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GRANT NAME: EMPG Grant GRANT N 06BG-04-10-40-01 -085 <br /> AMOUNT OF GRANT: $ 33.713 .00 <br /> DEPARTMENT RECETVNG GRANT: Emergency Services <br /> CONTACT PERSON: Nathan McCollum PHONE NUMBER: 567-8000 ext. 1225 <br /> 1 . How long is the grant for? 6 months Starting Date: March 21 2006 <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? Yes X No <br /> If yes, does the grant allow the match to be In Kind Services? Yes No <br /> 4. Percentage of match N/A 0010 <br /> 5. Grant match amount requited $ N/A <br /> 6. Where are the matching funds coming from (i.e. In Kind Services; Reserve for Contingency)? <br /> 7. Does the grant cover capital costs or start-up costs? Yes No <br /> If no, how much do you think will be needed in capital costs or start up costs <br /> (Attach a detail listing of costs) $ <br /> 8. Are you adding an additional positions utilizitrg the grant funds? Yes _ No <br /> If yes, please fist. �If addit onar space is needed, please attach a schedule.) <br /> Acet. 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 /> 10. What is the estimated cost of the grant to the county over five years? $ <br /> Grant Other Match Costs <br /> Amount Not Covered Match Total <br /> First Year $ $ $ $ <br /> Second Year $ $ $ $ . <br /> Third Year $ $ $ $ <br /> Fourth Year $ $ $ $ <br /> Fifth Year $ $ $ $ <br /> Signature of Preparer: Date: March 10 2006 <br />