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I— I <br />• <br />A. To 11111 Out Tills Application; complete all sections which correspond with the typo of proposed project <br />CeneraI Application Sections: <br />pp.1-6; All Applicants must complete these sections <br />Environmental Review: <br />pp. 7-10: All Applicants must complete these sections <br />11: Any applications involving public property, public ownership, or management <br />Maintenance Agreement: <br />Acquisition Worksheet: <br />p. <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 worksheet per structure <br />Drainage Worksheet: <br />Workshoot: <br />p. 20: Drainage Projects only <br />21-22: Wind retrofit projects only (HMGP only) — one worksheet per structure <br />Wind Retrofit <br />Attachment A: <br />pp. <br />FEMA Form 90.49 (Request for Public Assistance): A11 Applicants must complete, <br />Attachment k3: <br />if applicable. <br />I1MGP)FMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />H. Applicant Wormalion <br />FEMA -1300 -DR -FL Disaster Baine: Hrurlrnrze iYa ° <br />Title i Brief Descriptive Project Summary: Shelter retia#its #ra increase the county's shelter Capacity. <br />i.Applicant (Organization): Indian River County Department of Emergency Services <br />2, Applicant Type: IN State or Local Government G Recognized Native American Tribe a 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, FIDS 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: NIA <br />i0. Point of Contact <br />oMs. ®Mr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Street Address: 1840 261 Street <br />City; Vero Beach State: Florida Zip Code: 32960 <br />Telephone: 561 567-8000 Ext. 289 Fax: (561)770-5417 <br />Email Address (if available); Ircesnat sunet.nei <br />11. Application Prepared by: <br />oMs. NMr. aMrs. First Name: Nathan Last Name: McCollum <br />Title: Emerrtency Management Coordinator <br />Telephone: _0 {1 567-8000, Ext. 289 Fax: {561 } 770-5017 <br />12. Authorized Applicant Agent (proof of authorization authority required) <br />DMs. WMr. []Mrs. First Name:_ Douglas Last Name: Wrinht <br />Title,. Director Telephone: (561) 567-8000 Ext. 225} Fax: (561) 770.5017 <br />Street Address: 1840 2V" Street <br />City: Vera eachFlorida Zip Code: 32960 <br />Signature MA�� <br />Date _a 6 <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 />