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r <br />40 <br />A. To Fill Out This Application, complete all sections which correspond with the typo of proposed project <br />General Application Sections: <br />pp.1-6: All Applicants must complete these sections <br />Environmental Review: <br />pp. 7-141: All Applicanis must compiete these sections <br />11: Any appliration s involving pubfie properly, public ownership, or management <br />MaintenanceAgreemenf: <br />p. <br />Acquisition Worksheet: <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 />Wind Retrofit Worksheet: <br />p. 20: Drainage Projects only <br />pp. 21-22: Wind retrofit projects only (14MGP only) – one worksheet per structure <br />Atfachment A: <br />FEMA Form 90-49 (Request for Public Assistance): All Applicants must complete, <br />Attachment B. <br />if applicable. <br />t4MGPIFMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />B. Applicant infor•marlon <br />FERIA -1300 -DR -FL Disaster flame: Hurricane Ha rt <br />Title 1 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: 0 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. FIPS Code: 461-9906100 <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 />B. 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 />Ws. 1KMr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Street Address: 1840 25' Street <br />City: Vero Beach State: Florida Zip Code: 32964 <br />Telephone: 561 567-8004 Ext, 289 Fax: (561) 770-5017 <br />Email Address (if available): ircesnat sunet.net <br />11. Application Prepared by: <br />0Ms. NMr. UMrs. Hist Name: Nathan Last Name: McCollum <br />Tille: Emergency Management Coordinator <br />Telephone: (561) 567-8000, Ext. 289 Fax:_ (561) 774-5017 <br />12. Authorized Applicant Agent (proof of authorization authority required) <br />0Ms. 0Mr. ❑Mrs. First Name: Douglas Last Name: Wri ht <br />Title: Director Telephone: 561 567-800D Ext. 2251—Fax: (561) 774-5017 <br />Street Address: 1840 25" Street <br />City: Vero eachSt e: Florida - Zip Code: 32960 <br />Signature ° JvR- 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. fSee endorsement attached). <br />Page 3 of 15 <br />