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C-1 <br />i <br />A. To Fit] Out This Application: complete all sections which correspond with ilia type of proposed project <br />Gan oral Application Sec Flo ns: <br />pp.1-6: All Applicants must complete these sections <br />Environmental Review: <br />pp. 7-10: All Applicants must complete these sections <br />Main Conan coAgreement: <br />p. 11: Anyappl[cat cns involving public property, public ownership, or management <br />of property <br />Acquisition Workshoot: <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 Worksheot: <br />p. 20: Drainage Projects only <br />Wind Retrofit Worksheet: <br />pp. 21-22: Wind retrofit projects only (HMGP only) -- one worksheet per structure <br />Attachment A: <br />FEMA Form 90.49 (Request for Public Assistance): AIF Applicants must complete, <br />if applicable. <br />Attachment ik <br />HMGPIFMA Application Completeness Checklist: All applicants are recommended <br />to complete this checklist <br />B. Applicant Information <br />FEMA-1340-DR-IcL Disaster name: lfrrrritame Flo <br />Title/ Brief Descriptive Project Summary: Shelter retrofits to increase the enunty's shelter capacjty. <br />1.Applicant (Organization): Indian River County fie arlment of Emergency Services <br />2. Applicant Type: " State or <br />Local Government ❑ Recognized Native American Tribe ❑ Private Non -Profit <br />3. County: Indian River <br />4. State Legislative districts): <br />80 Congressional District(s); 15 <br />5. f=ederal Tax I.D. Number: <br />59-6000674 <br />6. FtPSCode: 061-9906100 <br />7. National Flood Insurance Program (NFIP) Community Identification Number (this number can be obtained from the <br />FIRM reap 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 />10, Point of Contact <br />❑Ms. NMr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Management Coordinator <br />Street Address: 1840 2V Street <br />City: Vero Beach State: Florida Zip Code: 32.960 <br />Telephone: 561 567-8000 Ext. 289 Fax: {561) 770-5017 <br />Email Address (if available): irgesnat(dsunet net <br />11. Application Prepared by: <br />❑Ms. ®Mr. ❑Mrs. First Name: Nathan Last Name: McCollum <br />Title: Emergency Mananement Coordinator <br />Telephone: (5611667-8000, _Ext. 289 Fax: (561) 770-5017 <br />12. Authorized Applicant Agent (proof of authorization authority required) <br />uMs. ®Mr. ❑Mrs. First Name: Douglas__ Last Name: Wright <br />Title: Director Telephone: (561) 567-8000, Ext. 225) _ Fax: (561) 770-5017 _ <br />Street Address: 1840 2Vh Street <br />City: Ver Beach St e: Florida Zip Code: 32960 <br />Signature .tit - Date /L - <br />13. <br />L 13. Ali 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 IS <br />