HomeMy WebLinkAboutResolution_50-05/06_02/16/2006RESOLUTION NO. 50 - 05/06
A R
PAL1
THE
CER'
THE
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THE
iOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE OF TEQUESTA,
BEACH COUNTY, FLORIDA, ACCEPTING THE TERMS AND CONDITIONS OF
BALM BEACH COUNTY EMERGENCY MEDICAL SERVICES (EMS) GRANT AWARD;
CFYING THAT MONIES FROM THE EMS GRANT WILL BE USED TO PURCHASE
:QUIPMENT SPECIFIED IN THE GRANT AWARD, WILL IMPROVE AND EXPAND
)SPITAL SERVICES IN OUR COVERED AREA; WILL NOT BE USED TO
CANT EXISTING TEQUESTA FIRE-RESCUE BUDGET ALLOCATION AND MEETS
COALS AND OBJECTIVES OF THE EMS COUNTY GRANT PLAN.
NOW THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE
VIL GE OF TEQUESTA, PALM BEACH COUNTY, FLORIDA, AS FOLLOWS:
Sec ion 1. That the Village of Tequesta, Palm Beach County,
Flo ida, does hereby accept the terms and conditions of the Palm
Bea h County EMS Grant Award and concurs with the amount of the
awa d, activity and expenditure plan attached and marked as Exhibit
~. A..
Sec ion 2. The Village of Tequesta, Palm Beach County, Florida,
her by certifies that the monies from the EMS County Grant award
wil be used to purchase a Revivant Autopulse Automatic Chest
Co ression Device, will improve and expand prehospital services in
our covered area, will not be used to supplant existing Tequesta
Fir -Rescue budget allocation and meets the goals and objectives of
the EMS County Grant Plan.
THE FOREGOING RESOLUTION WAS OFFERED by Vice Mayor Watkins, who
mo d its adoption. The motion was seconded by Council Member
Ge o, and upon being put to a vote, the vote was as follows:
FOR ADOPTION
Jim Humpage
Pat Watkins
Geraldine Genco
AGAINST ADOPTION
Tom Paterno
The
thi
3yor thereupon declared the Resolution duly passed and adopted
16th day of February, 2006.
MAYOR OF TEQUESTA
Jim ~Iumpage `~
ATTEST:
^ein ~~~-
e Carlisle
1 age Clerk
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cn'~n/GORPGr~ATED:
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January 4, 2006
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JAN ~ 4 2005
Department of Public Safety
Division of Emergency Management
Dffice of Emergency Medical Services
20 South Military Trail
West Palm Beach, FL 33415
(561) 712-6400
FAX: (561) 712-6449
www.pbcgov.com
^
Palm Beach County
Board of County
Commissioners
Tony Masilotti, Chairman
Addie L. Greene, Vice Chairperson
Karen T. Marcus
Jeff Koons
Warren H. Newell
Mary McCarty
Burt Aaronson
County Administrator
Robert Weisman
"An Equal Opportunity
Affirmative Action Employer"
Lt. Peter Allen, Firefighter/Paramedic
Tequesta Fire-Rescue
357 Tequesta Drive
Tequesta, FL 33469
Dear Lt. Allen: RE: EMS Grant C5050
The EMS Grant Review Committee has recommended .your agency receive
$14,910.00 from the EMS Grant Award Program; please see attached which
covers the items and work schedule for your EMS Grant Award.
The EMS Grant package is being presented to the Board of County
Commissioners at their January 10, 2006 meeting. Once it is approved by the
Board, it will be forwarded to the State EMS Office for their execution.
In the meantime, please provide us with a letter of confirmation from your
agency's administrator concurring with the amount of the award, activity and
expenditure plans, and assurance that your agency-will comply with state and
county grant requirements, including reporting. If you have not submitted a
Resolution from your Governing Board, kindly proceed to obtain same prior
to making the purchase certifying that monies from the Grant Award will:
1) Improve and expand prehospital services in that coverage area;
2) Not be used to supplant existing provider's budget allocation;
3) Meets the goals and objectives of the EMS County Grant Plan.
Thank you for your cooperation.
Since~eiy
,~
obert Butt~fieI ,EMS Manager
Division of Emergency Management
Enc.
~-=G ~~ LIB/L >~ G//~i~~'~~
r~~~-'
printed on recycled paper
ATTACl~NT 2
TEQUESTA FIRE RESCUE
Work Plan:
Work Activities:
Time I~Yames:
To purchase an AutoPulse System which will generate consistent and optimal chest
compressions, offering the promise of normal blood flow during cardiac arrest.
Receive notification of grant award 1'` Quarter
Purchase Zoll Antol'alse 1" Quarter
Train department on Zell Antol'alse 2°a Quarter.
Place equipment on Primary Rescue Vehicle 2nd Quarter
Respond to Cardiac Arrest 3ra Quarter
Respond to Cardiac Arrest 4a' Quarter
Proposed Expenditure Plan:
Unit Total
Line Item Price Quantity Cost
AutoPalse System $10,995.00 1 $10,995.00
Autol'ulse Batteries 575.00 3 1,725.00
Autol'alse Battery Charger 1,795.00 1 1,795.00
Autol'~ilse Soft Carry Case 395.Od 1 395.00
TEQ~IE~T~
~~~Ea~E~c`~>.tE
JAN 1 0 20115 y I~~
A~IY111~~~7 ~RMT1~Ar
TOTAL $14,910.00 ~ V
EXHIBIT "A"
DEPARTMLNT OF PUBLIC SAFETY
DIVISION OF EMERGENCY MANAGEMENT
OFFICE OF EMERGENCY MEDICAL SERVICES
PALM BEACH COUNTY EMS GRANT AWARD APPLICATION
PRIMARY GRANT REQUEST
Note: The total for all your primary requests must not be more than
$50,000.00.
1. Organization: Tequesta Fire-Rescue
Authorized Official: Michael Couzzo Title: Village Manager
Alternate Official: James Weinand Title: Fire Chief
Mailing Address: 357 Tequesta Dr., Tequesta, FL 33469
Telephone: (561} 744 -4051 FAX: {561) 575-6239
2. Authorized Contact Person: Peter J. Allen
Title: Firefighter/Paramedic
Mailing Address: 357 Tequesta Dr., Teq uesta, FL 33469
Telephone: (561} 744--4051 _ FAX: (561) 575-6239
3. Agency's Legal Status: Municipal Fire De artment
4. First Responders: Please attach a copy of your Memorandum of
Understanding (MOU) with a licensed provider. If you do not have a
MOU, attach documentation that you made reasonable efforts to get
one, that you cooperate with the provider, or that you requested but
did not receive a response from the providers in your area. Tequesta
Fire Rescue is a County Permitted ALS Provider.
5. Your Federal Tax ID Number: VF 59-6044081
6. Identify the EMS county plan goals this project will accomplish in
whole or in part. A copy of the goals is attached to this application.
1) MEDICAL RESCUE EQUIPMENT, A) Improve cardiac patient care by
providing, for example but not limited to Automatic External
Defibrillators (AEDs) and initial training to EMS agencies and first
responders.
1
PRIMARY EMS GRANT AWARD APPLICATION
ORGANIZATION: Tequesta Fire-Rescue
7. Communications Projects: All grant applications which involve PRIMARY
EMS communications equipment and/or services, in total or in part,
will be reviewed by the State of Florida Division of Information
Technology. FINAL APPROVAL MUST BE OBTAINED PRIOR TO ANY PURCHASE
COI~ITMENT. Copy of approval from the State must be submitted to the
County EMS Office with request for reimbursement.
8. Background: Describe your agency, its operations, and how it relates
to other EMS agencies in your area. Also, provide a description of
your major resources including the number of employees, vehicles, and
equipment.
Tequesta Fire-Rescue is an ALS-Transport EMS Provider that provides
ALS and BLS care as well as Transport to the Village of Tequesta and
is contracted to provide the same for the community of Jupiter Inlet
Colony. We provide mutual aid to any agency that requests it and we
function within the County-Wide mutual aid system for medical
response. Tequesta Fire-Rescue provides this service using two ALS
Transport Rescue Trucks, one ALS Non-Transport Fire-Engine and one BLS
Non-Transport Ladder Truck equipped with an AED. Tequesta employs 18
Full-Time FF/ENT's and FF/Paramedics as well as 15 Volunteer
Firefighters that are First Responder, EMT or Paramedic Certified.
9. Grant History: Briefly describe your current and previous grant awards
for the past three years. Explain how this application does not
conflict or duplicate them.
00 - Ol ---- ALS Training Mannequin
99 - 00 ---- AED
98 - 99 ---- Public Education Robot
01 - 02 ---- 800 MHz Radios
We are requesting this grant award to purchase a Revivant Autopulse
automatic chest compression device. This request does_ not conflict
with any previous grants nor does it du licate them. We have never
requested an automatic chest compression device on a County Grant and
this device will not conflict or duplicate any previous Grant award.
If necessary, you may attach additional pages to complete sections 8 and 9.
2
PRIMARY EMS GRANT AWARD APPLICATION
ORGANIZATION: Tequesta Fire-Rescue
10. Project Need Statement:
Write a clear, concise statement describing
this project. This must include: 1) numeri
the data; 3) source of the data, and;
population and geographic area.
the need(s) addressed by
c data; 2) time frame for
4) the involved target
Tequesta Fire-Rescue is requesting a grant award to purchase a Zoll
Autopulse automatic chest compression device. Tequesta Fire-Rescue has,
generally, been fortunate enough to have had an increasingly successful
resuscitation rate.
Tequesta Fire-Rescue defines a Cardiac Resuscitation somewhat
differently than simply a Return of Spontaneous Circulation. We define a
Cardiac Resuscitation as~atient who is in cardiac arrest at some point
during their treatment and in whom we successfully regain a viable rhythm,
with pulses, and who survives past the Emergency Room and is eventually
admitted to the Intensive Care Unit.
According to the Tequesta Fire-Rescue EMS Run Report system (Emer e
Pro v3.5), during the five years from 2000 to 2004, Tequesta has responded
to 39 cardiac arrests where treatment was initiated and successfully
resuscitated 12 of those patients for a avera e resuscitation rate of
30.8%. However, when broken down by year we see a trend:
2000 - 8 Cardiac Arrests with 2 Saves = 250
2001 - 9 Cardiac Arrests with 3 Saves = 330
2002 - 9 Cardiac Arrests with 3 Saves = 33~
2003 - 6 Cardiac Arrests with 4 Saves = 67%
2004 - 7 Cardiac Arrests with 0 Saves = 0%
This past year would give any EMS Manager reason for concern and as we
investigated each incident we could find no clear reason for the lack of
success other than simply a statistically bad year. However, we owe it to
our residents to make every effort to ensure their safety and we believe
that the acquisition of this equipment is a positive step towards that
goal.
While the absolute numbers of Cardiac Arrests are too small to assign
statistical validity to any assumptions drawn by this data, the fact
remains that Florida, and Tequesta, serve a large elderly population who
are at a greater risk of Cardiac Arrest. Unless we can resuscitate 1000 of
our Cardiac Arrest patients we have room for improvement. The seriousness
of the nature of Cardiac Arrest makes the importance of improving these
results critical. We believe that an automatic chest compression devir_e
Assoc 76th Scientific Sessions, Improved Survival with a Novel Chest
Compression Device, Nov. 10, 2003)
This equipment would be used primarily to respond to incidents within
the Tequesta Village limits, however; it would also be available to
neighboring agencies in Palm Beach and Martin County as well as the State
and Federal Governments if requested.
PRIMARY EMS GRANT AWARD APPLICATION
ORGANIZATION: Tequesta Fire-Rescue
11. Project Outcome Statement:
Write a concise quantifiable statement describing the degree to which
the need(s) will be changed by the project. This must contain the
same four characteristics as the need statement and indicate the
evaluation methods used to measure the efficiency and/or effectiveness
of the project's outcome.
A. According to Tequesta's Emergency Pro EMS Reporting System from
January 1, 2000 to December 31, 2004 there were 39 cardiac arrest
patients that were treated by our EMS system. Of those 39 patients, 12
had a return of a spontaneous pulse after treatment and had a pulse upon
arrival at the hospital. This represents a successful resuscitation rate
of 30.$%. No patients (0%} had the benefit of an automatic chest
compression device. All cardiac arrest patients were accompanied by an
extra crew member from our ALS Engine which reduced that units
capability while the patient was transported to the hos ital and until
the crew member could be returned to the Engine. Also all cardiac arrest
patients experienced some pauses in compressions due to patient being
moved or other circumstances.
B. In the 12 months after implementation of the automatic chest
compression devices in the Village of Tequesta and areas for which we
provide mutual aid, cardiac arrest survival rate where a patient arrives
at the hospital with a pulse should improve by at least 30$. Studies
have shown improvement of survival rates up to 73%. (Rezaee, M., et al,
Amer Heart Assoc 76 Scientific Sessions, Improved Survival with a Novel
Chest Compression Device, Nov. 10, 2003) The most recent study shows
aortic pressures 133% higher than manual CPR and Coronary Perfusion
Pressure 33% higher than manual CPR. (Timeraman, Cardoso, Ramires,
Halperin, Resuscitation 61 (2004) 273-280, Improved Hemodynamic
Performance With a Novel Chest Cam~.ression Device During Treatment of
In-Hospital Cardiac Arrest). Also, the incidence of improved rhythms
for defibrillation should improve by 30% due to restored normal blood
circulation thus circulating vital life saving drugs. Tn__additio_n_
intravenous success rates should improve due to veins being pum ed up
for easier cannulation. Medics will have more time to attend to vital
functions like airway control and drug therapy. Compressions will be
consistent and at a constant rate even when patient is being moved, even
down stairs. Patients will experience less rib fractures^and cartlidge
damage due to manual compressions. Rescuers will not experience the
fatigue associated with manual compressions and incidences of back and
other injuries should go down. Medics ma remain safely restrained in
the back of the ambulance providing vital care to the patient instead of
standing doing compressions, thus diminishingtheir chances of being
killed or in ured in the event of a vehicle im act while riding back to
the hospital in a "lights and siren" travel mode. Finally, after placin
the patient on the automated chest compression device, the backup
rescuer that would normally provide compressions on the way to the
hospital can return to his unit thus providing more available coverage
to respond to additional calls.
There is also mounting evidence in studies and actual incidences
throughout EMS that indicate additional safety measures should be taken
for medics in the field in regard to~their back safety and vehicle crash
safety. In addition to the above projected outcomes, we anticipate that
injuries to medics should be diminished due to not having to place
additional stress and strain on backs and other areas of the body _as
occurs when manual CPR is performed. Also if medics are seated and
restrained in the back of the unit enroute to the hospital during a
"lights and siren" response it will reduce the possibility of death or
injury to the medic in the unforeseen event of a vehicle crash. This
will also assist us in by decreasing response times by not having _to
request mutual aid when the primary unit is down due to an extra medic
doing manual compressions enroute to the hospital.
If necessary, you may attach additional pages to complete sections 10 & 11.
PRIMARY EMS GRANT AWARD APPLICATION
ORGANIZATION: Tectuesta Fire-Rescue
12. Major Activities and Time Frames:
If grant is awarded, you must follow your schedule. If, for some
reason, the schedule cannot be followed, please advise the EMS Office of
the activity change.
Please indicate time frame as lst quarter, 2nd quarter, 3rd quarter, 4th
quarter and fill in the year.
First Quarter =October 1 through December 31
Second Quarter = January 1 through March 31
Third Quarter =April 1 through June 30
Fourth Quarter = July 1 through September 30
Activit
Time Frames
Purchase Zoll Autopulse lst Quarter 2006
Train department on Zoll Autopulse 2nd Quarter 2006.
Place e uq ipment on Primary Rescue Vehicle 2nd Quarter 2006
Respond to Cardiac Arrest
3rd Quarter 2006
Respond to Cardiac Arrest 4th Quarter 2006
7
PRIMARY EMS GRANT AinTARD APPLICATION
ORGANIZATION: Tec~uesta Fire-Rescue
13. Budget:
The applicant must submit a written price quote for each line item.
For equipment include, the cost per item, quantity, and cite vendor
information. For each type of position, include the pay per hour,
number of hours, and cost of each benefit. For expenses, include unit
costs (if rental, give the cost per square foot).
Items/Quantities and Positions/FTEs
Cost Per Unit
Total
Autopulse System
Autopulse Batteries (3)
Autopulse Battery Charger
Lifeband (3-Pak)
Autopulse Soft Carrv Case
Total Cost:
$10,995.00
$575.00
1,795.00
$375.00
$395.00
10, 995.00
1,725.00
1,795.00
375.00
395.00
15,285.00
8
PRIMARY EMS GRANT AWARD APPLICATION
ORGANIZATION: Tequesta Fire-Rescue
14. Medical Director's Approvals: These are required for all projects which
involve professional education, medical equipment, or both.
(1) Professional Education: A11 continuing education described
in this application will be developed and conducted with my input
and approval.
Medical Director:
Printed Name:
Signature
Date
(2) Medical Equipment: I hereby affirm my authority and
responsibility for the use of all medical equipment in this
project.
Medical Director:
Printed Name:
Signature
Donald Tanabe, MD
May 13, 2005
Date
15. Resolution: Attach a resolution from the Governing Board(s),i.e.
City Commission, Town Council, Board of Directors, etc. certifying
that monies from the EMS County Grant Award will:
(1) Improve and expand prehospital services in that
coverage area.
Will not be used to supplant existing provider's budget
allocation.
b. Meets the goals and objectives of the EMS County Grant Plan.
16. Certification:
I, the undersigned official of the previously named entity, certify
that to the best of my knowledge and belief, all information contained
in this application and its attachments are true and correct.
I understand my signature acknowledges that I will comply fully with
the State Bureau of Emergency Medical Services' and Palm Beach
County's Rules and Regulations governing the administration of the
State of Florida Emergency Medical Services Grant Program for
Counties.
Authorized Official: May 13, 2005
Signature Date
Michael Gouzzo
Printed Name
Village Manager
Title
9
ZOLL
TO: Village of Teques#a
Department of Fire Rescue
P.O. Box 3273
Tequesta, FL 33469-0273
Attn: Peter Allen
ZOLL Medical Corporation
Worldwide Headquarters
269 Mill Road
Chelmsford, Massachusetts 01824-4105
(978) 421-9655 Main
(800)348-9011
(978) 421-0015 Telefax
QuoraTloN
DATE: February 15, 2005
TERMS: Net 30 Days
FOB: Shipping Point
M E4 NUMBER D SCR Q UNIT DISC PRICE TO AL
1 8700-0700-01 AutoPulse System Generates consistent and optimal Brest 1 $10,995.00 $10,995.00 $10,995.00
compressions, offering the promise of no-mal blood flow
during cardiac arrest Includes Backboard, User Guide,
Quick Reference Guide, Shoulder Restraints, Backboard
Cable Ties, Head Immobilizer, Grip Strips, In-Service
Training DVD and one year warranty.
2 8700-0702-01 AutoPulse Battery Original equipment Nickel-metal 3 $575.00 $575.00 $1,725.00
Hydride (NiMH) battery for use with the AutoPulse Platform.
Includes one year warranty.
3 8700-0703-01 AutoPulse Battery Charger, U.S. Charges and conditions 1 $1,795.00 $1,795.00 $1,795.00
up to two batteries and automatically assesses battery
charge level. Includes User Guide, U.S. power cord, and
one year warranty.
4 8700-0706-01 t.ifet3and 8 Pack Single-use chest compression band. 1 $375.00 $375.00 $375.00
(3 per package)
5 8700-0705-01 AutoPube Soft Carry Case Soft-sided carrying case holds 1 $395.00 $395.00 $395.00
AutoPulse Platform, spare battery, spare LifeBand and
Shoulder Restraints.
O Tl NAL
6 8778-0799 AutoPulse Platform, 2 Year Extended Warranty 1 $2,081.00 $2,081.00
F~ctended warranty for 2 years beyond the initial warranty period
on Autopulse System; includes 1 preventative maintenance per
year.
__-___ ___ ........... ........ `..... ~.... ~.. ,~.,... , vww,,v vv,wn,VnV JGI rVRln VP1
THE REVERSE SIDE HEREOF, AND THE WRITTEN ACCEPTANCE OF THIS QUOTATION.
1. DELIVERY WILL BE MADE BO-90 DAYS AFTER RECEIPT OF ACCEPTED PURCHASE ORDER.
2. PRICES WILL BE F.O.B. SHIPPING POINT.
3. WARRANTY PERIOD (See above end reverse side).
4. PRICES QUOTED ARE FIRM FOR 60 DAYS.
5. APPLICABLE TAX & FREIGHT CHARGES ADDITIONAL.
6. ALL PURCHASE ORDERS ARE SUBJECT TO CREDIT APPROVAL BEFORE ACCEPTANCE BY ZOLL.
7. PURCHASE ORDERS TO BE FAXED TO ZOLL CUSTOMER SERVICE AT 978-421-0015.
(VIAL
515,285.00
Kevin Jung/ef
Territory Manager
800-242-9150, x9576
GENERAL CONDITIONS` AND REQUIREMENTS
The EMS County grant general conditions and requirements are an integral part of the county
grant agreement between the agency/organization (grantee) and the state of Florida,
Department of Health (grantor.or department). in the event of a conflict, the following '
requirements shall always be controlling: .
FINANCIAL
FUND ACCOUNTING:
All state EMS. grant funds shall be deposited by the grantee in an accoun# maintained by the
grantee, and assigned an unique accounting code designator for all grant. deposits and
disbursements or expenditures thereof. Ali state EMS grant funds in the account maintained
by the grantee shall be accounted for separately from all other grantee funds.
USE OF COUNTY GRANT FUNDS:
All Mate EMS grant funds shall be used between the beginning and ending dates of the grant
solely for activities as outlined in the Notice of Grant Award letter,. its attachments if any, and
the application including its budget with its revisions, if any, on file in the state EMS office.
The grantee is not restricted to staying within the line item amounts within the: approved grant
budget. However, the grantee must adhere to the approved total grant budget. Any
expenditures beyond this budget are the full responsibility of the grantee.
ROLLOVERS
Any unencumbered EMS county grant program funds as of September 30, of each year ,
including interest, remaining in the assigned grantee account at the end of a grant period shall
be reported to the department. The grantee wiN retain these funds in the EMS County Grant
accounf and include them in a budget revision request after receipt of approval ~of their next
county grant application. ~ ~ .
8
~1-
DISALLOWED EXPENDITURES
No expenditures are allowable as grant costs unless they are clearly specified as a line item in
the approved grant budget, including approved change requests, or are clearly included under
an existing line item.
Any disallowed EMS county grant expenditure shall be returned to the EMS county grant
account maintained• by the grantee within 40 days after the department's notification. The
costs of disallowed items are the responsibility of the county.
VEHICLES AND EQUIPMENT
The grantee shall own all items, including vehicles and equipment purcha~edon ith ~ he ~ntee
EMS grant funds, unless otherwise described in the approved grant app ' 9
shall clearly document the assignment of equipment ownership and usage; and maintain these
documgnts so they are available to the department. The owner of the vehicle shall be
responsible for the proper insurance, licensing and, permitting and maintenance. All
equipment purchased with grant funds shall continue to be used for pre-hospital EMS or the
purpose for which it was purchased throughout its useful life. Wher1 any grant-funded
equipment is no longer usable, it may be sold for scrap or disposed of in the customary
procedure of the receiving agency.
TRANSFER OF PROPERTY
A private organization owning any equipment funded through the grant program in whole or in
part and purchased that equipment to provide services for a municipality, county or other
public agency ceasing operation within five years of the ending date of a grant~awarded to the
organization shall transfer the equipment or other items to the local agency. Then: shall be no
cost to the recipient organization. This provision is applicable when services cease. operating
due to a contract ending as well as any.other reason.
RELZUESTS FOR CHANGE
After a grant has been awarded, all requests for change shall be on DH Form 1684C EMS
Grant Program Change Request, June 2002. The grantee shall obtain written approval from
the department prior to making the requested changes. The following changes must be
requested:
1. Changes in the project activities. .
2. Redistribution of the funds between entities or equipment approved. • ~ •
~. Establishing a new line item in the budget.
4. Changing a salary rate more than 10%,
SUPPLANTING FUNDS
The applicant cannot propose to use grant funds to supplant or replace any county or other
funding source. Funds received under the county award grant program cannot be used to
fulfill the matching requirement for the matching grant program.
9
DEPOSIT OF FUNDS
County gl'ant funds provided to an applicant shall be deposited in a separate account. All
interest earned shall be documented on the required reports.
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.
GRANT SIGNATURE
The authorized individual listed on page one of the application shall sign each original
application. Should this not be possible before the due date a letter shall be submitted'to the
department explaining why and when the signed application shall be received.
RECORDS
The grantee shall maintain financial and other documents related to the grant to support all
revenue and expenditures. A file shall be of the a'ne cation and department approved budpgetf
the "Notice of Grant Award" letter, a copy ~ pp
and a copy of all approved changes.
FINAL REPORTS
Within 120 days of the grant ending date a final report shall be.submitted to the department.
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 relating to
the purchase of any equipment'and supplies. If the activity~funded was for training a list of all
individuals receiving the training shalt be submitted along with the dates, times and location of
the training. if the grant was for training to be obtained by sta# then a copy of alt invoices and
payment documents for the training shall also be submitted.
COMMUNICATIONS EQUIPMENT
The grantee shall have all communications activities, services, and equipment approved in
writing by the Department of Management Services; Information Technology Program (ITP).
The approval shall be. dated after the beginning date of the grant. Any commitment to
purchase the requested equipment and service shall also be dated after the beginning date'of
the grant.
10 .
EXPENDITURES
No expenditures may be incurred prior to the grant starting date or after the grant ending date.
Rollover funds may be used to meet expenditures prior to receipt of cun'ent year funds.
CREDIT STATEMENT
The grantee ensures that where activities supported by this grant produce original-writing,
sound recording, pictorial reproductions, drawings or other graphic representations and works
of any other nature, notices, informational pamphlets, press releases, advertisements,
descriptions of the sponsorship of the program, research reports, and similar public notices
prepared and released by the provider shall include the statement:
°Sponsored by [Your Organization's Name] and the State of Florida, Department of
Health, Bureau of Emergency Medical Services."
If the sponsorship reference is in written or other visual material, the words, °State of Florida,
Department of Health, Bureau of Emergency Medical Services" shall appear in the same size
letter or type as the name of the grantee's organization.
One complimentary copy of all such materials shall be sent to the department within three
weeks of their reproduction and delivery to the grantee.
If the proper credit statement is not included, or if a copy of each item produced is not provided
to the department within three weeks, the cost for any such materials produced shall be
disallowed.
Where activities supported by this grant produce writing, sound recordings, pictorial
reproductions, drawings, or other graphic representations and works of any similar nature, the
department has the right to use, duplicate and disclose such materials in whole or in part, in
any manner or purpose whatsoever and oXhers acting on behalf of the department. If the
materials so developed are subject to copyright, trademark, or patent, legal title and every
right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or
application for the samer will vest in the State of Florida, Department of State, for the exclusive
use and benefits of the state. Pursuant to section 286.02 (1), F.S., no person, firm or
corporation, including parties to this grant, shall be entitled to use the copyright, patent or
trademark without the prior written consent of the. Department. of State.
FINANCIAL AND COMPLIANCE,AUDIT REQUIREMENTS
This is applicable, if the provider or grantee, hereinafter referred to as provider, is any local
government entity, nonprofit organization, orfor-profit organization. An audit, performed in
accordance with section 215.97, F.S. by the Auditor General shall satisfy the requirement of
this attachment. .
STATE FUNDED
This part is applicable if the provider is a nonprofit organization that expends a total of
$100,000 or more in funds from the department during its fiscal year, which was not paid from
a rate contract based on a set state or area-wide fixed rate for service, and of which less that
11
ATTACHMENT 2
$300,000 is federally funded. The`determination of when a provider has "expended" funds is
based on when the activity related to the award occurs.
The grantee agrees to have an annual financial audit performed by independent auditors in
accordance with the current Government Auditing Staridards issued by the Comptroller
General of the United States. Such audits shall cover the entire organization for the
organization's fiscal year. The scope of the audit performed shall cover the financial
statements and include reports on internal control and compliance. The reporting package
shall include a schedule that discloses the amount of expenditures and/or receipts by grant
number for each grant with the department in effect during the audit period. Compliance
findings related td grants with the department:shali be based on the grant requirements, _
including any rules, regulations, or statutes referenced in the grant. The financial statements
shall disclose whether or not the matching requirement was met for each applicable grant. All
questioned costs and liabilities due to the department shall be fully disclosed in the audit
report with reference to the department grant involved. If the grantee receives funds ftom a
grants and aids appropriation., the provider shall have an audit, or submit an attestation
statement, in accordance with Section 215.97, F. S. The audit report shall include a schedule
of financial assistance, which discloses each state grant by number and indicates which grants
are funded from state grants and aids appropriations. The grantee has "received" funds when
it has obtained cash from the department or when it has incurred reimbursable expenses.
The grantee agrees to submit the required reports.
SUBMISSION OF AUDIT REPORTS
Copies of the audit report and any management letter by the independent auditors, or
attestation statement, required by this attachment shall be submitted within 180 days after the
end of the grantee's fiscal year to the following, unless otherwise required by F. S.:
A. ~ Department of Health
Office of the Inspector General
4052 Bald Cypress Way, Bin A03
Tallahassee, Florida 32399-1704
B. Department of Health
Bureau of Emergency Medical Services
County Grant Manager
4052 Bald Cypress Way, Bin C18
Tallahassee, Florida 32399-1738
C. Submit to this address only those audits performed or attestation statements
prepared in accordance with Section 215.97, F. S.:
Office of the Auditor General
Post Office Box 1735
Tallahassee, Florida 32302
ATTACHMENT 2
RECORDS RETENTION
The grantee shall ensure that audit working papers are made available to the department, or
its designee, upon request for a period of five years from the date the audit report is issued,
unless extended in writing by the department.