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GRANT NAME: EMS County Grant AMOUNT OF GRANT: 524,659.00 DEPARTMENT RECEIVING GRANT: Fire Rescue GRANT # C60 CONTACT PERSON: Brian Burkeen TELEPHONE: 772-226-3864 1. How long is the grant for? I Year Starting Date: December 16, 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 No 4. Percentage of match to grant 0 % 5. Grant match amount required S 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? 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? If yes, please list. (If additional space is needed, please attach a schedule.) X Yes No S Yes X No Acct. Description Position Position Position Position Position 011.12 Regular Salaries 011.13 Other Salaries g Waees (PT) 012.11 Social Security 012.12 Retirement — Contributions 012.13 Insurance — Life R Health 012.14 Worker's Compensation 012.17 S/Sec. Medicare Matching S 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 $24,659.00 S24659.00 Total First Year S24.659.00 S6.00 S 0.00 S24,659.00 Second Year S 10. What is the estimated cost of the grant to the county over five years? _ Grant Amount Other Match Costs Not Covered Match Total First Year S24.659.00 S6.00 S 0.00 S24,659.00 Second Year S S S S Third Year S S S S Fourth Year S S S S Fifth Year S S S S Signature of Preparer: t Date: November 3, 2017 P99