HomeMy WebLinkAboutGrant ApplicationEMS 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
1. County Name: MIAMI-DADE COUNTY
Business Address: 111 NW 1 Street, Floor 29
Miami, FL 33128•
Telephone: (305) 375-5311
Federal Tax ID Number (Nine Digit Number). VF #59-6000573
2. Certificai, m. (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 correct My signature acknowledges and assures that the County shall
comply fully with the conditions utlined in the Florida EMS County Grant Application. Date: 1�j
4/07
Signature:
Printed Name: George M. Burgess
Position Title:
County Manager
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: Scott Mendelsberf
Position Title:
Chief Financial Officer
Address: •
9300 NW 41 Street
• Miami, FL 33178
•
Telephone:
(786) 331-5121 j Fax Number:
(786)
331-5123
E-mail Address:
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)
SEE ATTACHMENT — I WORK PLAN FOR FY 2006-07 AND
•
•
ATTACHMENT— II EXPENDITURE PLAN FOR FY 2006-07 FOR DETAILS.
, Kev. June
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BUDGET PAGE
A. Salaries and Benefits:
•fpr each position ill , xovido:ihe arnotlrlt ait5014
hour!-ott?er flange ben ftsand the to#al'number�o ctj
`C per
SEE ATTACHMENT — I WORK PLAN FOR FY 2006-07 AND
Amount
ATTACHMENT --11 EXP. PLAN FOR FY 2006-07 FOR DETAILS.
TOTAL Salaries
TOTAL FICA
Grand total Salaries and FICA
8. Expenses; These are travel costs and the usual, ordinary, and incidental expenditures by an
• agency, suck -et -commodities and supplies of a consumable nature 'excluding expenditures classified as
operating capital outlay r see next category .
SEE ATTACHMENT — I WORK PLAN FOR FY 2006-07 AND
ATTACHMENT — II EXP. PLAN FOR FY 2006-07 FOR DETAILS.
-.
•
: Air.irtt •
TOTAL
C. Vehicles, equipment, and other operating capital"outlay. rneans equipment fixtures; and other
tangible personal property of a non consumable and'non expendable nature with a normat expected life
of one (1) year or more.
SEE ATTACHMENT -- I WORK PLAN FOR FY 2006-07 AND
ATTACHMENT — II EXP. PLAN FOR FY 2006-07 FOR D.ETAILS.
. TOTAL
OH Form 1684, Rev. June 2002
Grand Total
$1,061,617.86