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STATE OF ILLINOIS <br /> SMALL EQUIPM�NT GRANT PROGRAM <br /> OrFICC OF THE STATE FIRE MARSHAL <br /> 1035 STCV�NSON DRIVE <br /> SPRINGI+IELD,ILLINOIS (2703 <br /> GRANT APPLICATION FORM <br /> A. APPLICANT INFORMATION APPLICATION#: l0 -- (OSFM USE ONLY) <br /> 1. N�une a»d Mailing Address of Fire DeparhnenUl�istrrct: 2. I las this department/districi eaisted under a different nanic <br /> 1)��catur F�ire DeparU�lent or merged ��vith another compan��? YT;S ❑ NO � <br /> l 915 N \�1'ater St. <br /> I)c�caturlL. (i2,-�2(i II�Y1?S,listpreviousname(s): <br /> Legislati��eDistrict: Si?NA"fl�, 51 HOUS� �� <br /> 3. Federal L;mplo}�ec ID Nwnber 4. Local Governmeut Unit 5. Pirc llepartment/District Ntuiibei-s <br /> 37 6001308 Gity of Decatur 217-424-2811 <br /> -- ------- Name: ]'IIONF,: <br /> �A.NFIRS FDID Number <br /> Check Loc11 Govemment Type: 217-424-2792 <br /> MA111 I�AX: <br /> CIT Y <br /> ✓ <br /> 3B. Most receni ISO Rating and"I'ype �fOWNSFIIP Q 6. County <br /> (City,Rtua1 etc.) VILLAUE Q <br /> 4 Macon <br /> I�II2}?DI STRICT 0 <br /> 7. Name�i'iCle of Contaet Person for Application Contact Phone Ntunbers <br /> Jeff Abbott 217-424-2811 <br /> WORK: <br /> Deputy Fire Chief <br /> CLLL: <br /> 217-454-8506 <br /> jabbott@decaturil.gov 217-877-3025 <br /> F�Mail Address: HOMIs: <br /> B. GENERAL INFORMATION <br /> 8. Deparhnent Information (Required Fields) 9. Equipment Description <br /> Latest A�ulu��l Operating]3udget 15,270,110 15 sets of turn out gear consisting of bunker pants <br /> (Total Budget less personnel and Capitalj <br /> Emergency IZes��onses(Year) <br /> 8590 and bunker coats. <br /> 80,000 <br /> Population Covered � <br /> Area Covered <br /> �JD SqUafe fTll�@S Cost for Reqtiiested Lquipment: (Includc Cost per Uitit) <br /> �991 \ 15 _ 14865 <br /> Grants Received <br /> (include OSFM Grants) 2008 OSFM, 2009 AFG $689 � 15 _ 10335 <br /> 10. '1'lvs EQIJIPMEiN'1'IS �] A R}?YLl�Ci?MI?N"I 0 AN ADDITION <br /> 12. (Estimated)D}?LIVI�RY D1�7'E: <br /> 25,200.00 <br /> 1 1. TO'I'f�I.I;S"TIMl�7'ED COST: $ 3 months from date of order <br /> 13. '1'O'I'!AL�1N10UNT OP C'TRANT I2�,QiT�STED: �;25,200.00 <br />