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DocuSign Envelope ID:C6DC9C4F-C47A-4FD4-963D-64FC40BF7A2F <br /> ri"ix i ii .-.�i vj,jLNA EMERGENCY MANAGEMENT <br /> FFY 2018 EMERGENCY MANAGEMENT PERFORMANCE GRANT <br /> (EMPG) <br /> APPLICATION <br /> Submission Deadline: February 7,2018 <br /> EM FORM 66 <br /> A. Applicant Information <br /> (When awarded a grant, the applicant will be referred to as the sub-recipient) <br /> Applicant County of Orange, North Carolina <br /> Street Address 200 S. Cameron Street <br /> City, State, ZIP+4 Hillsborough, NC 27278 <br /> DUNS Number 069420961 <br /> Tax ID Number 56-6000327 <br /> Registered in SAM? Yes Expiration Date 16-NOV-2018 <br /> (Registration is required) <br /> B. Applicant Point of Contact Information <br /> (Primary point of contact for all communication regarding the ant) <br /> Name Kirby Saunders <br /> Agency Orange County Emergency Services <br /> Title EM Coordinator <br /> Phone(Work) 919-245-6135 Phone(Mobile) 434-517-1227 <br /> Street Address 510 Meadowlands Drive <br /> city Hillsborough I ZIP+ 4 T27278 <br /> Email I ksaunders ®ran ecoun nc. ov <br /> C. County EM Program Mana er Contact Information <br /> Name Kirby Saunders, EM Coordinator <br /> Email ksaunders@orangecountync.gov <br /> D. County Finance Director Contact Information <br /> Name Gary Donaldson <br /> Email gonaldson@orangecountync.gov <br /> E. MOA Signatory Information: <br /> (Individual who has the authority to sqw the grant agreement, if more than one signaloQ is required add contact information on separate sheet) <br /> Name Bonnie Hammersle <br /> Agency Orange County(Government) <br /> Title County Manager <br /> Street Address 200 S. Cameron Street <br /> (must be physical address, <br /> not PO Box <br /> city Hiilsborou h ZIP+4 27278 <br /> Email bhammersicy(&,orangecountync.gov <br /> Name <br /> Agency <br /> Title <br /> Street Address <br /> (must be physical address, <br /> not PO Box <br /> city ZIP+4 <br /> Email <br /> ***Please attach information for additional MOA signatory, if necessary <br /> EMPG Application Form 66 (Rev. 01/18) Page 3 of 8 <br />