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GRANT NAME: EMPG Grant GRANT#I 8-FG-XX-10-40-01-XXX AMOUNT OF GRANT:$ 77,858.00 DEPARTMENT RECEIVING GRANT: Emergency Services CONTACT PERSON: John King PHONE NUMBER: 772-226-3859 1. How long is the grant for? 1 year Starting Date: July 1,2017 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 startup 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 N/A N/A N/A N/A 011.13 Other Salaries&Wages(PT) N/A N/A N/A N/A N/A 012.11 Social Security N/A N/A N/A N/A N/A 012.12 Retirement-Contributions N/A N/A NIA N/A N/A 012.13 Insurance-Life&Health N/A N/A N/A N/A N/A 012.14 Worker's Compensation N/A N/A N/A N/A N/A 012.17 S/Sec.Medicare Matching N/A N/A N/A N/A N/A TOTAL N/A N/A N/A N/A 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 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 10. What is the estimated cost of the grant to the county over five years?S N/A Grant Other Match Costs First Year $N/A $N/A S N/A $N/A Second Year S N/A $NIA $N/A S N/A Third Year $N/A S N/A S N/A $N/A Fourth Year S N/A $N/A $N/A $N/A Fifth Year $N/A / $N/A S N/A S N/A Signature of Preparer: \t _, Date: August 2,2017 P42