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• <br />• <br />nmA. 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 />Environmental Review: <br />pp. 7-10: All Applicants must complete these sections <br />Ma in ton once Agreern ent: <br />p. 11: Any applications involving public property, public ownership, or management <br />of property <br />Acquisition Worksheef: <br />pp.12-14: Acquisition Projects only -- one worksheet per structure <br />Etevation Worksheet: <br />pp.15-19: Efevalion Projects only-- one worksheet per structure <br />Drainage Worksheet: <br />p. 20: Drainage Projects only <br />Wind Re fro fit Worksheet: <br />pp. 21-22: Wind retrofit projects only (HMGP only) — one worksheet per structure <br />Atfachmon( A. <br />FEMA Form 90.49 (Request for Public Assistance): All Applicants must complete, <br />if applicable. <br />Attachment B: <br />HMGPIFMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />B. Applicant information <br />};EWU-1300-DR-FL Disaster name: Hurricane 17o�^d <br />Title 1 Brief Descriptive Project Summary: Shelter retrofits to increase the county's shelter capacity. <br />1.Applicant (Organization): Indian River,Countv De artment of Emerciency 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, FtPS 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 />6. 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 />DMS. NMr. ❑Mrs. First Name: Nathan Last Name: MCColltlerl <br />Title: Emeqgency EmergencyManagement Coordinator <br />Street Address: 1840 25`" Street <br />City: Vero Beach State: Florida Zip Code: 32960 <br />Telephone: (561) 567-8000, Ext. 289 Fax: -(5611770-5017 <br />Email Address (if available): ircesnatAsunet net <br />11. Application Prepared by: <br />❑Ms. ®Mr. ❑Mrs. First Name: Nathan Last. Name: McCollum <br />Title: Emergency Management Coordinator <br />Telephone: (561)567-8004 Ext. 289 Fax: 1561 1 770-5017 <br />12. Authorizod Applicant Agent (proof of authorization authority required) <br />❑Ms. NMr. ❑Mrs. First Name: Douglas Last Name: Wright <br />Title: Director Telephone; (561) 567-8000. Ext. 225) _ Fax: (561 ) 770-5017 <br />Street Andress: 1840 26' Street <br />City; Vero f3each State: Florida Zip Code: 32960 <br />Signature IIrL Data <br />13. Ali proposed projects should be eluded 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. (Son endorsement attached). <br />Page 3 of 15 <br />