2017 Electronic Tablet Grant Application



EMS Electronic Tablet Grant Application


This notice announces the availability of the Emergency Medical, Fire, & Transportation Services Board Electronic Tablet Grant. 

The Ohio Department of Public Safety, Division of EMS and the Ohio Highway Patrol, Ohio Traffic Safety Office / Traffic Records Coordinating Committee has collaborated in an effort to distribute approximately 1200 electronic tablets to EMS Agencies throughout the State of Ohio for the promotion of EMS data reporting submissions to the Ohio Emergency Medical Service Incident Reporting System (EMSIRS) and for use with the OHTrac Mass Casualty Incident Mobile Application and Trauma Registry. 

This guidance document includes program information, guidelines, and instructions. Please follow all directions carefully to avoid delays in consideration. Applications will be available on-going until September 30, 2018, or all until electronic tablets have been distributed.

Applicants must provide an address that matches the address associated with their federal tax ID. Do not provide a personal
address or an address without mail service. 

All Electronic Tablet grant applicants must apply for funding using the electronic application process with the electronic
signature. Please note the following information concerning the application process and selection criteria for the grant
application / award process:

Applications must be completed using the electronic grant application located at:
All applicants will be required to electronically agree that they acknowledge that all fields are used to determine eligibility and the responses provided by the grantee are accurate and they are an eligible applicant under section 4765-5-02 of
the Ohio Administrative Code (O.A.C.).
Awards will be need based. Applications will be scored based on the information provided on the application. 
If an EMS organization’s medical director fails to meet the minimum qualifications established in section 4765-3-05 of the O.A.C., the EMS organization may be ineligible for the grant program established under section 4765.07 of the R.C. as provided in this chapter. Failure to provide the Medical Director’s License number may result in a delayed award.

If you do not have a medical director or do not think the medical director meets the minimum qualifications, please contact the
Ohio Division of EMS at (800) 233-0785.

                  For more information regarding the Ohio EMS Grant process, call (800) 233-0785.


Purpose: To provide EMS agencies with the ability to submit run detail electronically to assure greater data acceptability, as well as a more complete and timely view of traffic and trauma related injury surveillance.

Eligible Applicants: EMS organizations that meet the eligibility requirements pursuant to Section 4765-5-02 of the O.A.C.
4765-5-02 Criteria for eligibility.

(A)   The board shall only approve grants for applicants who are eligible to be grantees pursuant to Section 4765.07 of the R.C.
and this chapter.

(B)   Eligible grantees are limited to the following:

(1)   EMS organizations whose main responsibility is to provide continuous emergency medical services to the community pursuant to requests and / or calls from the public for emergency medical service response. Such EMS organizations must also meet one
of the following:

(a)   The EMS organization must be established or operated by a township, municipality, village, city, county, joint fire district,
joint ambulance district, or joint township fire district within the state;
(b) The EMS organization must provide services, pursuant to a contract or letter, to a township, municipality, village, city, county, joint fire district, joint ambulance district, or joint township fire district within the state.

(2)  Entities that meet the requirements of division (A)(2), (A)(3), (A)(4), (A)(5) or (A)(6) of Section 4765.07 of the R.C.

(C) Grant applicants must provide to the division documentation of eligibility in accordance with the grant application form.

(D) Eligible grantees must comply with all applicable provisions of Chapter 4765 of the R.C. and this chapter.

(E)  An EMS organization's failure to report as required under section 4765.06 of the R.C. and Chapter 4765-4 of the O.A.C. may
result in ineligibility status for purposes of the emergency medical services grant program established under section 4765.07 of
the R.C. and as provided in this chapter.

(F)  Effective January 1, 2013, if an EMS organization’s medical director fails to meet the minimum qualifications established in
rule 4765-3-05 of the O.A.C., the EMS organization may be ineligible for the grant program established under section 4765.07 of
the R.C. and as provided in this chapter.

Effective: 02/06/2012
R.C. 119.032 review dates: 11/16/2011 and 11/16/2016
Promulgated Under: 119.03
Statutory Authority: R.C. 4765.06, R.C. 4765.07, R.C. 4765.11
Rule Amplifies: R.C. 4765.06, R.C. 4765.07
Prior Effective Dates: 10/1/95, 2/22/99, 6/ 29/01, 1/13/02, 12/30/04, 12/29/08

Deadline for Applications: Applications will be accepted on an on-going basis.
For Questions:
Grant Program
Division of Emergency Medical Services
1970 West Broad Street
P.O. Box 182073
Columbus, OH 43218-2073



1) The EMS Grants Administration has discretion in approving or denying any, all, or a portion of a grant application.

2) Grant applications must be submitted utilizing the Ohio Division of EMS’s electronic on-line application . 

3) Incomplete, illegible, or paper applications will not be considered for funding.

4) Awarded equipment cannot:
A.  Be sold;
B.  Be traded;
C.  Be disposed of without prior written approval from the Division of EMS

5) All applications must include the following properly completed items:

A. Agency I.D., contact person, medical director, tax I.D., address, authorizing official, telephone number and e-mail address.

B. Certification by an authorizing official by electronic signature that the agency meets the criteria for
eligibility as described in O.A.C. Section 4765-5-02.
C. Completed eligibility indicators.

D. A grant agreement signed with an electronic signature through the online grant process.
6) Each applicant must be in substantial compliance with R.C. section 4765.06 and O.A.C. Section 4765-4. As noted in O.A.C. 4765-4-08, failure to report to the Incident Reporting System may result in ineligibility status for purposes of the EMS grant program.

7) Awarded grantees will be required to download the OHTrac Application on all awarded electronic tablets.

8) Awarded grantees will be required to pick up their awarded tablet(s), at a pre-arranged time, from the Division of EMS located at 1970 W. Broad St., Columbus, Ohio 43218.

9) Awarded agencies must report in EMSIRS version 3.4 within 6 months of receipt of the awarded equipment. If your agency will not be able to report to EMSIRS version 3.4 within 6 months, you must contact the grants administration at 1-800-233-0785, to work with them on a timeline for reporting. Failure to do so may result in your agency being required to return the awarded device(s). 

10) Agencies that left a Priority One Training and Equipment grant award balance of $300 or more during the last grant cycle, will not be eligible.

Estimated Number of Electronic Tablets:
 Approximately 1200

Grant Period:
October 16, 2017 through September 30, 2018, or until all electronic tablets have been awarded and distributed.

Selection Criteria:
Applications will be reviewed and funded using the following selection criteria:
  • The completion of an EMFTS electronic application.
  • The applicant must be in substantial compliance with Section 4765-4 of the O.A.C. regarding the submission of data to the Incidence Reporting System.
  • The applicant must meet the eligibility requirements of Section 4765-5 of the O.A.C.
Applicants will only be able to return to their incomplete application, however, applications will not be available for revisions
once submitted.
Please read the following information before you begin completing the required fields of this grant application.
This instruction page provides guidance for each of the fields on the application.

The information you provide on this application will be used to determine your eligibility for the EMS Electronic Tablet Grant.
Periodic audits will be performed to verify the accuracy of the data and proof of eligibility. All questions must be answered in
order to submit your application. If you are unable to submit your application, please review your responses and verify you have
answered all required questions. If you have not answered all required fields, a request to respond will appear in red text by the
corresponding question. 

The following instructions will provide guidance for each item on the application.

1.  In order to be eligible for an electronic tablet, an EMS agency must be registered and be assigned an Agency ID# with the Ohio Division of EMS.

2. Provide your Agency’s Federal Tax I.D. #. 

3. Provide the name and contact information for the Authorizing Official, and Contact person.

4. Provide the name and contact details for your agency’s Medical Director, and verify that they meet the requirements as defined in section 4765-3-05 of the O.A.C.  Failure to provide this information may result in a delayed award or an ineligible application. 

5. In accordance with O.A.C 4765-04-08, your agency must be in compliance with EMS data reporting. Please indicate whether
your agency is in compliance. 

6. If your agency is not in compliance, explain why you are not.

7. Indicate whether your agency uses vendor software to report incident reports, or if you self-report.

8. If your agency uses vendor software, provide the software vendor your agency uses. 

9. Indicate whether or not your agency is planning to change vendors within the next 12 months. 

10. If your agency is planning to switch vendors, provide the details of when you plan to switch, and what is the name of the new vendor?

11. Indicate whether you are submitting data in to EMSIRS version 2 or version 3.4.

12. If your agency is submitting data in version 2, indicate when your agency plans to begin submitting in version 3.4.

13. Enter the population of the area for which your department provides primary EMS service. Population can be
obtained through the census or a government agency. Include territory under contract if primary EMS services are provided. DO
NOT include areas where you respond under mutual aid agreements to provide supplemental protection.

14. Enter the number of active stations your department has established to respond to EMS calls in your service area. Only enter
active stations providing EMS in response to 911. Do not include remote non-staffed or storage stations.

15. Enter the number of EMS runs in your service area for a 12 month period (calendar year). The 12 month period should
be the same as the operating budget period. 

16. Indicate whether your agency currently uses an electronic tablet to record and submit data to Ohio EMSIRS.

17. If your agency uses an electronic tablet to record and submit data, provide the age of the tablet. 

18. Indicate the type of tablet and number of tablets your agency is requesting. Please note, even if awarded, your agency may not receive the number of requested tablets.

19. Indicate how long it will take your agency to begin utilizing the electronic tablets to submit data to EMSIRS version 3.4.

Please note, once your application has been submitted, you will not be able to make changes.

This agreement (hereinafter referred to as “the Agreement”) is made by and between the Ohio Department of Public Safety / Ohio Division of EMS, (hereinafter referred to as “the Division”) on behalf of the State Board of Emergency Medical, Fire, &
Transportation Services (EMFTS) (hereinafter referred to as “the Board”), and the above mentioned organization presently
located at the above mentioned address in question #3 of the application, hereinafter referred to as “the Grantee”, and is subject to the following terms and conditions.

1. TERM: This Agreement is to be effective from receipt of the electronic device through the end of the grant cycle as defined on the Notice of Award Letter. 

A. The Grantee declares that it is engaged as an independent business and shall furnish professional services performed according to applicable commercial standards. Neither the Grantee nor its personnel shall, at any time or for any purpose under this
Agreement, be considered as employees or agents of the Division or the State of Ohio. The Grantee shall determine the hours
required to perform the services to be provided under this Agreement, and retains discretion over its schedule when performing
services on the premises of the Division, subject to the Division’s normal business hours and security requirements.

B. The Grantee agrees to comply with all applicable federal, state, and local laws in performing the work under this Agreement.
The Grantee accepts full responsibility for the payment of all taxes, and the Division and the State of Ohio shall not be liable for
any taxes under this Agreement.

C. The Grantee shall perform the work under this Agreement and may subcontract, with the Division’s approval, for the purchase of articles, supplies, components, or special mechanical services that do not involve the type of work or services which are to be
performed by the Grantee under this Agreement, but which are required for the Agreement’s satisfactory completion. The Grantee is responsible for the expense of any and all subcontracted work. Neither this Agreement nor any rights, duties, or obligations
described in this Agreement, shall be assigned by either party without the prior express written consent of the other party.

D. Unless expressly provided for elsewhere in this Agreement, the Grantee shall be responsible for and assume all office and
business expenses that are incurred as a result of the performance of this Agreement.

2. WORKERS’ COMPENSATION AND OTHER BENEFITS: The Grantee and its employees shall be covered by workers'
compensation coverage purchased and maintained by the Grantee. In addition, the Grantee should ensure that any
subcontractors maintain workers' compensation insurance at all times during the term of this Agreement. Any workers'
compensation claims filed by the Grantee, or its employees or subcontractors, as a result of work performed under this
Agreement is not covered under the Division's workers' compensation insurance. The Grantee is not entitled to any State
employment benefits, including, but not limited to the Public Employees Retirement System of Ohio, for work performed under
this Agreement.

3. DRUG FREE WORKPLACE: The Grantee certifies that to the best of their ability, all of their employees will not purchase,
transfer, use, or possess illegal drugs or alcohol or abuse prescription drugs in any way while working on state property. Failure to comply may result in immediate termination of this Agreement.

A. The Grantee, and any of its subcontractors, shall comply with the requirements under R.C. section 125.111. The Grantee, and
any of its subcontractors, shall not discriminate against anyone because of race, color, religion, sex, age, disability, national
origin, ancestry, or military status.

B. The Grantee certifies that both the Grantee and any of its subcontractors are in compliance with all applicable federal and
state laws, as well as rules and regulations governing fair labor and employment practices.

C. The Division encourages both the Grantee and any of its subcontractors to purchase goods and services from certified Minority Business Enterprise (“MBE”) and Encouraging Diversity Growth and Equity (“EDGE”) vendors.

5. CONFLICT OF INTEREST: The Grantee shall not have any interest, direct or indirect, which is incompatible or in conflict with
the carrying out of the terms of this Agreement.

6. CAMPAIGN CONTRIBUTIONS: The Grantee hereby certifies that all applicable parties are in full compliance with Divisions (I)
and (J) of R.C. Section 3517.13.

7. OHIO ETHICS CLAUSE: Per R.C. 102.04 (D): The Grantee affirms by their signature they and any members conducting the
research are:

A. He / she or any members are not elected or appointed to an office of or employed by the General Assembly or any department, division, institution, instrumentality, board, commission, or bureau of the State, excluding the Courts,


B. If the Grantee or members of the research project are appointed or employed as described above, then the Grantee affirms by
his / her signature that he / she is a public official appointed to a non-elective office or is a public employee, but, is exempt from
the provisions of R.C. 102.04 (A), (B), or (C) because,

         I. The Grantee is supplying the good and / or services that are subject of the agreement to an agency other than the one withwhich he / she serves; AND

        II. The Grantee has filed the required statements with the following agencies:

               a) The appropriate ethics commission; AND

               b) The public agency with which he / she serves; AND

               c) The public agency to which the goods and / or services will be provided.


Grantees agree to abide by the Ohio Ethics Law as set forth in R.C. chapter 102, especially section 102.04, and chapter 2921
sections 2921.42, and 2921.43.

Board, Committee, and Work Group members whose employers wish to apply for funding must disclose this fact to the
Executive Director of EMS as soon as they become aware or at the time of application, whichever is earlier. Such members must not participate (e.g., discuss, deliberate, and / or vote) on the topics and / or topics involving grants, participate in any way in
the application process, or advise the individuals who are applying for the grant. Board, Committee, and Work Group members must abstain from discussing, deliberating, or voting in any situation where there is a conflict of interest, where their employer or another associate is the grant applicant, or if there is an appearance of impropriety.

Board, Committee, and Work Group members are prohibited from receiving funding from the grant, nor can they perform work
in furtherance of, or act as a consultant on the grant; recusal from discussing, deliberating, and / or voting on the grant will NOT overcome this prohibition. 

Applicants are responsible for knowing and understanding the Ohio Ethics Law. Violations can result in a grant application
being rejected, terminated, and / or in criminal prosecution.
If you have any questions regarding your obligations under the Ohio Ethics Law, you should contact the Ohio Ethics Commission for advice. 
affirms to have read and understands Executive Order 2011-12K and shall abide by those requirements in the performance of this
Agreement, and shall perform no services required under this Contract outside of the United States.

The Grantee also affirms, understands, and agrees to immediately notify the State of any change or shift in the location(s) of
services performed by the Grantee or its subcontractors under this Agreement, and no services shall be changed or shifted to a
location(s) that are outside of the United States.

A.Termination, Sanction, Damages:

If the Grantee or any of its subcontractors perform services under this Contract outside of the United States, the performance of
such services shall be treated as a material breach of the Contract. The State is not obligated to pay and shall not pay for such

If the Grantee or any of its subcontractors perform any such services, the Grantee shall immediately return to the State all funds
paid for those services. The State may also recover from the Grantee all costs associated with any corrective action the State may undertake, including but not limited to an audit or a risk analysis, as a result of the Grantee performing services outside the
United States.

The State may, at any time after the breach, terminate the Contract, upon written notice to the Grantee. The State may recover
all accounting, administrative, legal and other expenses reasonably necessary for the preparation of the termination of the
Contract and costs associated with the acquisition of substitute services from a third party.

If the State determines that actual and direct damages are uncertain or difficult to ascertain, the State in its sole discretion may
recover a payment of liquidated damages in the amount of one percent (1%) of the value of the Contract. 

The State, in its sole discretion, may provide written notice to Grantee of a breach and permit the Grantee to cure the breach.
Such cure period shall be no longer than twenty-one (21) calendar days. During the cure period, the State may buy substitute
services from a third party and recover from the Grantee any costs associated with acquiring those substitute services. 

Notwithstanding the State permitting a period of time to cure the breach or the Grantee’s cure of the breach, the State does not
waive any of its rights and remedies provided the State in this Contract, including but not limited to recovery of funds paid for
services the Grantee performed outside of the United States, costs associated with corrective action, or liquidated damages.

B. Assignment / Delegation: 

The Grantee will not assign any of its rights, nor delegate any of its duties and responsibilities under this Contract, without prior
written consent of the State. Any assignment or delegation not consented to may be deemed void by the State.

9. RESPONSIBILITY FOR CLAIMS: The Grantee agrees to indemnify and hold the Division harmless from any and all claims for
personal injury or property damage resulting from the fault or negligence of the Grantee and from claims for wages or overtime
compensation due its employees in rendering services under this Agreement, including payment of all costs in defense of any
claim made under the Fair Labor Standards Act or any other federal or state law. In no event shall either party be liable to the
other party for indirect, consequential, incidental, special, or punitive damages, or lost profits

A. Any and all written, electronic, or multimedia documents, presentations, reports, studies, deliverables, and / or software
developed under this Agreement (hereinafter referred to under this Section as “Deliverables”) shall become the property of the
Division. The Division, and any person, agency, or instrumentality providing financial assistance for the work performed under this
Agreement shall have an unrestricted right to reproduce, distribute, modify, maintain, and use the Deliverables. The Grantee shall not obtain copyright, patent, or other proprietary protection for the Deliverables without the written approval of the Division,
except that the Grantee shall reserve its rights in all methods, pre-existing work, software, and data used to prepare the
Deliverables. The Grantee shall not include in any Deliverables any copyrighted matter, unless the copyright owner and any
person, agency, or instrumentality providing financial assistance for the work performed under this Agreement gives prior written approval to use such copyrighted matter in the manner provided under this Agreement. The Grantee must identify in writing, prior to the start of work under this Agreement, any and all proprietary, copyrighted, and / or patented materials it intends to use.

B. The Grantee agrees that all Deliverables may be made freely available to the general public to the extent required by law.

C. This Section shall survive the termination of this Agreement and may be enforced by the Division in any court of competent

11 AVAILABILITY OF FUNDS: The obligations of the Division under this Agreement are subject to the determination by the Director of Budget and Management that sufficient funds have been appropriated by the General Assembly to the Division for the
purposes of this Agreement and to the certification of the availability of such funds by the Director as required by R.C. Section 126.07. The Division may suspend or terminate this Agreement if the General Assembly fails to appropriate funds or if federal grant
funds are not available for any part of the work under this Agreement.

12. AUDITOR RECOVERY FINDING - R.C. Section 9.24: The Grantee affirmatively represents and warrants to the Division that the Grantee is not subject to a finding for recovery under R.C. section 9.24, or that the Grantee has taken the appropriate remedial
steps required under R.C. section 9.24 or otherwise qualifies under that section. The Grantee agrees that if this representation
and warranty is false, the Agreement shall be void ab initio as between the parties to this Agreement, and any funds paid by the
Division hereunder shall be immediately repaid to the Division, or an action for recovery may be immediately commenced by the
Division for recovery of said funds.

13. GOVERNING CLAUSE: This Agreement and any claims arising out of this Agreement shall be governed by the laws of the State of Ohio. If any provision under this Agreement is later determined to be invalid or unenforceable, the remainder of this Agreement shall not be affected by such determination.


A. The Grantee or the Division may suspend or terminate this Agreement, with or without cause, by providing thirty (30) days
written notice to the other party. 

B. Any violations or breach of the terms stated herein, by the Grantee, shall provide the Division with the option of canceling this Agreement in its entirety, or withholding payment until such time as the violation or breach is remedied. Such option shall in no
way limit or exclude any other remedies available to the Division.
C. If either party fails to perform any of the requirements of this Agreement, or is in violation of a specific provision of this
Agreement, then the non-breaching party may suspend or terminate this Agreement if the breaching party fails to cure its 
non-performance or violation within ten (10) business days following delivery of written notice of the breach. In the case of late
payment by the  Division, however, the Grantee may not suspend or terminate this Agreement unless the payment is more than
sixty (60) days past due, and R.C. Section 126.30 shall apply.

D.  If this Agreement is suspended or terminated, the Grantee shall cease work on the suspended or terminated activities,
suspend or terminate all subcontractors relating to the suspended or terminated activities, take all necessary or appropriate
steps to limit disbursement and minimize cost, and, if requested by the Division, furnish a report describing the status of all work
under this Agreement, including results and conclusions accomplished, and such other matters as the Division may require.

The requirements in this paragraph shall occur in accordance with the following:

1. If the Agreement is suspended or terminated by the Division, the requirements in paragraph 16. D. of this Agreement shall
commence upon the date the Grantee receives notice of suspension or termination.

2. If the Agreement is suspended or terminated by the Grantee, the requirements in paragraph 16. D. of this Agreement shall
commence upon the date the Grantee sends notice of suspension or termination.

C.  If this Agreement is suspended or terminated, the Grantee, upon submission of a proper invoice, shall be entitled to
compensation which shall be calculated by the Division according to Paragraph 3 of this Agreement for the work performed prior
to the date on which the Grantee either receives notice of termination or suspension or sends notice of suspension or termination, whichever is applicable, less any funds previously paid by, or on behalf of, the Division.

Regardless of which party terminates the Agreement, any payments made by the Division in which services have not been
rendered by the Grantee shall be prorated and returned to the Division. Such payment(s) must be sent to the Division within
thirty (30) days of the date on which the Grantee either receives notice of termination or suspension or sends notice of
suspension or termination, whichever is applicable. The Division shall not be liable for any further claims.

15. ANTITRUST ASSIGNMENT: The Grantee assigns to the Division all State and Federal antitrust claims and causes of action
that relate to all goods and services provided for in this Agreement. Additionally, the State of Ohio will not pay excess charges
resulting from antitrust violations by the Grantee’s suppliers and subcontractors.

16. RECORD KEEPING: During the performance of this Agreement and for a period of three (3) years after its completion, the
Grantee shall maintain auditable records of all charges pertaining to this Agreement and shall make such records available to the Division, upon request. 

17. CHANGE OR MODIFICATION: This Agreement constitutes the entire agreement between the parties on the subject matter of
this Agreement. This Agreement supersedes all prior agreements, understandings, or representations, whether oral or written,
concerning the subject matter of this Agreement. Any changes or modifications of this Agreement shall be made and agreed to in writing. The provisions outlined in these Terms and Conditions shall take priority over any inconsistent or conflicting provisions included in the Grantee’s offer or quote, or any other provisions applicable to or incorporated into this Agreement.
18. DEBARMENT: The Grantee warrants that it is not currently subject to a finding by the Ohio Department of Administrative
Services debarring the Grantee from consideration for contract awards, and that Grantee does not currently appear on any federal or State of Ohio debarment list. In the event that, during the course of this Agreement, the Grantee is debarred from
consideration for the contract awards by the Ohio Department of Administrative Services, or otherwise appears on any federal or State of Ohio debarment list, then the Division may terminate this Agreement immediately.

19. FORCE MAJEURE: If the State or Grantee is unable to perform any part of its obligations under this Agreement by reason of force majeure, the party will be excused from its obligations, to the extent that its performance is prevented by force majeure, for
the duration of the event. The party must remedy with all reasonable dispatch the cause preventing it from carrying out its
obligations under this Agreement. The term “force majeure” means without limitation: acts of God, such as epidemics, lightning,
earthquakes, fires, storms, hurricanes, tornadoes, floods, washouts, droughts, any other severe weather, or explosions; restraint
of government and people; war; strikes; and other like events or any other cause that could be not reasonably foreseen in the
exercise of ordinary care, and that is beyond the reasonable control of the party.