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GRANT NAME: Florida Blue Foundation — Park Based Programming for Seniors GRANT # AMOUNT OF GRANT: $198.908 DEPARTMENT RECEIVING GRANT: GSA/Parks and Recreation CONTACT PERSON: Kevin M. Kirwin TELEPHONE: 772.226.1785 1. How long is the grant for? 3 Years 2. Does the grant require you to functthis function after the grant is over? 3. Does the grant require a match? If yes, does the grant allow the match to be In -Kind services? 4. Percentage of match to grant 0% 5. Grant match amount required $0 Starting Date: February 9, 2021 Yes X No 6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? N/A Yes X No Yes X No 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? X Yes 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 27,480 011.13 Other Salaries & Wages (PT) $0 012.11 Social Security 2,102 012.12 Retirement — Contributions 2,748 012.13 Insurance — Life & Health 13,260 012.14 Worker's Compensation 9.98 012.17 S/Sec. Medicare Matching 401 $ TOTAL 46,001 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 121,804 17,104 60,000 198,908 $101,000 $0 $0 $101,000 Second Year $62,000 $0 $0 $62,000 Third Year $35,905 $0 10. What is the estimated cost of the grant to the county over five years? -$0 Signature of Preparer: K kim Date: ;zeLv Grant Amount Other Match Costs Not Covered Match Total First Year $101,000 $0 $0 $101,000 Second Year $62,000 $0 $0 $62,000 Third Year $35,905 $0 $0 $35,905 Fourth Year $ $ 1 $ $ Fifth Year $ IZI 1 $ 1 $ $ Signature of Preparer: K kim Date: ;zeLv