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GRANT NAME : Hazardous Analysis Grant GRANT # N/A <br /> AMOUNT OF GRANT : $ _ 2,641 . 50 <br /> DEPARTMENT RECEIVING GRANT : Emergency Services <br /> CONTACT PERSON : John King PHONE NUMBER : 772-226-3859 <br /> 1 . How long is the grant for? 1 year Starting Date : July 1 , 2009 <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 0% <br /> 5 . Grant match amount required $ 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 anadditional positions utilizing the grant fuXnds? Yes No <br /> If yes, please list.any <br /> 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 /> 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 Preparers W. Date : November 3 , 2009 <br />