Laserfiche WebLink
GHSP -06 <br />North Carolina Governor's Highway Safety Program <br />Traffic Safety Equipment Project Contract — Form GHSP -06 <br />SECTION A – GENERAL INFORMATION <br />1. Name of Applicant Agency <br />4. Name of Project Contact Person for Agency <br />Cabarrus County Sheriff's Office <br />M. Daniel Harless <br />2. Address of Applicant Agency <br />5. Telephone Number of Contact Person <br />30 Corban Av. SE <br />(980) 521 -0167 <br />Concord, NC 28025 <br />6. Email Address of Contact Person <br />mdharless @cabarruscounty.us <br />3. Location of Project (if different from # 2) <br />7. Fax Number of Contact Person <br />Cabarrus County <br />(704) 454 -5071 <br />8. Federal Tax ID Number / Type of Agency <br />9. Type of Application <br />Federal Tax ID Number: <br />E Initial ❑ Continuation <br />Type of Agency <br />Year: E 1 ❑ 2 ❑ 3 <br />❑ State ❑ Non - Profit <br />E County ❑ Higher Education <br />❑ Municipality ❑ Hospital <br />10. Project Title (Optional): DWI Enforcement Project <br />11. Budget <br />Total <br />Source of Funds <br />Federal <br />State / Local <br />Project <br />Amount <br />% <br />Amount <br />% <br />Amount <br />Checkpoint Equipment <br />$20,425 <br />100 <br />$20,425.00 <br />0 <br />$ <br />Equipment Costs <br />$ <br />75 <br />$ <br />25 <br />$ <br />Special Equipment Costs <br />$ <br />50 <br />$ <br />50 <br />$ <br />Total Project Costs <br />$20,425 <br />$20,425.00 <br />$ <br />12. Specify How Non - Federal Share Will Be Provided: <br />FOR GHSP USE ONLY - <br />To GMS: ❑ SB ❑ FH ❑ CM <br />To Finance Officer: <br />Date: <br />❑ CL ❑ JS <br />—,20 <br />GMS Initials: Date: <br />, 20 <br />Finance Officer: Initials Date: <br />20 <br />Work Type <br />Project Number: <br />CFDA #: 20. <br />- - <br />- <br />Ref # <br />- <br />AO%gg" number 1 <br />Rev. 02/09 F-17 <br />