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FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2021-2022 EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT - EMPA <br />DIVISION FORM 4 - STAFFING DETAIL <br />COUNTY EMERGENCY MANAGEMENT AGENCY <br />ANTICIPATED SALARIES & BENEFITS <br />SUB -RECIPIENT: FL COUNTY <br />POINT OF CONTACT: Jane Doe, Planner I PHONE/EMAIL: 1231231234 <br />EMPLOYEE INFORMATION <br />LOCAL <br />STATE AND FEDERAL <br />Employee Name, Position Title & Appmx. # of Annual <br />Area of Responsibility Hrs. per week Total Salaries <br /># (Preparedness, Response, Recovery,General <br />Demoted to EM ' <br />Affigadon 8 finance & Benefits $ <br />adiHties by Position <br />I11 2 3 <br />% % <br />County Other <br />Fund Local <br />(Local) Funds <br />4 <br />% $ % $ % % % <br />EMPA EMPA EMPG EMPG HMGP Other Total <br />"- Planning State or <br />Base Grant Base Grant Base Grant Base Grant Grant Federal All <br />(State) (State) (Federal)_ (Federal) (State) Funds Funds <br />6 (7) 181 Ig) 1101 111]12 <br />1 Ex Jane Doe, Director, ALL 40 $ 60,000.00 <br />50% $30,000.00 50% $30,000.00 100% <br />2 <br />$ $0.00 0% <br />3 <br />$ $0.00 0% <br />4 <br />$ $0.00 0% <br />5 <br />$ $0.00 0% <br />6 <br />$ $0.00 0% <br />7 <br />$ $0.00 0% <br />8 <br />$ $0.00 0% <br />9 <br />$ $0.00 .0% <br />10 <br />$ $0.00 0% <br />11 <br />$ $0.00 0% <br />12 <br />$ $0.00 0% <br />13 <br />$ $0.00 0% <br />14 <br />$ $0.00 0% <br />15 <br />$ $0.00 0% <br />16 <br />$ $0.00 0% <br />17 <br />$ $0.00 0% <br />18 <br />$ $0.00 0% <br />19 <br />$ $0.00 0% <br />20 <br />$ $0.00 0% <br />TOTAL $30,000.00 $30,000.00 <br />DIRECTIONS: <br />1. In Column #1, list the name, position title and area of responsibili (s)for all Emergency Management staff, regardless if paid through grant funding. <br />2. M Column #2, enter the amount of anticipated hours worked per week for grant related activities for each EM position. <br />3. In Column #3, list total anticipated annual amount of Salaries and Benefits to be paid for each EM position. <br />4. In Columns #4-11, provide fire funding distribution (% or $) in each applicable column. <br />5. Column #12 calculates the sum of percentages entered in Columns 4 - 11 and must equal 100% of the anticipated annual salaries and benefits per EM position. <br />6. Please provide to the Division updates or revisions to this form throughout the period of the agreement, as necessary. <br />J: <br />7. This forth is to be submitted to the Division along with the 1st Quarter submission or by November 15 2021 whichever occurs first I I I <br />67 <br />