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GRANT NAME: EMPA Grant GRANT#16-BG-83-10-40-01-030 <br /> AMOUNT OF GRANT:$ 105,806.00 <br /> DEPARTMENT RECEIVING GRANT: Emergency Services <br /> CONTACT PERSON- John King PHONE NUMBER: 772-226-3859 <br /> 1. How long is the grant for? 1 year Starting Date: July I,2015 <br /> 2. Does the grant require you to fund this function after the grant is over? Yes X No <br /> 3 Does the grant require a match? Yes X No <br /> If yes,does the grant allow the match to be In Kind Services? Yes X No <br /> 4. Percentage of match N/A 0% <br /> 5. Grant match amount required$ N/A <br /> 6. Where are the matching funds coming from(i.e. In Kind Services;Reserve for Contingency)?N/A <br /> 7. Does the grant cover capital costs or start-up costs? N/A Yes No <br /> If no,how much do you think will be needed in capital.costs or start up costs <br /> (Attach a detail listing of costs) $ N/A <br /> 8. Are you adding any additional positions utilizin the grant funds? Yes X No <br /> If yes,please list. (If additional space is needed-please attach a schedule.) <br /> Acct. Description Position Position Position Position Position <br /> 011 12 Regular Salaries N/A N/A N/A N/A N/A <br /> 011.13 Other Salaries&Wages(PT) N/A N/A N/A N/A N/A <br /> 012.11 Social Security N/A N/A N/A N/A N/A <br /> 012.12 Retirement-Contributions N/A N/A N/A N/A N/A <br /> 012.13 Insurance-Life&Health N/A N/A N/A N/A N/A <br /> 012.14 Worker=s Compensation N/A N/A N/A N/A N/A <br /> 012.17 S/Sec.Medicare Matching N/A N/A N/A N/A N/A <br /> TOTAL N/A N/A N/A N/A N/A <br /> 9. What is the total cost of each position including benefits,capital,start-up,auto expense,travel and operating? <br /> Salary and Benefits Operating Costs Capital Total Costs <br /> N/A N/A N/A N/A <br /> N/A N/A N/A N/A <br /> N/A N/A N/A N/A <br /> N/A N/A N/A N/A <br /> N/A N/A N/A N/A <br /> 10. What is the estimated cost of the grant to the county over five years?$ N/A <br /> Grant Other Match Costs <br /> Amount ve ed Match <br /> First Year $N/A $N/A $N/A $N/A <br /> Second Year $N/A $N/A $N/A $N/A <br /> Third Year $N/A $N/A $N/A $N/A <br /> Fourth Year $N/A $N/A $N/A $N/A <br /> Fifth Year $N/A $N/A $N/A $N/A <br /> Signature of Preparers ,f - Date: September 25,2015 <br /> 0 <br /> 66 <br />