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ā€¢ <br />i <br />Dā€”M A. To Fill Out This Applicatlon: complete all sections which correspond with the type of proposed project <br />Gen oral Application Sections: <br />pp. 1-6: All Applicants must complete these sections <br />Environmental Review: <br />pp. 7-10: Ali Applicants must complete these sections <br />Main lenanceAgreemenf: <br />p. 11: Anyapplications involving public property, public ownership, or management <br />of property <br />Acquisitfon Worksheet: <br />pp.12-14: AcgWsitlon Projects only -- one worksheet per structure <br />Elevation Werksheet. <br />pp,15.19: Elevation Projects only-- one worksheet per structure <br />Drainage Worksheot: <br />p. 20: Drainage Projects only <br />Wind Retrofit Worksheet: <br />pp. 21-22: Wind reirokt projects only (HMGP only) -- one worksheet per structure <br />Attachment A., <br />FEMA farm 9049 (Request for Public Assistance): All Applicants must complete, <br />if applicable. <br />Attachment B: <br />HMGPCFMAApplication Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />B, Applicant tnformation <br />FEMA-i3QQ-DRFL Dlsmter name: Hurricarrc Fla.1 <br />Title/ Brief Descriptive Project Summary: Shelter retrofits to increase the county's shelter capacity, <br />1.Applicant (Organization): Indian River County Department of Emergency Services <br />2. Applicant Type: N State or Local Government ā‘ Recognized Native American Tribe ā‘ Private Non -Profit <br />3. County: Indian River <br />4. Slate Legislative di;strict(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): 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'. NCA <br />% Paint of Contact <br />OMs. VMr. DMrs. First flame: Nathan Last Name: McCallum <br />Title: Emergency Management Coordinator <br />Street Address: 1840 26"' 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): ircesnaticsunet- net <br />11. Application Prepared by: <br />oMs. OMr, QMrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Tetephone: 561 567.8000 Ext. 289 Fax: 561 770-5417 <br />12, Authorized Applicant Agent (proof of authorization authority required) <br />oMs. OMr. []Mrs. First Name: Douglas Last Name: Wright <br />Title, Director Telephone: _ (561) 567-8000, Exl. 2251 Fax: (561) 770-5017 <br />Street Address: _ 1840 261h Street <br />City: Vero Be ch State: Florida Zip Code: 3296D <br />Signature Date <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 />