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North Carolina Governor's Highway Safety I <br />Instructions for Form GHSP -06 <br />Traffic Safety Equipment Project Contract <br />Instructions for the completion of Form GHSP -06: <br />A. General Instructions <br />1. All cost figures must be for one year only. <br />2. All cost figures must be in whole dollars only. <br />3. All information must be included on the form. If additional space is needed, attach <br />additional information to the form. <br />4. Complete one signed original contract application. When approved, a copy of the <br />completed original will be returned to the grantee. <br />5. Mail the form to Governor's Highway Safety Program, Attn: Manager, Planning, <br />Programs, and Evaluation, 215 East Lane Street, Raleigh, NC, 27601. <br />6. If you have questions about any aspect of the funding process, including the completion <br />of form GHSP -06, please call the Planning, Programs and Evaluation unit of the GHSP <br />at 919- 733 -3083 or 800 -999 -9676. <br />B. Instructions for Section A — General Information (Page 1) <br />I. Name of Applicant Agency— The name of the agency requesting funding. <br />2. Address of Applicant Agency— The mailing address of the agency. <br />3. Location of Project — Indicate the location of the project if it is different than the mailing <br />address of the agency <br />4. Name of Project Contact Person for Agency — The primary contact for the agency. <br />5. Telephone Number of Contact Person — The telephone number of the primary contact <br />for the agency. <br />6. Email Address of Contact Person — The email address of the primary contact for the <br />agency. <br />7. Fax Number of Contact Person — The fax number of the primary contact for the agency. <br />8. Federal Tax 1D Number/ Type of Agency — Fill in the agency's Federal Tax ID Number <br />and check the box of the type of Agency. <br />9. Type of Application — Indicate if this is an Initial or Continuation project and the year of <br />funding. If this is an Initial application, the year of funding will be "l ". <br />10. Project Title — The title of the project. This field is optional <br />11. Budget — This information will be the summary of the total category costs brought <br />forward from Section B — Budget Detail, <br />12. Specify How Non - Federal Share Will Be Provided — Explain the source of the State or <br />Local funds that will be used as matching funds. If the Agency is a part of a county or <br />municipal government, attach Form GHSP -06 -A, Local Government Resolution. <br />Rev. 02/09 F 137 AOYdgn�O number 1 <br />