members will be trained on this more sophisticated, technologically advanced equipment. This project integrates seamlessly into MFR's goals: to decrease the mortality rate and upgrade service delivery to the community. 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. ALL HF'F'LIUAIV I J IVIUJ I UU1W'Lt I t I I tIVI "1 0. 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. 3) Coordination of all EMS communication links, with police, fire, emergency vehicles, and other related services. DH FORM 1767 [2013] 15. Statutory Considerations and Criteria (1 PAGE): A) Serving the Requirements of the Population of Miami: The purchase of automated CPR devices will serve the needs of the over 1 million people who live and visit Miami daily by enabling MFR to provide effective and uninterrupted CPR. Also, it will aid in administering the life-saving acute medical care necessary when treating critically injured people. Miami has a critical need for these ACPR devices due to its voluminous number of EMS calls requiring CPR and the large number of obese residents living here who are at increased risk of cardiac arrest. This equipment will also reduce transport times by equipping MFR with the ability to provide accurate, effective, and expeditious CPR to all patients. B) Enabling of Emergency Vehicles to Conform to Standards: This funding will assist MFR in meeting Goal 1.0, Strategy 1.3 of the Emergency Medical Services State Plan 2016 — 2021 to, "reduce EMS medical errors" and Goal 2.0, Strategy 2.2 to, "improve patient care quality and outcomes". The automated CPR devices will improve successful CPR, thereby reducing the possibility of adverse impacts to patients and transport times. C) Enable vehicles to contain minimum equipment and supplies: The new ACPR devices comply with the requirements of the Florida Administrative Code 64J-1 and well exceed our current system regarding patient safety. In addition, MFR requires that its vehicles contain these devices as a part of its minimum equipment requirement. D) Enable vehicles communications: N/A E) Enable your organization to improve or expand the provision of services: The acquisition of these automated CPR devices will exponentially improve MFR's ability to serve residents in the City of Miami and throughout the county. The improved capacity to accurately, safely, and expeditiously care for patients will allow MFR to better protect its residents and visitors. 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 Grant Acceptance (Commission approval)) 1 2 Procure equipment 3 5 Training 6 9 Equipment implementation 10 12 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. Not Applicable DH FORM 1767 [2013] 18. Budget: Salaries and Benefits: For each position title, provide the amount of salary per hour, FICA per hour, fringe benefits, and the total number of hours. Costs Justification: Provide a brief justification why each of the positions and the numbers of hours are necessary for this project. TOTAL: $ 0.00 Right click on 0.00 then left click on "Update Field" to calculate Total 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). Costs: List the price and source(s) of the price identified. Justification: Justify why each of the expense items and quantities are necessary to this project. TOTAL: $ 0.00 Right click on 0.00 then left click on "Update Field" to calculate Total DH FORM 1767 [2013] Vehicles, equipment, and other operating capital outlay means equipment, fixtures, and other tangible personal property of a non- consumable and non -expendable nature, and the normal expected life of which is 1 year or more. Costs: List the price of the item and the source(s) used to identify the price. Justification: State why each of the items and quantities listed is a necessary component of this project. 25 — Automated CPR Devices $351,550 The equipment is sold at $14,062 each and are all needed to facilitate this ant's goals. TOTAL: $351,550.00 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 "Update ® Matching: 75 Percent $263,662.50 Field" to calculate Total Right click on 0.00 then left click on "Update ❑ Rural: 90 Percent $0.00 Field" to calculate Total Local Match Amount (Check applicable program) Right click on 0.00 then left click on "Update ® Matching: 25 Percent 87887.50 Field" to calculate Total Right click on 0.00 then left click on "Update ❑ Rural: 10 Percent 0.00 Field" to calculate Total Grand Total & O A «„ ,,,, Right click on 0.00 then left click on "Update DH FORM 1767 [2013] 7 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 any attached grant terms and conditions and acknowledge this by signing below. 1 / 31 /22 Signature of Authorized Grant Signer MM / DD / YY (Individual Identified in Item 2) DH FORM 1767 [2013] THE TOP PART OF THE FOLLOWING PAGE MUST ALSO BE COMPLETED AND SIGNED. 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: A finance person in your organization who does business with the state should provide the address and corresponding 9 and 3 digit numbers of this part of the form, but it should be signed by the person identified in Item 2, 1st application page. Name of Agency: City of Miami Department of Fire - Rescue Address in State: 1151 NW 7 St. 3rd Floor Financial System Miami, FL 33136 Federal 9-digit Identification number: VF596000375 3-digit seq. code Authorized Official:� " 1/31/22 Signature Date Lillian Blondet, Director of Grants Administration 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: _Approved By: Approved By: Signature of State EMS Unit Supervisor Grant ID: Code: Date Signature of Contract Manager Date State Fiscal Year: 2021 - 2022 Organization Code E.O. OCA Object Code CategorX 64-61-70-30-000 03 SF003 751000 059999 Federal Tax ID: VF Grant Beginning Date: Seq. Code: Grant Ending Date: DH 1767P, December 2008 (rev. June 8, 2018), incorporated by reference in F.A.C. 64J-1.015 9