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GRANT NAME: FDOT Small County Outreach Program (SCOP) Aviation Boulevard/20th Avenue Intersection Improvements GRANT # 437004-1-58-01 AMOUNT OF GRANT: $292,545.00 DEPARTMENT RECEIVING GRANT: Public Works CONTACT PERSON: Christopher J. Kafer, Jr., P.E. County Engineer TELEPHONE: (772) 226-1221 1. How long is the grant for? Until June 30, 2017 Starting Date: When executed by FDOT 2. Does the grant require you to fund this function after the grant is over? 3. Does the grant require a match? If yes, does the grant allow the match to be In -Kind services? 4. Percentage of match to grant Balance 5. Grant match amount required '91,573 00 Yes X No 7t Yes No 6. Where are the matching funds coming from (i.e. In -Kind Services; Reserve for Contingency)? Optional Sales Tax/Cash Forward Yes X No 7. Does the grant cover capital costs or start-up costs? Yes X No If no, how much do you think will be needed in capital costs or start-up costs: $ N/A (Attach a detail listing of costs) 8. Are you adding any additional positions utilizing the grant funds? If yes, please list. (If additional space is needed, please attach a schedule.) Yes X No Acct. Description Position Position Position Position Position 011.12 Regular Salaries $ 586,068.00 Second Year $ $ $ 011.13 Other Salaries & Wages (PT) $ $ $ $ Fourth Year 012.11 Social Security $ $ Fifth Year _ $ f .1h,7 012.12 Retirement — Contributions 012.13 Insurance — Life & Health 012.14 Worker's Compensation 012.17 S/Sec. Medicare Matching TOTAL 9. What is the total cost of each position including benefits, capital, start-up, auto expense, travel and operating? Salary and Benefits Operating Costs Capital Total Costs 10. What is the estimated cost of the grant to the county over five years? $ 475pin nn °., - Grant Amount Other Match Costs Not Covered Match Total First Year $ 292,545.00 $ $ 293,523.00 $ 586,068.00 Second Year $ $ $ $ Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year _ $ f .1h,7 $ $ Signature of Preparer: Date: 35