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Res 38-00RESOLUTION NO. 38-00 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF DELRAY BEACH, FLORIDA, REQUESTING FUNDS FROM THE PALM BEACH COUNTY EMERGENCY MEDICAL SERVICES GRANT AWARD PROGRAM FOR FY 2000/2001. WHERF_dkS, the Delray Beach Fire and Emergency Medical Services Department represents the emergency medical services interests of the City of Delray Beach; and WHEREAS, the Delray Beach Fire Depaxtment is requesting funding for FY 2000/2001 through the Palm Beach County Emergency Medical Services Grant Award program for the purchase of eight (8) Capnography Monitors, six (6) IV Infusion Pumps, and three (3) EMS Patrol Bikes; and WHEREAS, the City of Delray Beach Fire Depag~ent is eligible to receive funds collected by the Office of Emergency Medical Services pursuant to Chapter 401.113, Florida Statutes; and WHEREAS, the equipment to be purchased with these funds will enhance the City's overall emergency medical services operation and improve the delivery and level of emergency medical care provided to the citizens of and visitors to the City of Delray Beach. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DELRAY BEACH, FLORIDA, AS FOLLOWS: Section 1. That the Mayor of the City of Delray Beach is hereby authorized to execute all documents which are necessary to complete the request for funds from the Palm Beach County Emergency Medical Services Grant Award program. PASSED AND ADOPTED in reguhr session on this the 16* day of May, 2000. MAYOR ATTEST: -- d City ~lerlt~ - ~' [ITY OF DELRRY BERTH FIRE DEPARTMENT DELRAY BEACH F L 0 R I O A SERVING DELRAY BEACH · GULFSTREAM · HIGHLAND BEACH Ali. America C~ 1993 TOz FROM: DATE: DAVID . HARDEN, CITY MANAGER ROBE~E CHIEF MAY 3.21:)00 SUBJECT: REQUEST CITY COMMISSION APPROVAL AND RESOLUTION TO ALLOW PARTICIPATION IN THE PALM BEACH COUNTY E.M.S. GRANTS PROGRAM. Each year the County E.M.S. Grants Program makes funds available to licensed E.M.S. Providers. To utilize these non-matching funds we must submit an application requesting the purchase of equipment or services that are not budgeted through the City and a supporting resolution from the City Commission. The resolution is needed to demonstrate that the Delray Beach Fire and Emergency Medical Services Department, in fact. represents the Emergency Medical Services for the City and that the equipment or services purchased with these funds expands and improves the level of care provided to our citizens. For FY 2000-01 we wish to submit three (3) grant applications: 1. Capnography Monitors - 8 units at $1,700 each for a total of $13,600. (See attached copy from the grant application for description) 2. IV Infusion Pumps - 6 units at $4,650 each for a total of $27,900. (See attached copy from the grant application for description) 3. EMS Bike Patrol - 3 units at $1,900 each for a total of $5,700. (See attached copy from the grant application for description) We request this item be placed on the May 16, 2000 agenda. Division Chief Richard Murphy has forwarded the information for the resolution to Barbara Garito. FIRE DEPARTMENT HEADQUARTERS · 501 WEST ATLANTIC AVENUE ° DELRAY BEACH, FLORIDA 33444 (561) 243-7400 · SUNCOM 928-7400 · FAX (561) 243-7461 Printed on Recycled Paper ~ ·/~t o DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MANAGEMENT OFFICE OF EMERGENCY MEDICAL SERVICES PALM BEA CH CO ~.INTY EMS GRANT A 3VARD APP£ICA TION Organization: Authorized Official: Robert Alternate Official: Mailing Address: 501 West Telephone: (561) 243-7400 Authorized Contact Person: Title: Division Chief Delray Beach B. Rehr Atlantic Fire Department Title: Fire Chief Title: Avenue,. Delray Beach~ FL 33444 Richard Murphy Fax: (561) 243-7461 Mailing Address: 501 West Atlantic Avenue, Delray Beach, FL 33444 Telephone: (561) 243-7444 Fax: (561) 243-7461 Agency's Legal Status: City/Municipality First Responders: Please attach a copy of your 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. Your Federal Tax ID Number: VF 59-6000308 Identify the EMS county plan goals this project will accomplish in whole or in part: Reduce mortatility and morbidity using state of the art equipment Communications Projects: All grant applications which involve 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 commitment. 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. The Delray Beach Fire Department responds to all cal!s for assistance within the City cf Delray B~a,:'.h and contracted areas of the Town of Gulf Stream and Town of Highland Beach. Tt,~se include fire suppression, special operations, fire prevention and safety, injury prevention, disaster response and emergency medical service including transportation. We began our EMS service in the 1950's providing basic first aid, evolving into the paramedic level service in 1979. Currently, we provide first response medical assessment and treatment at the advanced life support level and transportation to local hospitals and trauma centers. Our annual budget is $10.2 Million. We have 138 full time ernployees. We operate six (6) paramedic rescue vehicles with (2) in reserve for back-up and maintenance with cellular phone/fax capabilities. Our remaining fleet consists of six (6) Engines, three (3) Aerial Trucks, one (1) Brush Truck, one (1) Special Operations Truck, one (1) Tanker, two (2) Command vehicles, two (2) golf carts, one (1) Public Education unit, twelve (12) staff cars for a total of thirty-seven (37) units. Other resources are provided under an existing countywide mutual aid agreement. o 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. In the past three years, the Delray Beach Fire Department has received grant awards that would enhance our medical equipment and response. We have added cardiac monitor/defibrillators, AED's and a golf cart to our service. You may attach additional pages, if necessary, to complete sections eight and nine. 2 10. Project Need Statement: Write a clear, concise statement describing the need(s) addressed by this project. This must include 1) numeric data, 2) time frame for the data, 3) source of the data, and 4) the ' ' involved target population and geographic area. In calendar year 1999, Delray Beach Fire Depart,ment medical records indicate there were 8,161 medical calls of these 1,423 patients required intubation. The service are.~ ;or the City of Delray Beach, Town of Gulf Stream and Town of Highland Beach, is 18.1 square miles, has a population of 57,780 according to statistics from the University of Florida. Advancements in the means of proper ventilation has resulted in measuring the end tidal CO2 of intubated patients. Capnography is a necessary part of monitoring and analysis of these patients. Capnography provides a means to access not only the alveolar ventilation, but also the integrity of the airway, cardiopulmonary function, subtleties of rebreathing and other fine points in the respiratory cycle. These points are especially important in the field where auscultation of the lungs may be limited or hindered by extraneous noises or conditions. In addition, it can detect esophageal intubation, circuit disconnection, apnea, total airway obstruction, cardiac arrest or failure to restore cardiopulmonary function with external chest compressions secondary to either mechanical or obstructive causes. No other device or technique has proven more effective at the detection of esophageal intubation or in documenting the failure to restore cardiopulmonary function. Capnography provides the paramedic with real data, to make diagnostic, and therapeutic, decisions that were purely guesswork previously. Currently we ventilations. 11. have no means other than auscultation of the lungs to ensure adequate 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. With the addition of capnography units, we will enhance the level of service by accurately providing quantitative data regarding the efficacy of ventilation and resuscitation efforts 100% of the time. Reviewing the medical records from the Delray Beach Fire Department through its Q/A process will provide evaluation of the effectiveness of this program. " You may attach additional pages, if necessary, to complete section ten and eleven. 3 12. Major Activities and Time Frames: You must follow your schedule, if grant is awarded, and justify your time frames. · Activity Number of Months After Grant Starts Receive Grant Award Notification Bid Process Bid Award and Order Equipment Receive Equipment Train Personnel Place into service 30 Days (1 Month) 5 Days (1 Week) 30 Days (1 Month) 10 Days (2 weeks 5 Days (1Week) 80 Days (2.75 Months) You may attach additional pages, if necessary, to complete section twelve. 4 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, incl'ude unit costs (e.g. if rental give the cost per square foot). Items/Quantities and Positions/FTEs ' Cost Per Unit Total 6 Capnography units $3,250.00 $19,500.00 You may attach additional pages, if necessary, to complete this item or justify any budget item or its quantity. 5 14. 15. 16. Medical Director's Approvals: These are required forall projects which involve professional education, medical equipment, or both. (1) Professional Education. All continuing education described in this application will be developed and conducted with my input and app, royal. Medical Director: Signature Date Printed Name: (2) Medical Equipment. medical equipment in this project. Medical Director: ,~_.~.~~ Signature Printed Name: I hereby affirm my authority and responsibility for the use of all Date Resolution: Attach a resolution from the Goveming Board(s), City Commission, Town Council, Board of Directors, etc. certifying that monies from the EMS County Grant Award will: improve and expand prehospital services in that coverage area. not to be used to supplant existing provider's budget allocation. meets the goals and objectives of the EMS County Grant Plan. 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 all 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 Officiah .~~.~ ./~ ~~'--- ~,~, ">//~) ~ Signatu're / Date Robert B. Rehr Fire Chief Printed Name Title IV'ca',romc Phy.~o-Control Corp PHYSIO-CONTROL To: Lieutenznt Bradford Fitzer City of Delray Beach Fire Department 501 West Atlantic Avenue Defray Beach, FL 33444 FAX: 561-243-7461 Sales Quotation #: SMB7323319-A Page #: Quote Date: Representative: 1 218/2000 Charlee Oliver 800-a42-1142 x2648 FOB: Redmond, WA Shipping: 15-30 Terms: Net 30 Days This quote is firm until: 3/27/2000 Unit Part # Description Oty Price Total 3012174-000 LIFECAPTM handheld capnograph 1 $3,250.00 $3,250.00 Includes carrying case, rechargeable battery pack, one Adult/Pediatric FilterLineTM set, one Adult Nasal FilterLine, one Adult Airway Adapter, one Infant/Neonatal Airway Adapter and operating instructions. TOTAL THIS QUOTE $3,250.00 NOTE: TERMS CONTAINED ON THE REVERSE SIDE OF THIS DOCUMENT ARE EXPRESSLY MADE PART OF THIS SALES AGREEMENT 'SMB AND ARE INCORPORATED HEREIN. Apol~cab,~ ~'e '~ht arid sales tax wdl b~ added to the qdoted I}L,rct]ase price A,,,e, ~: s B~' r'~ ,, , .., ~ ' .~. ~ ' ,.~- -~ DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MANAGEMENT OFFICE OF EMERGENCY MEDICAL SER VICES PALM B £A CH CO UNTY EMS GRANT A WARD APPL ICA TION Organization: Authorized Official: Robert Alternate Official: Mailing Address: 501 West Telephone: (561) 243-7400 Authorized Contact Person: Title: Division Chief Delray Beach Fire Department B. Rehr Title: Fire Chief Title: Atlantic Avenue, Delray Beach~ FL Richard Murphy Fax: (561) 243-7461 33444 Mailing Address: 501 West Atlantic Avenue, Delray Beach, FL $3444 Telephone: (561) 243-7444 Fax:(561) 243-7461 Agency's Legal Status: City/Municipality First Responders: Please attach a copy of your 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. Your Federal Tax ID Number: VF 59- 6000308 Identify the EMS county plan goals this project will accomplish in whole or in part: Reduce morbidity and mortality due to c~rdi~ ,-oldish emergencies Communications Projects: All grant applications which involve 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 commitment. 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. ' The Delray Beach Fire Department responds to all, calls for assistance within the City of Delray Beach and contracted areas of the Town of Gulf Stream and Town of Highland Beach. These include fire suppression, special operations, fire prevention and safety, injury prevention, disaster response and emergency medical service including transportation. We began our EMS service in the 1950's providing basic first aid, evolving into the paramedic level service in 1979. Currently, we provide first response medical assessment and treatment at the advanced life support level and transportation to local hospitals and trauma centers. Our annual budget is $10.2 Million. We have 138 full time employees. We operate six (6) paramedic rescue vehicles with (2) in reserve for back-up and maintenance with cellular phone/fax capabilities. Our remaining fleet consists of six (6) Engines, three (3) Aerial Trucks, one (1) Brush Truck, one (1) Special Operations Truck, one (1) Tanker, two (2) Command vehicles, two (2) golf carts, one (1) Public Education unit, twelve (12) staff cars for a total of thirty-seven (37) units. Other resources are provided under an existing countywide mutual aid agreement. 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. In the past three years, the Delray Beach Fire Department has received grant awards that would enhance our medical equipment and response. We have added cardiac monitor/defibrillators, AED's and a golf cart to our service. You may attach additional pages, if necessary, to complete sections eight and nine. 2 10. Project Need Statement: Write a clear, concise statement describing the need(s) addressed by this project. This must include 1) numeric data, 2) time frame for the data, 3) source of the data, and 4) the ' ' involved target population and geographic area. In Calendar Year 1999, Delray Beach F'ire Rescue Medical Records show that there were 8,161 medical calls, of these 2,668 were cardiac calls requiring 12-Lead EKG's. The service area for the City of Delray Beach, Town of Gulf Stream and Town of Highland Beach, which is 18.1 square miles, has a population of 57,780 with 46% over the age of 50 according to statistics from the University of Florida and Florida Atlantic University. Advancements in the medical treatment of ischemic heart disease include precise delivery of parenteral medications to a patient in acute distress. Intravenous Nitroglycerin delivered by an infusion pump has been the standard of Care in the Emergency Department and Intensive Care Units. The benefits of intravenous Nitroglycerin by an infusion pump include the immediate onset of action and minute by, minute control of the dose so that hypotension does not develop, as is it commonly does when given sublingually. Hypotension in the patient with myocardial ischemia may cause more damage to nutrient starved myocardial cells, converting a small area ofischemia into a larger one. The latest edition of the Advanced Cardiac Life Support book by the American Heart Association states that "with unstable angina pectoris or myocardial infarction IV administration is preferred." Intravenous infusion pumps will raise the level of pre-hospital care being delivered. Currently DBFD does not administer IV Nitroglycerin. Our need is to equip six (6) ALS transport units with IV pumps to provide immediate onset of action and minute by minute control of Nitroglycerin. This will reduce the chances of hypotension and the ischemic area enlarging do to hypotension. l l. 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. With the addition of IV infusion pumps and Intravenous Nitroglycerin capabilities on our six (6) ALS transport units in our service area, we will be able to provide defir~i'ti~,e cardiac care to cardiac/heart patients 100% of the time while reducing the area of myocardial ischemia due to hypotension. The Quality Management Team and Medical Director, through medical record review, will monitor the program to ensure correct medication administration is being accomplished and the "Card~ac Alert" program is being followed. You may attach additional pages, if necessary, to complete section ten and eleven. 3 12. Major Activities and Time Frames: You must follow your schedule, if grant is awarded, and justify your time frames. Activity Number of Months After Grant Starts Receive Grant Award Notification Bid Process Bid Award and Order Equipment Receive Equipment Train Personnel Place into service 30 Days (1 Month) 5 Days (1 Week) 30 Days (1 Month) 10 Days (2 weeks 5 Days (1Week) 80 Days (2.75 Months) You may attach additional pages, if necessary, to complete section twelve. 4 ,-,.. ~8~. ~.~000 2:34PM PBC EMRG MED SVCS 13. Budget: The applicant must submit a written phc, include, the cost per item, quantity, and cite vend, include the pa), per hour, number of hours, and cc unit costs (e.g. if rental give the cost per square/i ,', terns/Ouantities and Pqsltions/FTEs Equipment 6 - IV infusion pumps H0.140 P.2 : quote for each line item. For equipment )r information. For each type ofposition, ,st of each benefit, For expenses, inc'l'ud¢ Cost Per Uni~..,, Total $ 4,650 27,900 You may attach additional pages, ii'necessary, to complete this item or justify any budget item its quantity. 5 14. Medical Director's Approvals: These are required forall projects which involve professional education, medical equipment, or both. ,, (1) Professional Education. All continuing education described in this application will be developed and conducted with my input and approval. Medical Director: Signature Date Printed Name: Printed Name: (2) Medical Equipment. I hereby affirm my authority and responsibility for the use of all medical equipment in this project. Medical Director: //~~--r~'~-dffc.~/~ ~/-,,lfa -o '0 · Signature /'/ Date 15. 16. Resolution: Attach a resolution from the Governing Board(s), City Commission, Town Council, Board of Directors, etc. certifying that monies from the EMS County Grant Award will: improve and expand prehospital services in that coverage area. not to be used to supplant existing provider's budget allocation. meets the goals and objectives of the EMS County Grant Plan. 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 all 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: .... , Signature Date Robert B. Rehr Fire Chief Printed Name Title 6 Fitzer, Raymond From: Sent: To: Subject: Quinlan, Julie [JQuinlan@alarismed.com] Wednesday, February 23, 2000 11:51 AM 'rbfitzer@gate.net' medsystem iii pricing Hi, Brad! It was nice talking to you this morning. As we discussed, I will be sending you literature regarding our MedSystem III Infusion System. While we still have the version that yo,3 ~robably saw at the trade show last June, we also have an upgraded version (MedSystem III DLE) which includes software for a Drug List Editor (DLE). The DLE is a complementary PC-based software accessory package that allows the creation of customized Dose Rate Calculator drug list defaults. This includes the ability to add, delete, or modify these defaults and drug names. Brad, ! will include information regarding this latest generation of the MedSystem III in your package for tomorrow. I will be happy to go over it with you upon receipt. Therefore, below is pricing for both MedSystem IIIs, based on the purchase of (6) units. Model 2865 is the version which includes the DLE software. Model Price/unit Extended Price 2863 $ 4,450.00 $26,700.00 2865 $ 4,650.00 $27,900.00 Per your request, this is considered my Outright Sale Price. I do have an EMS Program going on at this time that you would qualify for, which is based on quantity. This program is effective until May 31, 2000. We can go over that when you are ready. Brad, I am waiting on an answer regarding availability in order to send you a demo unit. Also, I would like to talk with you after you receive the literature to determine which version you would like to evaluate. I appreciate your interest in ALARIS Medical System's products and services. Please feel free to contact me at 800-854-7128 x7849; otherwise, I will be following up with you shortly. Best regards, Julie Quinlan Julie Quinlan Corporate Sales Representative ALARIS Medical Systems 10221 Wateridge Cirlce San Diego, California 92126 PH: 800/854-7128 x7849 FX: 858/458-6108 jquinlan@alarismed.com DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MANAGEMENT OFFICE OF EMERGENCY MEDICAL SER VICES PALM BEACH CO UNTY EMS GR,4NT A }t.'ARD APPLICATION Organization: Delray Beach Fire Department Authorized Official:Robert B. Rehr Title: Fire Chief Alternate Official: Title: Mailing Address: 501 West Atlantic Avenue, Delray Beach, FL 33444 Telephone: (561) 243-7400 Fax: (561) 243-7461 Authorized Contact Person: Richard Murphy Title: Division Chief Mailing Address: 501 West Atlantic Avenue, Delray Beach, FL 33444 Telephone: (561) 243-7444 Fax: (561) 243-7461' Agency's Legal Status: City/Municipality First Responders: Please attach a copy of your 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. Your Federal Tax ID Number: VF 59-6000308 Identify the EMS county plan goals this l~roject will accomplish in whole or in part: Reduction of response times Communications Projects: All grant applications which involve 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 commitment. 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. The Delray Be.~ch Fire Department responds to all calls for assistance within the City of Delr.'-,y Beach and contracted areas of the Town of Gulf Stream and Town of Highland Beach. These include fire suppression, special operations, fire prevention and safety, injury prevention, disaster response and emergency medical service including transportation. We began our EMS service in the 1950's providing basic first aid, evolving into the paramedic level service in 1979. Currently, we provide first response medical assessment and treatment at the advanced life support level and transportation to local hospitals and trauma centers. Our annual budget is $10.2 Million. We have 138 full time e.rnployees. We operate six (6) paramedic rescue vehicles with (2) in reserve for back-up and maintenance with cellular phone/fax capabilities. Our remaining fleet consists of six (6) Engines, three (3) Aerial Trucks, one (1) Brush Truck, one (1) Special Operations Truck, one (1) Tanker, two (2) Command vehicles, two (2) golf carts, one (1) Public Education unit, twelve (12) staff cars for a total of thirty-seven (37) units. Other resources are provided under an existing countywide mutual aid agreement. 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. In the past three years, the Delray Beach Fire Department has received grant awards that would enhance our medical equipment and response. We have added cardiac monitor/defibrillators, AED's and a golf cart to our service. You may attach additional pages, if necessary, to complete sections eight and nine. 2 10. Project Need Statement: Write a clear, concise statement describing the need(s) addressed by this project. This must include 1) numeric data, 2) time frame for the data, 3) source of the data, and 4) the involved target population and geographic area. The Delray Beach Fire Department provides EMS site coverage for City sponsored special events held throughout the year. Data received from the Chamber of Commerce and the Parks & Recreation Department for the City shows that in FY 97~98 there were 1,068,00 visitors in attendance, and FY 98~99 there were 1,228,200 visitors. This is an increase of 15% in total attendance of special events. Run Report and Dispatch records from the Delray Beach Fire Department indicate that in FY 98~99 there were 45 EMS calls associated with special events. An EMS Bike Patrol designed to deliver Emergency Medical Services in the unique environment associated with large crowds is needed 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. By adding an EMS Bike Patrol, EMS delivery and response by the Delray Beach Fire Department will be enhanced to serve the 15% increase in visitor attendance 100% of the time. Evaluation of the Bike Patrol's effectiveness will be performed by reviewing Dispatch and Run Report Records from the Delray Beach-Fire Department. You may attach additional pages, if necessary, to complete section ten and eleven. 3 12. Major Activities and Time Frames: You must follow your schedule, if grant is awarded, and justify your time frames. Activity Number of Months After Grant Starts Receive Grant Award Notification Bid Process Bid Award and Order Equipment Receive Equipment Train Personnel Place into service 30 Days (1 Month) 5 Days (1 Week) 30 Days (1 Month) 10 Days (2 weeks ,5, Days (1Week) 80 Days (2.75 Months) You may attach additional pages, if necessary, to complete section twelve. 4 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 ofpositiqn, include the pay per hour, number of hours, and cost of each benefit. For expenses, include unit costs (e.g. if rental give the cost per square foot). Items/Quantities and Positions/FTEs Cost Per Unit Total 3 EMS Bicycles with equipment EMS Bicycle Operations Course (3 Students) $1,900.00 $5,700.00 $ 176.00 $ 528.00 $6,228.00 You may attach additional pages, if necessary, to complete this item or justify any budget item or its quantity. 5 14. 15. 16. Medical Director's Approvals: These are required for al_! projects which involve professional education, medical equipment, or both. ~, (1) Professional Education. All continuing education described in this application will be develo.r, ed and conducted with my input and a~pproval. Medical Director: Signature Date Printed Name: (2) Medical Equipment. medical equipment in this project. Medical Director: I hereby affirm my authority and responsibility for the use of all Signature t~ t Date Printed Name: ~~,,q~_c_ c_. ~-~,',.,'=~, Resolution: Attach a resolution from the Governing Board(s), City Commission, Town Council, Board of Directors, etc. certifying that monies from the EMS County Grant A;vard will: improve and expand prehospital services in that coverage area. not to be used to supplant existing provider's budget allocation. meets the goals and objectives of the EMS County Grant Plan. 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 all 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: /-.~_~,,,_~x~_~.,~~.~ z~~ ~'~-~ ~/foo /~ '~- / Signat-~r~' ~ "; Da{e Robert B. Rehr Fire Chief Printed Name Title 6 RIDE SAFE AND ALWAYS WEAR YOUR HELMET! RETURNS SUBJECT TO 15% RESTOCKING FEE NO WARRANTY ON TIRES OR TUBES! RICHWAGEN'S CYCLE CENTER. INC. 217 EAST ATLANTIC AVENUE DELRAY BEACH, FL 33444 (561) 276-4234 DELRA¥ FIRE RESCUE 501 WEST ATLANTIC AVE ATT.BRAD FITZER DELRAY BEACH, FL 33444 Authorization Signature: No.: T01012686 Customer No.: 243-7400 Salesperson: Date: APRIL 28, 2000 Product Code Description Qty Unit Price Extended 1 1 1 1 1 1 1 1 1 1 1 1 K-2 RAZOR BACK HT MTB DUEL HEAD LIGHT SYSTEM VISTA FRT/REAR STROB LITE JAND REAR HEAVY DUTY RACK REAR PANNIER BAGS TOP RACK BAG FRONT BAG TRICO GEL SEAT WATER BOTTLE CAGES WATER BOTTLE SIREN BELL HELMET 1.00 1900.00 1900.00 N 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T 1.00 0.00 0.00 T PRODUCTS SUBTOTAL: $1900.00 SUBTOTAL -- 1900.00 TOTAL $1900.00 Thank you for letting us serve you! FOR OVER 40 YEARS! (est.1958)