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GRANT NAME: Emergency Management Preparedness Assistance Grant (EMPA) GRANT # 16 -BG -83-10-40-01-030 AMOUNT OF GRANT- $ 10.000.00 Modification DEPARTMENT RECEIVING GRANT- Emergencv Services CONTACT PERSON. _John King PHONE NUMBER: 226-3859 Description 1. How long is the grant for? 12 months Starting Date: (Upon Execution) June 7 2016 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 N/A 0% N/A 5. Grant match amount required $ N/A 01 6. Where are the matching funds coming from (i.e. In Kind Services; Reserve for Contingency)?_ Social Security 7. Does the grant cover capital costs or start-up costs? Yes No If no, how much do you think will be needed in capital costs or start up costs 012.12 (Attach a detail listing of costs) $ N/A 8. Are you adding any additional positions utilizingthe 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 N/A 10 011.13 Other Salaries & Wages (PT) N/A $ 01 012.11 Social Security N/A $ $ 012.12 Retirement -Contributions N/A $ $ 012.13 Insurance -Life & Health N/A $ $ 012.14 Worker=s Compensation N/A 10 012.17 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 N/A $ N/A $ 10,000.00 Second Year $ N/A $ $ $ N/A Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ 1 r $ $ $ 10. What is the estimated cost of the grant to the county over five years? Signature of Preparer: Date- May 31 2016 64 Grant Amount Other Match Costs Not Covered Match Total First Year $ 10,000.00 odificatio $ N/A $ N/A $ 10,000.00 Second Year $ N/A $ $ $ N/A Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ 1 r $ $ $ Signature of Preparer: Date- May 31 2016 64