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DocuSign Envelope ID:25D7535C-94DF-4869-A143-BOA7DD1251F8 <br /> North Carolina FY 2017 HSGP Sub-Recipient Application <br /> Due: 3/3/17 <br /> Cit Concord ZIP +4 28027 <br /> Email <br /> C. MOA Signatory Information: <br /> (Individual who has the acrthority to sign the grant agreement, add another box if more than one is required) <br /> Name Alan Thompson <br /> Agency: Cabarnis COUnty Emergency Medical Services <br /> Title Director <br /> Phone Work 704-920-2601 Phone Mobile 704-791-2907 <br /> Mailing Address (must be 31 Willowbrook Drive, NW <br /> physical address, not PO <br /> Box <br /> City Concord ZIP + 4 28027 <br /> Email <br /> Part 2: Budget Information <br /> In addition to completing this section, applicants will need to submit at least one Budget <br /> Sheet attachment for every solution area in which they request funding. <br /> 1. Proposed Funding <br /> Solution Area Amount of Funding $ Funds Dedicated to LETP* <br /> Planning $ $ <br /> Equipment $34,088 $ <br /> Training $ $ <br /> Exercises $ $ <br /> Total Proposed Funding: $34,088 $ <br /> *If applicable, provide the proposed funding amount that will be spent on Law Enforcement Terrorism <br /> Prevention (LETP). <br /> Part 3: Grant Proposal Information <br /> A. Historical Information <br /> 1.) Does this project support a previously awarded investment? No <br /> 2.) If yes, from which year? <br /> 3.) Project name? <br /> 4.) How much funding was awarded? $ <br /> 5.) Last completed milestone? <br /> B. Baseline: New or Ongoing Project <br /> 1.) Is this project new or ongoing? New <br /> 2. This project will <br /> November 30, 2016 NC Emergency Management Page 2 of 4 <br /> Attachment number 1 \n <br /> F-8 Page 196 <br />