Wireless E911 Emergency Communications Carryover Fund Application (Page 2 of 2) in pdf

Wireless E911 Emergency Communications Carryover Fund Application Page 2

Wireless E911 Emergency Communications

Carryover Fund Application

County E911 Service Board Requesting Funds

for PSAP (name):

Attach a detailed project description to include cost proposal(s) and a timeline for completion.

(Application will not be eligible without a project description)

Detailed Funding Explanation:

Completion date:

Total Funds Needed for Project

‐

Local Wire Line Surcharge Funds

Local Wireless Surcharge Funds

(funds received each quarter)

Funding from Other Sources

Fund Amount Requested from Wireless Carryover Fund

(This amount shall not exceed 50% of the project total or exceed the maximum of $50,000, whichever is less)

As the Chair of the County E911 Service Board, I certify that this request for funds is made in accordance

with Iowa Code Chapter 34A and Iowa Administrative Code Section 605 Chapter 10. This request for

Wireless Carryover Funds when Combined with Local Wireless surcharge funds shall be used for

communication equipment for the implementation and maintenance of E911 services. My signature

below states that I understand the following conditions:

The maximum amount of Wireless Carryover funds any Service Board shall receive

in a given Fiscal Year shall not exceed $50,000 per Public Safety Answering Point

(PSAP).

The project must be completed in the current fiscal year. NO EXTENSIONS

No funds will be paid until the project is complete and original invoices along with

a completed Attachment B form are presented to the E911 Program Manager.

Signature of Board Chair

Date

For Office Use Only

Denied / Approved By: _________________________________Approved Total: _________________

Date:

Revised 06/11/2013

Wireless E911 Emergency Communications Carryover Fund Application Page 2