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40 <br />A. To Fill Out This Application: complete all sections which correspond with the type of proposed project <br />General Application Sections: <br />Environmental Review: <br />pp.1.6: All Applicants must complete ttlese sections <br />pp. 7-10: All Applicants must complete these sections <br />Ma in tenance Agra emen 1: <br />p. 11: Anyapplications involving public properly, public Ownership, or management <br />Acquisition Worksheot: <br />of property <br />pp.12-14: Acquisition projects only-- one worksheet per structure <br />Elevation Worksheet: <br />pp.15-19: ,Elevation projects only-- one worksheot per structure <br />Drainage Worksheet: <br />Wind Retrofit Worksheat: <br />p. 20: Drainage projects only <br />pp. 21-22: Wind relrofrf projetcfs only (NMGP only) — one worksheet per structure <br />Attachment A: <br />FEMA Form 90-49 (Request for Public Assistance): All Applicants roust complete, <br />Attachment B: <br />if applicable. <br />HMGPIFMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />U. Applicant informattaai. <br />FEMA -L300 -UR -FL Disaster name: thirdeane Ptopd <br />Title I Brlof Dascriptive Project Summary: Shelter retrofits to i )creaso the count 's Shelter cggq l(V. <br />1.Applicant (Organization): Indian River Count De artment of Emer enc Services <br />2, Applicant Type: C9 State or Local Government ❑ Recognized Native American Tribe 11 Private Nan -Profit <br />3- County: Indian River <br />4, State Legislative district(s):-A-0 Congressional District(s): _L5_ <br />5. Federal Tax I.D. Number: 59-6000674 <br />6. FIPS Code: 061-9906100 <br />7. National Flood Insurance program (NFif') Community Identification Number (this number can be obtained from the <br />FIRM map for your area): 120119 <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 />uMs. MMr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emer enc Mana ement Coordinator <br />Street Address: 11340 2V' 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): ircesna sunet,net <br />11. Application Prepared by; <br />❑Ms. KMr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emorgengy Man errant Coordinator <br />Telephone:561 567-8000,,Ex1.289 Fax:, (551]770.5017 <br />12. Authorized Applicant Agent (proof of authorization authority required) <br />RMs. '0Mr. ciMrs. First Name: --[2 ou las Last Name: Wright <br />Title: Director Telephone: 561 567.8000 Ext. 225 Fax (561 ) 770.5017 <br />Street Address: 1840 25i' Str at <br />City: Ver Beach Sta e: Florida Zip Code: 32960 <br />SignatureDate <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 115 <br />