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GRANT NAME: Community Emergency Response Team(CERT)Grant GRANT# 15-CI-XX-XX-XX-XX-XXX <br /> AMOUNT OF GRANT:$ 5.461.00 <br /> DEPARTMENT RECEIVING GRANT: Emergency Services <br /> CONTACT PERSON: John King PHONE NUMBER: 226-3859 <br /> 1. How long is the grant for? 9 months Starting Date: January 13,2015 (Ul2on Execution of <br /> rant <br /> 2. Does the grant require you to fund this function atter 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 No <br /> 4. Percentage of match N/A 0% <br /> 5. Grant match amount required$ Yes <br /> 6. Where are the matching funds coming from(i.e. In Kind Services; Reserve for Contingency)? In Kind Services <br /> 7. Does the grant cover capital costs or start-up costs? 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) $ <br /> 8. Are you adding any additional positions utilizingthe grant funds? Yes X No <br /> If yes,please list. (If additional space is neededplase attach a schedule.) <br /> Acct. Description Position Position Position Position Position <br /> 011.12 Regular Salaries N/A <br /> 011.13 Other Salaries&Wages(PT) N/A <br /> 012.11 Social Security N/A <br /> 012.12 Retirement-Contributions N/A <br /> 012.13 Insurance-Life&Health N/A <br /> 012.14 Worker=s Compensation N/A 10 <br /> 012.17 S/Sec. Medicare Matching N/A <br /> TOTAL 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 /> 10. What is the estimated cost of the grant to the county over five years?$ <br /> Grant Other Match Costs <br /> Amount Not Covered Match Total <br /> First Year $5,461.00 $ N/A $ N/A $5,461.00 <br /> Second Year $ N/A $ $ $ N/A <br /> Third Year $ $ $ $ <br /> Fourth Year $ $ $ $ <br /> Fifth Year $ IF $ $ $ <br /> /' . , <br /> Signature of Preparer: kM _ Date: January 5.2015 <br /> r , <br /> 114 <br />