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GRANT NAME: IRC/SJRWMD Countywide Well -Plugging Cost -Share Agreement GRANT # Contract # 31748 <br />AMOUNT OF GRANT: $20,000 <br />DEPARTMENT RECEIVING GRANT: Community Development <br />CONTACT PERSON: Roland M. DeBlois TELEPHONE: ext. 125.8 <br />1. How long is the grant for? Three years (to September 30, 2020) <br />2. Does the grant require you to fund this function after the grant is over? <br />3. Does the grant require a match? <br />If yes, does the grant allow the match to be In -Kind services? <br />4. Percentage of match to grant 50% <br />5. Grant match amount required S70,000 <br />Starting Date: October 2017 <br />_Yes X No <br />X Yes No <br />Yes X No <br />6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? <br />MSTU Contingencies (FY2017-18): PlanningXode Enforcement Budget Account# 00420724-033190 under "Professional <br />Services" (FY 2018-19. FY 2019-20) <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: $N/A <br />(Attach a detail listing of costs) <br />8. Are you adding any additional positions utilizing the grant funds? Yes 2L_No <br />If yes, please list. (If additional space is.needed,.please attach a schedule.) <br />Acct. <br />Description Position Position Position Position Position <br />011,12 <br />Regular Salaries <br />011.13 <br />Other Salaries & Wages (PT) <br />012.11 <br />Social Security <br />012.12 <br />Retirement — Contributions <br />012.13 <br />Insurance — Life & Health <br />012.14 <br />Worker's Compensation <br />012.17 <br />S/Sec. Medicare Matching <br />$20,000 <br />TOTAL <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 />10. What is the estimated cost of the grant to the county over five years? $0,000 <br />Signature of Preparer: Date: <br />// I <br />P70 <br />Grant Amount <br />Other Match Costs Not Covered <br />Match <br />Total <br />First Year <br />$20,000 <br />$ <br />$20,000 <br />$40,000 <br />Second Year <br />$20,000 <br />$ <br />$20,000 <br />$40,000 <br />Third Year <br />$20,000 <br />$ <br />$20,000 <br />$40,000 <br />Fourth Year <br />$ <br />$ <br />$ <br />$ <br />Fifth Year <br />$ <br />$ <br />$ <br />$ <br />Signature of Preparer: Date: <br />// I <br />P70 <br />