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GRANT NAME• Community Emergency Response Team (CERT) Grant GRANT # 14 -CI -XX -XX -XX -XX -XXX AMOUNT OF GRANT $ 11,200.00 DEPARTMENT RECEIVING GRANT: Emergency Services CONTACT PERSON: John King PHONE NUMBER: 226-3859 1. How long is the grant for? 12 months Starting Date: September 1, 2013 2. Does the grant require you to fund this function after the grant is over? Yes X No 3. Does the grant require a match? Yes X No If yes, does the grant allow the match to be In Kind Services? . Yes No 4. Percentage of match N/A 0% 5. Grant match amount required $ Yes 6. Where are the matching funds coming from (i.e. In Kind Services; Reserve for Contingency)? In Kind Services 7. Does the grant cover capital costs or start-up costs? Yes No If no, how much do you think will be needed in capital costs or start up costs (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 9. What is the total cost of each position including benefits, cap'tal, start-up, auto expense, travel and operating? Grant Amount Salary and Benefits Acct. Description Position Position Position Position Position 011.12 Regular Salaries N/A Total Fust Year $ 11,200.00 $ N/A $ N/A 011.13 Other Salaries & Wages (PT) N/A Second Year $ N/A $ $ 012.11 Social Security N/A Third Year $ $ $ $ 012.12 Retirement -Contributions N/A $ $ $ Fifth Year $ 0 012.13 Insurance -Life& Health N/A y $ • 012.14 Worker=s Compensation N/A 012.17 S/Sec. Medicare Matching N/A TOTAL N/A 0 9. What is the total cost of each position including benefits, cap'tal, start-up, auto expense, travel and operating? 10. What is the estimated cost of the grant to the county over five years? $ Grant Amount Salary and Benefits Operating Costs Capital Total Costs N/A Match Covered N/A N/A N/A Total Fust Year $ 11,200.00 $ N/A $ N/A $ 11,200.00 Second Year $ N/A $ $ $ N/A Third Year $ $ $ $ 10. What is the estimated cost of the grant to the county over five years? $ Signature of Preparer: Date: November 18,2013 38 Grant Amount Other Not Match Covered Costs Match Total Fust Year $ 11,200.00 $ N/A $ N/A $ 11,200.00 Second Year $ N/A $ $ $ N/A Third Year $ $ $ $ Fourth Year $ $ $ $ Fifth Year $ $y $ y $ Signature of Preparer: Date: November 18,2013 38