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GRANT <br />NAME: Hazardous. Analvsis Grant GRA\fi 9 19 -CP -11 -10 -40 -01 -XXX <br />AMOUNT OF GRANT: $ 3,143.00 <br />.Position <br />DEPARTMENT RECEIVING GRANT: Emergency Services <br />Position <br />CONTACT PERSON: Tad Stone PHONE NUMBER: _ <br />772-226-3859 <br />I. <br />How long is the grant for?. 1 year Starting Date: Inty 1.2019 <br />Second Year <br />2. <br />Does the grant require you to fund this function after the grant is over? Yes <br />X No <br />3. <br />goes the grant require a match? - Yes <br />X No <br />S <br />If yes, does the grant allow the :match'to be In Kind Services? Yes <br />X No <br />4. <br />Percentage of match N/A 0% <br />Social Security <br />5. <br />Grant match amount required S N/A <br />6. <br />Where are the matching funds coming from (i.e. In Kind Services; Reserve for Contingency)? N/A. <br />012.12 <br />7. <br />Does the grant cover capital costs or start-up costs?. Yes <br />No <br />S <br />If no, how much do you think will be needed in capital costs or start up costs <br />012.13 <br />(Attach a detail listing of costs) SNIA <br />N/A <br />8. <br />Are you adding an additional positions utilizin the grant funds? Yes <br />1'f list. is needed <br />X No <br />yes, please (yIf additional space please attach a schedule.) <br />Worker's Compensation <br />Acct. <br />Description <br />Position <br />.Position <br />Position <br />Position <br />Position <br />01.1.12 <br />Regular Salaries <br />N/A <br />Second Year <br />SN/A <br />$ <br />0I 1.13 <br />Other Salaries & Wages (PT) <br />N/A <br />S <br />$ <br />S <br />012'11 <br />Social Security <br />N/A <br />$ <br />S <br />S <br />012.12 <br />'Retirement -Contributions <br />N/A <br />S <br />S <br />012.13 <br />Insurance -Life & Health <br />N/A <br />012.14 <br />Worker's Compensation <br />N/A <br />012.17 <br />S/Sec. Medicare Matching <br />N/A <br />TOTAL <br />N/A <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 />Operating Costs <br />Capital <br />Total Costs <br />NIA <br />N/A <br />N/A <br />N/A <br />S N/A <br />$3,143.00 <br />Second Year <br />SN/A <br />$ <br />$ <br />$N/A <br />Third Year <br />S <br />$ <br />S <br />S <br />Fourth Year <br />S <br />$ <br />S <br />S <br />Fifth Year <br />S <br />S <br />S <br />S <br />10. What is the estimated cost of the grant to the county over five years'. S <br />Signature of.Preparer; &/ fq, Date: August 16, 2018 <br />130 <br />Grant <br />Amount <br />Other Match Costs <br />Not CoveredMatch <br />First Year <br />$3,143.00 <br />$ NI/A <br />S N/A <br />$3,143.00 <br />Second Year <br />SN/A <br />$ <br />$ <br />$N/A <br />Third Year <br />S <br />$ <br />S <br />S <br />Fourth Year <br />S <br />$ <br />S <br />S <br />Fifth Year <br />S <br />S <br />S <br />S <br />Signature of.Preparer; &/ fq, Date: August 16, 2018 <br />130 <br />