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GRANT NAME: IRC/SJRWMD Countywide Well-Plugging Cost-Share Agreement GRANT# Contract#28223 <br /> AMOUNT OF GRANT: $20,000 <br /> DEPARTMENT RECEIVING GRANT: Community Development <br /> CONTACT PERSON: Roland M. DeBlois TELEPHONE: ext. 1258 <br /> 1. How long is the grant for?Three years(to September 30,2017) Starting Date: June 2015 <br /> 2. Does the grant require you to fund this function after the grant is over? Yes X No <br /> 3. Does the grant require a match? X Yes No <br /> If yes,does the grant allow the match to be In-Kind services? Yes X No <br /> 4. Percentage of match to grant 50% <br /> 5. Grant match amount required SOn flan <br /> 6. Where are the matching funds coming from(i.e. In-Kind Services; Reserve for Contingency)? <br /> MSTU Contingencies(FY2014-15): Planning/Code Enforcement Budget Account#00420724-033190,under"Professional <br /> Services"(FY 2015-16 and FY 2016-17) <br /> 7. Does the grant cover capital costs or start-up costs? N/A Yes No <br /> If no,how much do you think will be needed in capital costs or start-up costs: $N/A <br /> (Attach a detail listing of costs) <br /> 8. Are you adding any additional positions utilizing the grant funds? Yes X No <br /> If yes,please list. (If additional space is needed,please attach a schedule.) <br /> Acct. Description Position Position Position Position Position <br /> 011.12 Regular Salaries <br /> 011.13 Other Salaries&Wages(PT) <br /> 012.11 Social Security <br /> 012.12 Retirement—Contributions <br /> 012.13 Insurance—Life&Health <br /> 012.14 Worker's Compensation <br /> 012.17 S/Sec.Medicare Matching <br /> TOTAL <br /> 9. What is the total cost of each position including benefits,capital,start-up,auto expense,travel and operating? <br /> Salary and Benefits Operating Costs Capital Total Costs <br /> , <br /> 10. What is the estimated cost of the grant to the county over five years? $60 nnn <br /> f., . , , " ',,= Grant Amount Other Match Costs Not Covered Match Total <br /> First Year $20,000 $ $20,000 $40,000 <br /> Second Year $20,000 $ $20,000 $40,000 <br /> Third Year $20,000 $ $20,000 $40,000 <br /> Fourth Year $ $ $ $ <br /> Fifth Year $ $ $ $ <br /> Signature of Preparer: Date: 572Z//5— <br /> ATTACHMENT 3 88 <br />