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02/15/2017 Grant ApplicationDEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency O.M.B. No. 1660-0025 FEMA GRANTS APPLICATION Expires September 30, 2017 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 0.75 per response, The burden estimate Includes the time for reviewing lnslruictions�, searching a J� ex stin data sources, f— Thi. ­11.'fi Type oTSubrnIssIon:* El Pre -application F-1 Application Continuation Other (Speci!y) Changed/Correct Application Revision L 3. Date Received** : ....................... 4 A plicant Identifier: '#gpy y fifier: 5a. Fed!qat,gptit 1111 M, ............ JjLzrrll,�� I'll 11 .................................... . ..................... 6. Date Received by State: 7. State Application Identifier: Applicant Information: -*' I ................................................ fiT4 m Monroe County Board of County Commissioners d. Address: Street 1:* LOO imonton Street Street 2: Clty�* County/ParisW F�onroe State:* IFIL Province� ----------------- L Country:* IUSA Zip/Postal Code. [3304� z. Organizational Unit: Department Name:lMonroe County Emergency Management Division Mb�F ( i =T_Tqnill I MOITI-1 ,�E!mergency Management Senior Planner -jeff@monroecounty-fl,gov manning 9. Type of Applicant: Applicant 1:1 ounty Government Applicant 2: Select Applicant Type Applicant 3: elect Applicant Type _J=' 047 ------------ ---------- - -------------- --.- . ........... S-16- lip MT-D47-000-99 iLJL!=, mmmr-,M. MMINT'R 13. Areas Affected Title: lPre-Disaster Mitigation Title] FY16 Pre -Disaster Mitigation fim County Florida; Fishermen's Community Hospital serves residents and visitors from Cudjoe Key, FL ( 25 miles south of the facility) to FL ( 25 miles north of the facilitv). 1-11111119-iol-- power the facility during a power outage andlor severe weather -related events. Completion of these miligation activities will allow the ispital to remain ape rational dunng future storms i n order to provide services a nd supporl to immediate commun ity and close by cities. All 1allations will be in strict compliance with the Florida Building Code. 16. Congressional Districts of:* Applicant 16. Proposed Project:* Start Date. 17. EsUmated Funding Federal: L.8�4 �62�� Statw Local Applicant Other' 194,875 Program Income: FRI a. This application was made available to the State under EO 12372 Process for Review on: b. Program is Subject to EO 12372, but has not been selected by the State for review. c. Program is not covered under EO 12372, 19. Is the Applicant Delinquent on Any Federal Debt?Provide an Explanation In Attachment):* I L] Yes nX No Smu til ine ur.Mmen-&L nel true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to comply with any -esulting terms if I accept an award. I am aware any false, fictitious or fraudulent statements or claims may subject me to criminal, in! hri 1, or administrative penalties. (US Code, Title 218, Section 1001)* Z I Agree Qr■, -■ F-i . .......... ... . .. . ...... -'- I . . ............... . .......................... Prefix, M-r. First Name: OFRoman ] Mddle Name: I Last Name,*rGastesi 1 (305) 292-4441 IN, Ilt - I Date SigneVl/ I Th is form (incl ud ing the co ntinuation sheet) is required for use as a cover sheet for submission of pre -applications, applications and related !information under discretionary programs. Some of the items are required and some are optional, Required items are identified with an asteds ,on form and are specified in the instructions below. N. Date Received: Leave this field blank, the date will be assigned by the Agency. w Applica ntIdentifier: FedleralEntll Identifier: Enter the number assigned to your organization by FEMA, if any - previously assigned Federal Award Identifier number, If a changedilcorrected application, enter the Federal Identifier in lac!' 1an-with Agency 7 State ApplIcation Identifier: Leave this field blank, this identifier will be assigned by the State (if applicable) Applicant ! ■ following: Legal Name (Required): Enter the regal name of the applicant that will undertake the assistance activity- This is the name that the organization has registered with the Central, Contractor Registry (CCR), Information on regisledng with CCR may be obtained by visiting the Grants gov website, organization Organization DUNS (Required): Enter the organizations DUNS or DUNS+4 number received from Dun and Bradstreet. Information on obtaining a DUNS number may be obtained by visiting the Grants.gov website, rganizational Unit: Enter the name of the primary organizationa[ unit (and Department or Division, (if applicable) that will ridertakethe assistance activityapplicable) relatedName and Contact Information of Person to be Contacted on Matters Involving this Application: Organizational affiliation (if affiliated with an organization other on: Enter the name (First and Last, than the application organization (Required)), Telephone Number (Required), Fax Number, and E�mail Address of the person to contact on matters to this application (Required), FEMA Form I 1 DRAFT FEMA • o.