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GRANT NAME: Hazardous Analysis Grant GRANT # 15 -CP -11-10-40-01-000 AMOUNT OF GRANT: $ 3,029.00 DEPARTMENT RECEIVING GRANT: Emergency Services CONTACT PERSON: John King PHONE NUMBER: 772-22 1. How long is the grant for? 1 year Starting Date: July 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? Yes X No If yes, does the grant allow the match to be In Kind Services? Yes X No 4. Percentage of match N/A 0% 5. Grant match amount required $ N/A 6. Where are the matching funds coming from (i.e. In Kind Services; Reserve for Contingency)? N/A 7. Does the grant cover capital costs or start-up costs? N/A 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) $N/A 8. Are you adding any additional positions utilizing the 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 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 /A 10. What is the estimated cost of the grant to the county over five years? $ Grant Other Match Costs Amount Not Covered Match Total First Year $3,029.00 $ N/A $ N/A $3,02 .00 Second Year $N/A $ $ $N/A Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ $ $ $ Signature of Preparer: Date: October 30, 2014 166