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GRANT NAME. Community Emergency Response Team(CERT)Grant GRANT# not assigned , i AMOUNT OF GRANT:$ 3,392.00 DEPARTMENT RECEIVING GRANT: Emergency Services 11 CONTACT PERSON:_ John Kine PHONE NUMBER: 226-3859 1. How long is the grant for? 24 months Starting Date: October 1.2014 2. Does the grant require you to fund this function after the grant is over? Yes X No 3 Does the grant require a match? X Yes No If yes,does the grant allow the match to be In Kind Services? X Yes No 4 Percentage of match 100 % 5. Grant match amount required$ N/A 6. Where are the matching funds coming from(i.e. In Kind Services;Reserve for Contingency)? In Kind Services 7 Does the grant cover capital costs or start-up costs? Yes No If no,how much do you think will be needed in capital costs or start up costs (Attach a detail listing of costs) $ 8. Are you adding any additional positions utilizingthe grant funds? Yes X No , If yes,please list. (If additional space is needed-,please attach a schedule.) Acct. Description Position Position Position Position Position 011.12 Regular Salaries N/A 011.13 Other Salaries&Wages(PT) N/A 012.11 Social Security N/A 1 012.12 Retirement-Contributions N/A 012.13 Insurance-Life&Health N/A 012.14 Worker=s Compensation N/A 012.17 S/Sec.Medicare Matching N/A TOTAL N/A 9. What is the total cost of each position including benefits,capital,start-up,auto expense,travel and operating? Salary and Benefits Operating Costs Capital Total Costs N/A N/A N/A N/A 10. What is the estimated cost of the grant to the county over five years?$ Grant Other Match Costs Amount Not Covered Match First Year $3,392.00 $ N/A $ N/A $3,392.00 Second Year $ N/A $ $ $ N/A Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ $ $ $ Signature of Preparer: a YAlt Date. September 28 2015 60