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GRANT NAME: Shelter Plus Care Grant - 2010 Chronics Renewal GRANT # FL0360C411091001 AMOUNT OF GRANT: $ 99,000 DEPARTMENT RECEIVING GRANT: Treasure Coast Homeless Services Council, Inc. CONTACT PERSON: Louise Hubbard TELEPHONE: 567-7790 1. How long is the grant for? One year Starting Date: April 1, 2011 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 No 4. Percentage of match to grant % 5. Grant match amount required 6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? 7. Does the grant cover capital costs or start-up costs? _ _ Yes X 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 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 011.13 Other Salaries & Wages (PT) 012.11 Social Security 012.12 Retirement — Contributions 012.13 Insurance — Life & Health 012.14 Worker's Compensation 012.17 S/Sec. Medicare Matching $ TOTAL 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 10. What is the estimated cost of the grant to the county over five years? Signature of Preparer: Date: March 8, 2011 35 Grant Amount Other Match Costs Not Covered Match Total First Year $ 99,000 $ $ $ Second Year. $ $ $ $ Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ $ $ $ Signature of Preparer: Date: March 8, 2011 35