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GRANT NAME: Library Services and Technology Grant GRANT # AMOUNT OF GRANT: $9,646 DEPARTMENT RECEiVING GRANT: General Services/Libray Servi:cZ CONTACT PERSON: Tracey L. Wehking { 1. How long is the grant for? 15 months Starting Date: July 1, 2020 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 Y Nn If yes, does the grant allow the match to be In -Kind services? Yes No 4. Percentage of match to grant _. % 5. Grant match amount required $ 6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? 7. Does the grant cover capital costs or start-up costs? x _Yes No 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? Yes x ---No If yes, please list. (If additional space is needed, please attach a schedule.) Acct. Description Position Position Position Position Position 011.12 Regular Salaries 011.13 Other Salaries & Wages (PT) 012.11 Social Security 012.12 1 Retirement — Contributions 012.13 Insurance — Life & Health 012.14 Worker's Compensation 012.17 S/Sec. Medicare Matching $ 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 10. What is the estimated cost of the grant to the county over five years? I Signature of Preparers Date: Grant Amount Other Match Costs Not Covered Match Total First Year $ $ $ $ Second Year $ $ $ $ Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ $ $ $ Signature of Preparers Date: