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GRANT NAME: -a-� e -k d +o GRANT # <br />AMOUNT OF GRANT: g rj , S N I �S+1 YYI Gt I <br />DEPARTMENT RECEIVING GRANT:( {_ � cSP.VVI�2S �L,bra� (Wour, <br />-I' Geu 00 - 103 <br />CONTACT PERSON: TELEPHONE: <br />1. How long is the grant for? l- `f ` eatl Starting Date: W -D ber <br />2. Does the grant require you to fund this function after the grant is over? YesNo <br />3. Does the grant require a match? Yes �1Vo <br />If yes, does the grant allow the match to be In -Kind services? Yes _No <br />4. Percentage of match to grant % <br />5. Grant match amount required S <br />6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? <br />7. Does the grant cover capital costs or start-up costs? Yes No <br />If no, how much do you think will be needed in capital costs or start-up costs: $ <br />(Attach a detail listing of costs) <br />8. Are you adding any additional positions utilizing the grant funds? Yes 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 />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? $ <br />Grant Amount Other Match Costs Not Covered Match Total <br />