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AA <br /> APPNUM 03 <br /> SJRWMD office use <br /> ST. JOHNS RIVER WATER MANAGEMENT DISTRICT <br /> ALTERNATIVE WATER SUPPLY <br /> CONSTRUCTION COST-SHARING PROGRAM <br /> APPLICATION FORM <br /> Fiscal Year 2002=2003 <br /> Submission deadline : Applications must be received by SJRWMD or dated by the U. S . Postal Service or a <br /> commercial carrier no later than Friday, December 6, 2002 . Submit three copies of this form and all supporting <br /> materials to Elizabeth Thomas c/o Cheryl Worgum, St. Johns River Water Management District, P . O. Box 1429, <br /> Palatka, FL, 321784429 if sent by U. S . mail or to 4049 Reid Street, Palatka, FL, 3217844292 if sent by courier. <br /> For application assistance contact Elizabeth Thomas at (407) 6594868, (877) 2284658 or <br /> ethomas@sjrwmd. com. You may add up to one additional page of supporting material for any answer that <br /> needs further explanation . Applications that are substantially incomplete or that are not completed <br /> according to instructions will be disqualified. Excess materials will not be considered. Read and follow <br /> instructions . Selected evaluation criteria are accompany questions pertaining to them in the application. <br /> Complete evaluation criteria are provided in the separate instructions document. <br /> Maximum contract time limit: Parties receiving funds through this program must complete their projects <br /> within 18 months of the execution of a cost-share contract with SJRWMD . <br /> Type or print clearly the requested information in the spaces provided. <br /> A. Applicant Information <br /> 1 . Name of Applicant : Indian River County, Utilities Department <br /> (May be utility, local government, agency, company, individual, or other.) <br /> 2. Name, address, and phone numbers of project manager or contact person. <br /> SJRWMD will sent correspondence concerning this application ONLY to this person. <br /> Name Michael C . Hotchkiss P.E. <br /> Mailing address 1840 25 h Street <br /> City and zip code Vero Beach, FL 32960 <br /> Phone (772) 567-8000_ ext. 1821 FAX (772) 770-5143 <br /> (include are code) (include area code) <br /> 3. Name, address, and phone numbers of person with authority to enter into a contractual agreement, <br /> if other than project manager or contact person. <br /> Name Kenneth R . Macht Chairman, Indian River County Board of County Commissioners <br /> Mailing address 1840 25"' Street <br /> City and zip code . Vero Beach, FL 32960 <br /> Phone (772) 567-8000 . ext. 1830 FAX (772) 770-5143 <br /> (include area code) (include area code) <br />