HomeMy WebLinkAboutGrant Award & ApplicationMission:
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
June 13, 2014
Ms. Lillian Blondet, Director •
Grants Administration
City of Miami Department of Fire -Rescue
444 Southwest 2nd Avenue, Fifth Floor
Miami, Florida 33130
Dear Ms. Blondet:
Rick Scott
Governor
John H. Armstrong, MD, FACE
State Surgeon General & Secretary
I am pleased to award City of Miami Department of Fire -Rescue an emergency medical services (EMS)
matching grant in the amount of $125,937.00. The grant ID code is M3007. In accordance with section
401.113(b), Florida Statutes, the grant budget is 75 percent state funds and 25 percent matching funds.
Your required local cash match for this grant is $41,979.00. The purpose of this grant is to improve and
expand EMS by assisting your organization in the purchase of 12 power hydraulic stretchers.
This grant program is number 64.003 in the Florida Catalog of State Financial Assistance. The state
money is paid from the Department of Health's EMS Trust Fund and there are no federal funds
involved.
Your signed grant application affirms you have read, understand, and will comply with the terms and
conditions in the "Florida EMS Matching Grant Program Application Packet, June 2008."
The grant begins the date of this letter and ends June 30, 2015, Reports are due the third week of
November 2014, March 2015, and July 2015 (the final report). Please include with your final report a
refund check for any unspent state funds and interest earned, if any. Enclosed is a copy of the
expenditure report summary form and reporting requirements,
Thank you for your participation in this state EMS grant program. If you need assistance, please feel
free to contact Mr. Alan Van Lewen, Health Services and Facilities Consultant in the EMS Program, at
(850) 245-4440, extension 2734.
Sincerely,
William
Director
WHNavI
Enclosures
cc: Captain Adrian Plasencia
Florida Department of Health
Division of Emergency Preparedness and Community Support
4052 Bald Cypress Way, Bin A-22 . Tallahassee, FL 32399-1722
PHONE: 850/245-4440- • FAX 8501921.5162
Anderson, DHA, FACHE
www.Floridallealth.Bov
TWITTER:HealthyFLA
FACEBOOK:FLDepartmentotHeallh
Y0UTUSE: fldoh
Department of Health
EMS GRANT PROGRAM EXPENDITURE REPORT
Organization Name: Grant ID Code:
Time Period Covered: Beginning Date: Ending Date: -
Earned Interest: Amount $ as of: Day Month
Final Report (Check one): riYes ENo
Major Line Items
Approved Budget by Major Line Item(s)
TOTAL BUDGETED EXPENDITURES
Year
TOTAL
$ 0.00
Approved Expenditure to Date by Major Line Item(s)
TOTAL EXPENDITURES
$
$ •0.00
BALANCE (Budgeted Less Actual Expenditures)
$ 0.00
Include with the progress notes an explanation of how project personnel, equipment, and any problems or barriers
may impact on the grant progress.
I certify the above reports are true and correct, Expenditures were made only for items allowed by
the above referenced grant,
Signature of Authorized Grantee Official
Printed Name
Date
IDH 1684A, December 2008 64J-1.018, F,A.C.
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,
FINAL REPORTS
A final report shall be submitted to the department by its due date. 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 or other payment documentation relating to
the purchase of any equipment, services, expenses, 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.
If any refund is due to the state, the paper check will need to be sent to us with the report.
Also, please briefly summarize a description of the impact of the project.
22
EMS MATCHING GRANT APPLICATION
FLORIDA DEPARTMENT OF HEALTH
Bureau of Emergency Medical Services
Complete all items unless instructed differently within the application
Type of Grant Requested: r. Rural ! Matching
ID C. de (The State Bureau of EMS will ass lc n the 1D Code _ leave this blank)
1'. Or aalzsiion Dame: City df Hurt i'Deaartrrttt if 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: Lllllan Blond t
Position Title: Director of Grants Administration
Add re 444 S.W, 2' Avenue, 6Floor
City: Miami
County: Miami -Dade County
State: Florida
Zip Cade: 33130
Telephone: 305-416-1 36
Fax Number 305-416-2151
E-Mail Address: Ibiondet(sniaml+ ov,c am
3, Contact Person: (The individual with direct knowledge
of the project on a day-to-day basis and
This person may sign project reports and may
person may be the same.)
responsibility for the implementation of the grant activities.
request project changes. The signer and the contact
Name: Captain Adrian Pla enc a
Position Title; Fire Ca iain
Address: 1151 NW 7m Street
City: Miami
i Count .
la
Dade
State: Florida
Zip Code:
33136
Telephone: 305-416-5422
Fax Number:
305-400-5354
E.-Mail cdr ss:a lasencia rriierniccov.con�
DH FORM 767 t20't 3]
64.J-1,015, F.A.C.
1
aI Status of Applicant Organization (Check only one resp
(I) El Private Not for Profit (Attach documentation-5O
(2) 0 Private For Profit
(3) City/Municipality/Town/Village
County
State`
(6I ❑ ether (specify):,
Onset:
(4)
()
Federal Tax ID Number (NineDigit Number), 'VF 5.1XJ113J5:_
6 EMS License Number: 2276 Type; .0Transport' ❑Non. -transport ❑Both
7. Number of permitted vehicles by type; L 24 ALS Transport 3 ALS raon transport,
$• Type of Servfce (check ono): 1Rescue ❑Fire ❑Third Service (County or City Govern ent
nonfire) DAir ambulance ❑Fixed wing ❑Rotawing OBoth ❑Other (specify)
J.. Medical;li rector of licensed EMS provider; If this project is approved, t agree by signing beisW that i
.will affirm my authority and responsibility for the use of all medicaai equipment andlor the provision of all
continuing EMS education in this project, (No ure is needed medical equipment and
professional EMS ducetion are ,not In this project]
Signature Date;
Print/Type: Narrte Dr. Kathleen hrank, M.D, FA C PLFACP
FL Me 39896
of Director
d, Lic. No.
Note: All organizations that are not licensed EMS providers must obtain the signature of the medical
director cf the licensed EMS provider responsible for EMS services in their area of operation for projec
that involve medical equipment and/or continuing EMS educadan.
ay
If your activity is
Number 14. Other
a research or evaluation project; ortiIt
ee, proceed to Item 10 and the follow." it n
1(7. Justification Sums ary: Provide on no more than three one
addr ssirtg this 'project, covering each topic listed below.
1 , 11, 1, 13, and sk
ed, double spaced pages a sums
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 (Presentyour 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 a
F) The proposed time frames (Provide a list of the time fran e(s) for completing this project);
G) Data Sources (Provide a complete description ofdata .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 progra
DI FORM 1767 [2013]
ITEM 10. Justification Summar Pages
A) Problem Description: Miami Rescue (MFR) is currently utilizing stretchers that do ;not meet the incre
needs of the community and have a plethora of issues. They are deteriorated, constantly in need of repair, obsolete,
in poor condition and lacking vital functions needed in'1
MR's ability to provide the highest level of
e to the
and safe transport of patients. These issues impede
itizens of Miami and cause delays in patient transport and
esult in an extensive amount of back and shoulder injuries to MFR's r
capabilities, such as mechanisms to facilitate
variety of key tasks, including
b
The stretchers lack enhanced
overnent, adequate stretcher height
justment and effective loading and unloading from the rescue patient cornpartmen
ambulance stretcher operations and
suit in significan
MFR responders are critical in the
patients
in Miami and several other
Adverse events occur during
njury to patients and rescue personnel.
pd assassment, triage,,on scene treatm
and transport of voluminous
-Dade County municipalities where it provide
aid. Many of the over 79,44 EMS calls Last year were to
mutual aid and automatic
heavy patients; home to nearly 2.5 million residents
Miami -.Dade has a 67% rate of obesity'. In 2009, Miami was the most obese city in the LI,S,2. 1n addition, Miami has
a disturbingly high mortality rate, which makes it critical to, transport patients expeditiously and without delays. On
ons, our current stretchers have caused transport delays when our rescue units had to call for an
additional unit to assist tiers
ving heavy patients. Furthermore, excessive malfunctions in stretchers regretfully
cause an undue loss of precious time.
8 Present Situation: MFR provides both fire and Elti
consisting of 24 fully staffed ALS rescue transport
units and over 23 rather ALS and BLS non -transport units, iur stretchers are outdated, deteriorated, malfunction
frequently and require extensive servicing. The stretchers do not facilitate field portability and are not strong enough
to handle large patient loads, They lack enhanced capabilities such as mechanisms to facilitate a variety of key
tasks including movement, adequate height adjustment and effective loading and unloading to our rescues1. The
stretchers limit and decrease the efficiency In MF 's care of residents and visitors,
In 2013 MFR: transported 38,674 patients to hospital emergency departments and responded to over 79,544
EMS calls. There were 22 injuries attributed to ineffective stretchers. These injuries equated to 9% of MFR total
injuries and $245,923 in workers' compensation claims, which equates to an over 80% innrease in Maims in only 2
years. In 2013, stretcher malfunctions resulted in $240,000 in injuries to paUents. They are difficult to maintain and
require costly repairs which divert funding away from other critical EMS supplies and equipment. MF_R stretchers are
over 9 years old and a 35% increase in stretcher maintenance costs occurred from 2012 to 2013, Litigation costs
due to people falling from the stretchers also severely burden MFR. Further, levers malfunction at times, rendering
stretchers dysfunctional and requiring several lifts and non -ergonomic movements to lift patients into rescue
vehicles, thus resulting in unnecessary injuries to MFR personnel, MFR stretchers lack sturdiness and the ability to
transport obese patients forcing MFR to constantly call and wait upon other units to arrive and assist with transport.
This results in critical delays in hospital anival and treatment and increases the chance of permanent injury and
death.3
C) Proposed Solution It is imperative that MFR provides effective treatment and improve its ability to care
for the more than 1 million people transiting through Miami daily. We are requesting financial assistance to purchase
24 battery powered hydraulic stretchers to ensure EMS units do not lose their ability to safely transport patients and
are not at risk of endangering patient lives and safety by having to wait on assistance in patient transport Without
all 24 stretchers, many of the emergency victims treated during MFR's 79,544 EMS calls will not have the rapid
lifesaving transport they require These stretchers will include a hydraulic liftsystem with manual backup, oversized
expandable surface to support a variety of patient sizes, steering locks, and several other features to ensure
effective service to all of our residents, visitors and members. These stretchers will allow for increased chances of
survival for patients by providing enhanced transporting capabilities and afford MFR members the ability to safely
transport patients without the risk of injury,
D) Consequences if Not Funded: Without this grant, MFR will not be able to fund this project, patient lives may
be endangered and patients and members will be at risk of Mjury. Workerscompensation claims for stretcher
related injuries and legal costs from patient injuries will continue to rise and further deplete an already strained
budget. MFR stretchers are continuously out of service for repairs, are deteriorated, obsolete, in poor condition and
lack vital functions, If this continues, MFR's ability to provide the highest level of care to Miami citizens and visitors
will be impeded and there will be delays in patient transport as well as extensive injuries tc members. The stretchers
do not facilitate field portability and are not strong enough to handle large patient loads, They lack enhanced
capabilities such as mechanisms to facilitate a variety of key tasks. These new stretchers ;are the difference
between life and death. Unfortunately, MFR does not hay 'th funds to purchase them without state; assos rice........n
E) The geographic area to be addressed: The City of Miami is comprised of 34 sq. miles with about408,750
residents.. Daily, the population swells to over 1 million durii
of ill -health due to poverty: Miami has a 27.7% poverty rate and is one
vulnerabilitiesare:1) High rate
FIVE MOST 'IMPOVERISHED
CITIES, IN THE U,S. ; 2) High rate of elders: The City has the nation's 7th largest elderlypopulation (over age 65)
comprising 16% of the total population; 3) High rate of obesity: Miami -Dade County has a 67% rate of obesity. 4)
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 commissioners for approval, r
supply and purchase of equipment. MFR'anticipates units will
Month 6 to 7: training of 600 plus firefighters/ pararnedi=
ive in four to fiv
eks from the date ordered;
nd; Month 8 Implen entatian of units into service and
record and evaluate the positive erects of the newly acquired stretchers,
G) Data Sources: Ambulance Stretcher Adverse Events, http://www.heaithca�
ldownloadslan-Arnbulance%2i
ys
hers.pdfl; Most Obese Cities in the U.S., http:
rig
ering.com
fw w.lowdensity
.00nrltire-most-obese-cities-in-the-u-s12; Miami Department o Fire Rescue3; Comeau
to fork, www.cdc;org4.
H)
er
nt of Non•Duplica
$ Putting Frey
n; This funding will :enable MFR to obtain reliable stretchers with necessary
advanced capabilities and establish new response capacity in MFR facilities. The City of Miami has not received
funding for stretchers from the Florida EMS matching grant program before and does not duplicate the work of any
other grant funded initiative.
Next, only complete arse of the following: Items 11, 12, or t3. Read al[ #hree and then select and
complete the one that pertains them st t the preceding Justification Summary. Note that on
three, that before -after differences f remergencyvictim 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 Provjcie 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 an -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.,
) 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.
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 pia
ITEM 11. Outccnfe For Protects That Provide or Effect. Direct Services To Emergency Victims: (2 PAGES)
A) Quantify Situation in Last 12 Months: From January 1, 2013 through December31, 2013, MFR responded to ..
ponses, during which stretchers were employed in the
92,675 incidents, Of those, 79,544 calls were E
ent and treatment of 38,674 patients, During the last 2 years, we had an 80% increase in costs associated
with lifting and patient movement injuries, which could have been prevented with battery powered hydraulic
stretchers, In the,last 12 months, this equated to . 245,923 in workers compensation
ms and a total of 810 days
that injured personnel were unable to work in emergency response positions. Currently, MFR has a large, pending
lawsuit due to a patient falling off the stretcher and sustaining debilitating injuries. Miami also has a high level of
obesity as well as a high percentage of poverty and elderly. This exponentially increases our population's risk of
heart attacks, cardiac and other events and intensi
rapid transport of patients,
s our need for stretchers' which
w the safe and
MFR has had several issues with its current stretchers, They are constantly removed from s
undergo repairs and have become unreiiable and are obsolete, in poor condition and lack vitaI functions needed in
the care of patients, These issues impede MFR's ability to provide the highest level of care to citizens and cause
delays in patient transport and injuries, The stretchers do not facilitate field portability and are not strong enough to
handle large patient loads, increasing the need for functional and reliable stretchers that. MFR uses daily.
The City of Miami has a significant number of high risk patients and plethora of EiS responses and array of
calls necessitating effective stretchers, These critical issues make it imperative that MFR acquires functional and
reliable stretchers to effectively serve and decrease the risk of mortality of our residents, visitors and firefighters.
Data of Change with Project implementation: Equipping all City of Merril Fire -Rescue Department ALS
vehicles with battery powered hydraulic stretchers wiCC ensure that MFRcan safely effectively and efficiently perform
saving transport and assessments, We expect`ta decrease stretcher and patient sifting related injuries by over
this has been exhibited in studies where agencies acquired these stretchers. This would resuit in an over
90% ($221,330) decrease in costs associated with these injuries, a 90% (710 days) decrease in stafng shortages'
due to sifting and patient moving injuries, an over`8% decrease in MFR total injuries, an almost 100% decrease in
litigation costs associated with patient injuries due to stretcher malfunctions, decreased transport times overall, a 4
minute average decrease in transports that would have required additional assistance (sicgnificantly improving patient
survival),_a 100% decrease in
cher. maintenance costs and assure MFR is afforded the ability to transport.....
patients of all sizes easily and effectively with the personnel already on scene. Statistics exhibit an over 90%
under warranty will eliminate maintenance costs. In
addition, current litigation costs were due to stretcher malfunetioris that would have been avoided with the new
improvement in injuries and having all new functional stretche
stretchers. MFR has exhibited a significant increase in calls and population served each year. This project is critical°
to MFR's efforts in effectively serving our residents and visitors and in decreasing morbidity and mortality in Miami
for years to come. Residents, visitors and members will be better protected and receive an extensive increase in
quality of care and better service and the health of firefighters will be better protected.
Justification and Explanation of Above Data: information given in question (A) and (B) was obtained using
data from the Miami Fire -Rescue Department data collection system and the article, "The impact of Gurney Design
on EMS Personnel";
D) Additional Outcomes: The finding; of this project will result in the improved transportation and wellbeing of
obese :patients by providing stretchers with
need abilities to support and transport them in a timely and efficient
lleviate the burden of increasing call volumes and serious logistical issues posed by the growing
t,obese people in the nation's most obese city, If will improve MFR's abjtity'to provide mutual aid to other
EMS providers, MFR morale and confidence will also be `unproved as the new stretchers Will reduce chronic back
problems when our members respond to over 79,000 EMS calls, MFR will also be .able to provide citizens and
visitors with
nsistent state of the art treatment. The new stretchers are extremely durable, safer and have been
battle tested by several other agencies in South Florida.
E) integration into Agency's Five Year plan: Miami Fire -Rescue's five year plan includes a complete review of
air current treatment protocols and equipment needs and the Impact of AHA guidelines, This project integrates
y into the achievement of MFR's goals. In addition, our plan includes improving the wellness and health of
our members, These stretchers will effectuate this by lessening the likelihood and frequency of injury, This is critical
when statistics show that one in four EMS providers suffer a career -ending injury' in their first four years on the job
(http.11)mww,ems 1 comfe s-produetsipatient-handlinglarticiesl1371-825-A-virtual-plague-could-be-coming-to-EMS/).
Skip Item 14 and go to item 1'S, unless your'projec
completed theprecedingJustification Summary and one ou
ALL APPLICANTS MUST COMPLETE ITEM 15,
15. Statutory Considerations and Criteria: The following are Lased on s. 401.113(2)(b) and 401.117, F.
Use no more than one additional double spaced page to complete this i
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 imp
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 feast 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 corrtrnunications linkup with
the operating base and hospital designated as the primaryreceiving 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.
m, Write NJA for those things in
1 . Statutory Considerations and Criterion PAGE):
A) Se
the Requirements of the Population of Miami; The purchase_ of stretchersMould .serve t[ e,:needs.of'
the over 1,000,000 people who live and visit lliarni daily by providing effective, safe transport to hospitals. A[so, it
will provide the effective transportation and life-saving acute rrredical care necessary when treating critically injured
people(http://www.ncbi.nirri.nih.govipularried/22792181). lviiami has a critical need for these stretchers due to its
voluminous number of transports and the large number of obese residents that live in Miami. These stretchers will
also reduce transport tunes through effective loading and unloading of patients of all sizes.
B) Enabling of Emergency Vehicles to Conform to Standards: This funding will assist MFR in meeting Goal 9 of
the Florida EMS Strategic Plan 2010-2912 to, "increase access to care by improving patient safety, responder
nd the
safety of the general public'. The battery powered hydraulic
patient and personnel injuries by over 90% therefore,
costs and transport tunes.
C) Enable vehicles to contain minimum equipment and supplies; The new stretchers comply with the
requirements of the Florida Administrative Code 64J and well exceed our current system regarding patient safety.
In addition; MFR requires that its vehicles contain stretchers as a part of its minimum equipment requirement,
nsively reducing worke
will reduce the number of'.
compensation costs, litigation.
t) Enable vehicles communications: N/A
E) Enable your
anization to improve or expand the' provision of services The acquisition of the stet+
will exponentially,[rrtprove IFR's ability
rve
pulations in the Laity of Miami and throughout the county. The
improved capacity to safely and expeditiously transport the numerous patients MFR transports each year, as well as
the many obese patients MFR transports will allow MFR to better protect its re,
also facilitate increased longevity in the careers of MFR members and assu
available to assist residents and vi
The reduction in injuries
re that healthy personnel are always
16. or c ractiviiies and tlrr e frames; Indicate the major activities for completing the prcject (use:gnly the
space provided): Be reasonable, most projects cannot be completed in less then 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 Star
Grant Acceptance (commission approval}
Begin; End
MMJDD/YYY`>") (MMJDDIYYYY)
l2
Bid issuance and vendor selection
Purchase urtlt
Training;
7
7
Unit Deploys
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,
/A
DI-1 FORM 1767 [2
12
1 Bud et:
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 positic ns and the numbers
of hours are necessary for this project.
ff
T '1TA1 ;
0.0t3
Right' dick on 0.00 then left dick on
"Update Field" to calculate Total
Expenses: These are Craver costs
and the usual, ordinary, and
incidental expenditures by an
agency, such as, commodities and
supplies of a consumable nature,
excluding expenditures classified
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.
as operating capital outlay (see
next category)
Q
TOTAL:
$ 0.00
Right click on 0.00 then left click on
"Update Field" to calculate Total
Vehicles, equipment, and oth
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 ear or more.
24 - Stretch
osts: List the pric
f the item and the
sources) used to
identify the price.
ustification: State why earth of the items
and quantities listed is a necessary
corpone.t of this project. ,._
The units are.sold at,$13,993 each and are
all necessary to facilitate the goals of this
grant and reduce mortality in the City of Miami.
TOTAJ
2.00
Right oliok on :0.00 then left click on
"Update Field" to calculate Total
State Amount
{heck applicable prograrrroj
El Matching: 75 Percent'.
LYl' Aural: 90 Percent
L l Match Amount
heck applicable program)
. Matching: 25 Percent
Rural: 10 Percent
Grand Total
251„74
0
00
0.00,
5,032.00
Right oil on 0.00 then left click on
'Update Field° to calculate Total
Right click on 0.00 then left c1€ck on
"Update Field'' to calculate Totaf
Right click an:'0.00 then left click on
"Update Field" to calculate Total
Right click on 0,00 then left click on
'Update Field' to calculate Total
Right click on 0.00 then left click on
DH FORM 1767 (2013]
14
19. Certification;
lviy signal
below c
les the fofowing,
l a 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. 1 understand that any information 1 give may be investigated as allovved by law. 1
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.
1 agree'that any and all information submitted in this application wilI 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 E.S.
I accept that in. the best inter•sts of the S
rejector revise any and all grant propose
proposals received, and can exercise that ri
1, the undersigned, understand and accept that tie Notice of Matching Grant Awards wilt b
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.
Florida Bureau of E'1 reserves the right to
ive any minor irregularity or technicality in
fy ghat the cash irratch 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.
udget for the activities identif"red. In addit►on, the budget shall not exceed, the department,
approved funds for those activities identified in the notification letter. No funds count towards
tisfying this grant if the funds were also used to satisfy a matching requirement of another
to 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.
cceptano of Terms,and Conditions: If awarded a grant, 1 comity that 1 wvill'comply with all of the
above and also accept the attachedgrant terms and conditions and acknowledge this by signing
below:
Signature of Authorized Grant Signer
Individual Identified in Item
H FOR
767 f204
THE TOP PART OF THE FO LOWtNG PAGE € UST ALSO BE Co" PLBTED AN 'L StGNEP.
15
FLORIDA DPAS TMENT OF HEALrn
EMS GRANT PROGRAM
REQUEST FOR GRANT FUND DISTRIBUTION
n accordance with the provisions of Section 401.113(2)(b), F. S„ the undersigned hereby
requests an EMS grant fund distribution for the improvement and expansion or continuation of
pre -hospital EMS,
DOH Remit Payment lice»
Name of AgencyCity of Miami Department of Fire Resue
ing Addr;
Federal identification Nu
Authorized Agency Official:.
Lillian Biaridet, Director of
Type Name and Title
ants Adrninis
tion
Sign and return this page with your application to:
Florida Department of Health
BEMS Grant Program
4052 Bald Cypress Way, Bin CIS
Tallahassee, Florida 3 99-1736
Do not write below this lin
Grant Amount F
For use by Bureau of Emergency Medical Sonic personnel only
State To Pay:
Approved By;
Signature of to
State Fiscal Year:
Organization Code; E.
04-4.-10-00-000 0
Federal Tax ID: VF
nt Beginning Date:
Grant ID Code:
EMS Grant Officer Date
OCA
SF003
Object C
750000
d
Grant Ending Date:
OH FORM 1767p"f.PM`13i