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GRANT NAME: EMPG Grant GRANT# 13-FG-XX-10-40-01-098 <br /> AMOUNT OF GRANT:$ 74 416.00 <br /> DEPARTMENT RECEIVING GRANT: Emergency Services <br /> INTACT PERSON: John King PHONE NUMBER: 772-567-8000 ext 3859 <br /> 1. How long is the grant for?__ 1 year Starting Date: July 1,2012 <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 an additional positions utilizing 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&NX-rages(PT) N/A 1_`ILA 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 /> 12.17 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 Not Covered Match Total <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 /> -awignature of Preparer: Date:_ December 7,2012 <br /> 93 <br />