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Attachment A <br />(Submit one (1) sheet for each vessel requested in grant application) <br />Derelict Vessel Data Sheet <br />Law Enforcement Case Number: FWC21ON0006601 <br />County of Vessel's Location: Indian River <br />Has the vessel's owner or responsible party been charged with a violation of NO <br />either Section 823.11, F.S. or Section 376.15, F.S.? <br />If the vessel's owner or responsible party has not been charged with a violation <br />of Section 823.11, F.S. or section 376.15, F.S., did law enforcement request that NO <br />the State Attorney file charges directly? <br />Describe the vessel's location: (example: Vessel is in shallow water within mangroves at boat ramp. <br />West shoreline of the Indian River Lagoon, just outside the ICW at channel marker 50. <br />Vessel Coordinates: (Degrees -Decimal Minutes) <br />Has law enforcement officer issued a Letter of Removal Authorization: <br />Vessel Color: <br />Vessel Length: <br />Vessel Registration: <br />Investigating Agency: <br />Photo of Vessel: (include photos as attachment in this tab) <br />Select Removal Type: <br />Are there pollutants on the vessel requiring removal? <br />Is the vessel located in or above seagrass or coral? <br />Vessel Removal Cost (Include contractors written quote for the vessel) <br />Contractor's Name: <br />Contractor's Address: <br />Contractor's Phone <br />(N) 27.617345 <br />(w) -80.831247 <br />YES <br />Blue <br />32 <br />FL4188CB <br />FWC <br />YES <br />BULK REMOVAL <br />NO <br />NO <br />4,800.00 <br />Outlaw Maritime LLC <br />7673 Lakeview Dr. West Melbourne, FL 32904 <br />321 480-2975 <br />FWC/DV-APP (Feb 2020) 12 Rule 68-1.003 <br />