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Home My WebLink AboutRequest for Grant FundFLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM 10-12-11Pp1 RCV 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: MIAMI-DADE COUNTY BOARD OF COUNTY COMMISSIONERS Mailing Address: 111 NW 1 STREET, FLOOR 26 (FINANCE DEPT) MIAMI, FLORIDA 33128 Federal Identification number / #59-6000 73 Authorized Official: Signature Date Genaro "Chip" Iglesias, Chief of Staff/Deputy Mayor 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: $ 125, 667. o 0 Approved By : A Ca, Signature of EMS Grant Officer State Fiscal Year: Z D I D - 2 61 1 Organization Code E.O. 64-42-10-00-000 05 OCA S -005 Federal Tax ID: VF 39 6o oa 573 02_ Grant Beginning. Date: ---DH-1684, December 2008 - Grant ID: Code: coal 3 Object Code 750000 Off, IS Zo II • If "11 Grant Ending•Date 13 64J-1.015, F.AC. Date 0 1 STATE OF FLORID PARTMENT OF FINANCIAL SERVI. REMITTANCE ADVICE THIS IS NOT A PAYMENT DEVIC FLAIR ACCOUNT CODE 64-202192002-64200800-00-05999800 OLO 640000 SITE 80 DOCUMENT NUMBER D2000221295 OBJECT 7500 DATE 11/02/11 PAYMENT N 0231308 MIAMI-DADE COUNTY BOARD OF COUNTY COMMISSIONERS 111 NW FIRST STREET FINANCE DEPARTMENT, SUITE 2620 MIAMI FL 33128 PAYMENT AMOUNT $ 125,667.00 DO NOT CASH AGENCY DOCUMENT NO V006965 ALL VENDORS MUST SUBMIT A NEW ELECTRONIC FORM W-9 PRIOR TO 3/5/2012 TO CONTINUE RECEIVING PAYMENTS FROM THE STATE. GO TO HTTPS://FLVENDOR.MYFLORIDACFO.COM TO SUBMIT A NEW FORM W-9. PLEASE DIRECT QUESTIONS TO: (850) 245-4502, HQ, ACCOUNTING - LYNN ROBINSON VENDORS NOW CAN VIEW PAYMENT INFORMATION AT HTTP://FLAIR.DBF.STATE.FL.US INVOICE NUMBER AMOUNT C0013 $ 125,667.00 UATS C an-L NOV ] 4 2011 THE PAYMENT HAS BEEN TRANSMITTED ELECTRONICALLY (EFT) TO'YOUR FINANCIAL INSTITUTION ACCORDING TO YOUR INSTRUCTIONS. MIAMI-DADE COUNTY BOARD OF COUNTY COMMISSIONERS 111 NW FIRST STREET FINANCE DEPARTMENT, SUITE 2620 MIAMI FL 33128 FY2010-11 EMS COUNTY GRANT# C0013 NEW GRANT REVENUE EXPECTED FROM THE STATE PER 07-21-2011 AWARD LETTER FOR THE SECOND/FINAL OF TWO PAYMENTS APPROVED DISTRIBUTED PER TOTAL EMS CALLS FOR CALENDAR YEAR 2009 GRANTEE/SUB-GRANTEES: 1 2 3 4 5 6 TOTAL EMS CALLS FOR CALENDAR YEAR 2009 (UNITS) MIAMI-DADE COUNTY FIRE RESCUE DEPT. (CALLS per John E. Gardner, EMS Div Chief, 11-08-2010) CITY OF MIAMI FIRE RESCUE DEPT. 17 (CALLS per Bruce A. Oestreich, EMS Chief, on 11-18-2010) CITY OF MIAMI BEACH FIRE RESCUE DEPT. 2010) 7 1 CITY OF HIALEAH FIRE RESCUE DEPT. (CALLS per Mike Anchia, Assistant Fire Chief, on 11-05-2010) CITY OF CORAL GABLES FIRE RESCUE DEPT. (CALLSper Marc Stolzenberg, Deputy Fire Chief, on 11-10-201_0) VILLAGE OF KEY BISCAYNE FIRE RESCUE DEPT. (CALLS per Jose Marti, EMS Captain, on 11-15-2010) TOTALS NOTES':" A) EMS CALLS DEFINITION APPROVED BY EACH FIRE -RESCUE CHIEF: ALL SITUATIONS FOUND TO BE EMS RELATED BY THE RESPONDING UNIT AND AN EMS PATIENT REPORT HAS BEEN GENERATED. B) CALENDAR YEAR (C.Y.) DEFINITION APPROVED BY EACH FIRE -RESCUE CHIEF: FROM JANUARY 1 TO DECEMBER 31 2 TOTAL EMS CALLS FOR CALENDAR YEAR 2009 NEW REVENUE EXPECTED VIA FINAL PAYMENT FOR FY 2010-11 Revised: 09-01-2011 A. REYES NEW NEW REVENUE REVENUE DISTRIBUTION NET DISTRIBUTION PER FINAL PAYMENT ROUNDING PER FINAL PAYMENT FOR FY 2010-11 ADJUSTMENT FOR FY 2010-11 ' r"! ) (ROUNDED) 3,186 59.41% $125,667 $74,655.87 $0.13 74,696 ),772 23.86% $125,667 $29,988.45 ($0.45) 29,988 i,483 5.22% $125,667 $6,560.66 $0.34 6,561 1,382 9.91% $125,667 $12,450.13 ($0.13) 12,450 1,858 1.30% $125,667 $1,634.76 $0.24 1,635 890 0.30°/ $125,667 $377.12 ($0.12) 377 ,571 100.00% $125,667 $125,667.00 $0.00 125,667 296 C) TOTAL NEW REVENUE PER FINAL OF TWO PAYMENTS EXPECTED FOR FY 2010-11 IS $125,667.00, AS PER AWARD LETTER FROM FLORIDA DEPT OF HEALTH -EMS DATED 07-21-2011 AND RECEIVED BY THE COUNTY EMS GRANT BUREAU ON 07-25-2011. SOURCE:; "FY 20.10-11 EMS CNTY GRT C0013-FINAL PMT-NEW REV-CNTY-CITIES" FILE. MIAMI-DADE COUNTY WORK PLAN FOR APPROVED STATE EMS COUNTY GRANT #C0013 PER TOTAL SECOND/FINAL NEW REVENUE OF $125,667 EXPECTED FROM DEPARTMENT OF HEALTH, BUREAU OF EMS Revised: 09-27-2011 Total new revenue funding of $125,667.00 approved for Dade County under the state EMS County Grant C0013 (expiring on 04-13-2012) per second/final of two payments expected from the Florida Department of Health, Bureau of Emergency Medical Services, per award letter dated 07-21-2011, will be apportioned and passed through to the six participating municipal fire departments in support of the projects herein proposed. The total new revenue will be distributed as follows: Miami -Dade County Fire Rescue Department $74,656 City of Miami Fire Rescue Department $29,988 City of Miami Beach Fire Rescue Department $6,561 City of Hialeah Fire Rescue Department $12,450 City of Coral Gables Fire Rescue Department $1,635 Village of Key Biscayne Fire Rescue Department $377 Total Budget per second/final payment for EMS Grant C0013 $125,667 SOURCE:::''FY 2010-11 EMS CNTY GRT C0013-2ND-FINAL PMT-WORK PLAN-09-27-11.doc" File. Page 1 of 15 MIAMI-DADE COUNTY WORK PLAN FOR APPROVED STATE EMS COUNTY GRANT #C0013 PER TOTAL SECOND/FINAL NEW REVENUE OF $125,667 EXPECTED FROM DEPARTMENT OF HEALTH, BUREAU OF EMS Revised: 09-27-2011 CITY OF MIAMI FIRE RESCUE DEPARTMENT OBJECTIVES Project # MF.03.01 EMS EQUIPMENT, MATERIALS, SUPPLIES & SERVICES AND COMPUTER HARDWARE, SOFTWARE & SUPPLIES FOR EMS Total allocation from New Revenue per second/final payment $29,988. Provide new EMS equipment, materials, supplies and services and computer hardware, software & supplies, which will enhance the service capabilities of the EMS System and improve the level of service provided to the residents of the City of Miami. Some of the equipment to be purchased for FY 2002-03, FY 2003-04, FY 2004-05, & FY 2005-06 included the following: • A computer system (hardware and software) to maintain tracking and control of EMS supplies (expiration dates, controlled substances, etc.) • Thumpers for all ALS emergency response vehicles. • Life Pak 500 units for BLS response units. • Multi -range gas detectors for emergency response personnel. • A laptop computer needed to provide the State's mandated "Fit Testing" for EMS particulate face masks. The new laptop will maintain records, run the required software, and provide the actual testing at different designated locations. SOURCE: ."FY 2010.11 EMS CNTY GRT C0013-2ND-FINAL PMT-WORK PLAN-09-27-11.doc" File. Page 7 of 15 EU IAMI-DADE COUNTY WORK PLAN FOR APPROVED STATE Ems COUNTY GRANT #C0013 PER TOTAL SECOND/FINAL NEW REVENUE OF $125,667 EXPECTED FROM'DEPAR-MEWT OF HEALTH, BUREAU OF EMS Revised: 09-27-2011 CITY OF MIAMI FIRE RESCUE DEPARTMENT OBJECTIVES Project # MF.03.01-Continued: EMS EQUIPMENT, MATERIALS, SUPPLIES & SERVICES AND COMPUTER HARDWARE, SOFTWARE & SUPPLIES FOR EMS • New items will be purchased for FY 2006.07: ° New items will be purchased for FY 2007- 08. Some of the items to be purchased for FY 2007-08 include the following: • Ferno stretchers. • EKG and video transmission system. • Life Net receiving stations. • Airway training kits • Smart Strip chemical ID badges. Actions and Time Frames: Identify, purchase, and place into service the new. equipment, materials, supplies and services needed and the computer hardware, software & supplies needed for EMS within the grant period, upon formal approval and actual receipt of grant funds and formal approval of Change Request #1-B.1 and 3-B.1 during FY 2004-05. New equipment, computer hardware, software, materials, supplies and services will be purchased during FY 2008-09, FY 2009-10, and FY 2010-11. SOURCE: "FY 2010-11 EMS CNTY GRT C0013-2ND-FINAL PMT-WORK PLAN-09-27-11.doc" File. Page 8 of 15