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i <br />40 <br />A' To Fill Out This Application: complete all sections which correspond with the type of proposed project <br />General Application Sections: <br />pp.1-6: All Applicants must complete these sections <br />icans must complete these sections <br />Environmental Review: <br />Main terranco Agreement: <br />pp11: Anapp ppAll iplatlon1 <br />p• s invoivin9 public property public ownership, c management <br />Acquisition Worksheet: <br />of property <br />pp.12-14: Acquisition projects arrty -- one worksheet per structure <br />Elevation Warksheet: <br />pp.15-i9: Elevation Projects only-- one worksheet per structure <br />Drainage Worksheet: <br />Wind Retrofit t+llorksheet: <br />p. 20: Drainage ,Projects only <br />pp. 21-22: Wind retrofit projects only (FlAfiaP only) one worksheet perostructure <br />Attachmont A: <br />FEMA f=orm 90.49 (Request for Public Assistance): All Applicants must complete, <br />Attachment B: <br />if applicable. <br />I-IMGPIFMA Application Completeness Checklist. Ail applicants are recommended <br />to complete this checklist <br />R. Applicant Infnrmatiun <br />FEMA -L300 -DR -FL 300 -LIR -FL Disaster name: <br />llrrrrirnne f 1 d <br />Title t Brief Descriptive Project Summary: Shelter retrofits to increase the counter's shelter capad , <br />1.Applicant (Organization): jndian River Count De artment of Emergency Services <br />❑ Recognized Native American Tribe 11 Private Non Profit <br />2. Applicant Type: 0 'State or <br />Local Government <br />3. County: Indian River <br />4. State Legislative district(s): <br />80 Congressional Dislrict(s): 15 <br />5. Federal Tax I.D. Number: <br />59-6000674 <br />6. FIPS Code: 061-9906100 _ <br />7. National Flood Insurance Program (NFIP) Community Identiflcation 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: IIIA <br />10. Point of Contact <br />c1Ms. OMr. DMrs. First Name: Nathan Last flame: McCollum <br />Title: Emerigenc Mana ement 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)7745017 <br />Email Address (if available): ircesnat stmet.net <br />Application Prepared by: <br />raMs. HMr. nMrs. First Name: Nathan Lost blame: McCollum <br />Title: Emer enc Management Coordinator <br />Telephone: (561] 567-8000 Ext. 289 Fax: 551 770.5017 <br />12, Authorized Applicant Agent (,proof of authorization authority required) <br />❑Ms. omr. oMrs. First Name: Douglas Last Name: V4ri hi <br />Title: Director Telephone: 561 567-900{1 Ext. 22.5 Fax: _ (561)770 5817 <br />Street Address: 1840 26" SSrest <br />Cily: Vero ch at ; St_Florida Zip Code: 32964 <br />ea <br />Signature ��- Date ID -31-00 <br />13. Ail proposed projects should be included in the county's Local Mitigation Strategy (LMS), please attach a letter rat <br />endorsement for the project from the county's Local Mitigation Strategy Coordinator. (See endorsement attached). <br />Page 3 of 15 <br />