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GRANTNAIME: EMPA Grant <br />AMOUNT OF GRANT: S 115 806.00 <br />DEPARTMENT RECEIVING GRANT: Emergency Services <br />CONTACT PERSON: Tad Stone PHONE <br />GRANT#19-BG-XX-XX-XX-XXX <br />NUMBER: 772-226-3859 <br />1. How long is the grant for? 'I year <br />Starting Date: <br />July 1, 2018 <br />2. Does the grant require you to fund this .function after the grant is over? <br />Yes <br />X No <br />3. Does the grant require a match? <br />Yes <br />X No <br />If yes, does the grant allow the match to be In Kind Services? <br />Yes <br />X No <br />4. Percentage of match N/A 0% <br />Other Salaries & Wages (PT) <br />N/A <br />5. Grant match amount required S N/A <br />N/A <br />N/A <br />6. Where are the matching funds coming from (i.e. In Kind Services, Reserve for Contingency)? N/A <br />012.11 <br />7. Does the grant cover capital costs or start-up costs? N/A <br />Yes <br />No <br />If no, how much do you think will be needed in capital costs or startup costs? <br />N/A <br />N/A <br />(Attach a detail listing of costs) <br />S N/A <br />N/A <br />8. Are you adding any additional positions utilizing the grant funds? <br />If yes, please list (If additional space is needed; please attach a schedule.) <br />Yes X <br />No <br />Acct. <br />Description <br />Position <br />Position <br />Position <br />Position <br />Position <br />011.12 <br />Regular Salaries <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />011.13 <br />Other Salaries & Wages (PT) <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />012.11 <br />Social Security <br />NIA <br />N/A <br />N/A <br />N/A <br />N/A <br />012.12 <br />Retirement -Contributions <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />012.13 <br />Insurance -Life & Health <br />N/A <br />NIA <br />N/A <br />N/A <br />N/A <br />012.14 <br />Worker's Compensation <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />012.17 <br />S/Sec. Medicare Matching <br />N/A <br />N/A <br />N/A . <br />N/A <br />N/A <br />TOTAL <br />N/A <br />N/A <br />N/A <br />N/A <br />NIA <br />9. What is the total cost of each position including benefits, capital, start-up, auto expense, travel and operating? <br />Salary and Benefits <br />O erating Costs <br />Capital <br />Total Costs <br />NIA <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />NIA <br />NIA <br />NIA <br />N/A <br />N/A <br />N/A <br />N/A <br />NIA <br />N/A <br />N/A <br />N/A <br />NIA <br />10. What is the estimated cost of the grant to the county over five years? S NIA <br />Signature of Preparer:l t^" Date: May 15. 2018 <br />69 <br />Grant <br />Other :Match Costs <br />First Year <br />S N/A <br />S N/A <br />$ NIA <br />N/A <br />Second Year <br />S NIA <br />S N/A <br />$ N/A <br />S N/A <br />Third Year <br />$ NIA <br />S N/A <br />S N/A <br />S N/A <br />Fourth Year <br />$ N/A i <br />$ N/A <br />S N/A <br />S N/A <br />Fifth Year <br />S N/A I 1 <br />5 N/A <br />N/A <br />S N/A <br />Signature of Preparer:l t^" Date: May 15. 2018 <br />69 <br />