Laserfiche WebLink
40 <br />L:: <br />A. To Fill Out This Application: complete all sections which correspond with the type of proposed project <br />General Application Sections: pp. 1-6: All Applicants must complete these sections <br />Environmental Review: pp. 7-10: All Applicants must complete these sections <br />iWaintenance Agreement: p. 11: Any applications involving public property, public ownership, or management <br />of property <br />Acquisition Worksheet: pp. 12-14: Acquisition Projects only -- one worksheet per structure <br />Elevation Worksheet: pp.15-19: Elevation Projects only -- one worksheet per structure <br />Drainage Worksheet: p. 20: Drainage Projects only <br />Wind Retrofit Worksheet: pp. 21-22: Wind retrofit projects only (IIMGP only) — one worksheet per structure <br />Attachment A: FEMA Form 90-49 (Request for Public Assistance): All Applicants must complete, <br />if applicable. <br />Attachment B: HMGP/FMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />B. Applicant Information <br />FEMA -1300 -DR -Fl. Disaster name: Hurricane Floyd <br />Title I Brief Descriptive Project Summary: Shelter retrofits to increase the county's shelter capacity. _ <br />1.Applicant (Organization): Indian River County Department of Emergencv Services <br />2. Applicant Type: ® State or Local Government ❑ Recognized Native American Tribe ❑ Private Non -Profit <br />3. County: Indian River <br />4. State Legislative district(s): 80 Congressional District(s): 15 <br />5. Federal Tax I.D. Number: 59-6000674 <br />6. FIPS Code: _ 061-9906100 <br />7. National Flood Insurance Program (NFIP) Community Identification Number (this number can be obtained from the <br />FIRM map for your area): 12.0119 <br />8. NFIP Community Rating System Class Number: 7 <br />9. Attach proof of current Flood Insurance Policy (FMA only). Flood Insurance Policy Number: NIA <br />10. Point of Contact <br />❑Ms. ®Mr. []Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Street Address: 1840 25" Street <br />City: Vero Beach State: Florida Zip Code: 32960 <br />Telephone: _ 561 567-8000, Ext. 289 Fax: (561) 770-5017 <br />Email Address (if available): ircesnat(cbsunet net <br />11. Application Prepared by: <br />[]Ms. UMr. []Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Telephone: (561) 567-8000, Ext. 289 Fax: (561) 770-5017 <br />12, Authorized Applicant Agent (proof of authorization authority required) <br />Ws. ®Mr. []Mrs. First Name:__Douglas Last Name: Wright <br />Title: Director Telephone: (561)567-8000, Ext. 225) Fax: (561)770-5017 <br />Street Address, 1840 25" Street <br />City: _ Vero Beach S te: ` Florida_ Zip Cade: 32960 <br />Signature__ M _ Date—ZO_�3%—�U <br />13. All proposed projects should be included in the county's Local Mitigation Strategy (LMS), please attach a letter of <br />endorsement for the project from the county's Local Mitigation Strategy Coordinator. (See endorsement attached). <br />Page 3 of 15 <br />