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APPLICATION FOR HIGHWAY SAFETY PROJECT REIMBURSEMENT GRANT <br /> STATE OF HAWAII SAFE COMMUNITY PROGRAM -SAFETY OFFICE <br /> FOR SCP-SO IIS8 ONLY <br /> PART I <br /> (Applicant to Complete) Project Number: OP03-OS (O1-H-02) <br /> 1. APPLICANT (Name and Address) Title: HCPD Seat Belt Program <br /> Hawaii County Police Department <br /> 349 Kapiolani Street Standard Area OP <br /> Hilo, HI 96720 <br /> 2. AGENCY SNIT (Name and Address) Effective Date: 10/1/02 <br /> Hawaii County Police Department <br /> 349 Kapiolani Street Federal Funds Obligated $103,300.00 <br /> Hilo, HI 96720 FY Funds 2003 Addendum X YES NO <br /> 3. DIIRATION (Month, Day, Year) <br /> A. Grant Period B. Project Period Benefit of STATE X COUNTY <br /> From: 10/1/02 From: 10/1/99 <br /> To: 9/30/03 To: 9/30/03 <br /> 4. LOCATION OF PROJECT Sa. Type of Application (Check Appropriate Item(s) <br /> Hawaii County Police Department iInitial X Revision -Continuation <br /> 349 Kapiolani Street <br /> Hilo, HI 96720 Sb. RSIMBIIR38MSNT SCHSDIILS DESIRED <br /> Monthly X Quarterly <br /> 6. PROJECT DESCRIPTION (Schedule A) <br /> 7. PROJECT OBJHCTIVSS AND TASKS SIIMMARY FROM SCH'SDIILS A Funds will be used to reduce <br /> fatalities and injuries to all occupants of motor vehicle collisions and to raise the <br /> seat belt usage rate. <br /> 8. BIIDGST (Schedule B) <br /> 8A. COST CATEGORY Total <br /> Expenditures <br /> Grant Period Prior Years Project Period <br /> (1) Personal Services $100,000.00 $93,311.00 $193,311.00 <br /> (2) Consultant Services <br /> (3) Commodities $3,300.00 $3,300.00 <br /> (4) Other Direct/Indirect Costs <br /> TOTAL ESTIMATED COSTS (Inc. Non-Fed. Share) $103,300.00 $93,311.00 $196,611.00 <br /> SB. SOIIRCS OF FIINDS C. SPECIFY HOW NON-FHDERAL <br /> (1) Federal (100 ~ of TOTAL) $103,300.00 SHARE WILL BS PROVIDED <br /> (2) Applicant Age <br /> 9. MILESTONHS (Schedule C) <br /> 10. AGRHHMSNT OF IINDSRSTANDING AND COMPLIANCE (See Schedule D, attached) <br /> 11. ACCHPTANCB OP CONDITIONS. It is understood and agreed by the undersigned that a ceimburaement grant received as a <br /> result of this application is subject to Public Law 89-564 (Highway Safety Act of 1966) and all administrative <br /> regulations governing grants established by the U.S. Department of Transportation and the State of Hawaii. It is <br /> <br /> expressly agreed that this project conetitutea an official part of the Hawaii Highway Safety Program and that said <br /> <br /> applicant agency will meet the requirements as set forth herein, including accompanying schedules A, a,C 6 which are <br /> incorporated herein and made a part of this application. Authorization to proceed with Chia Highway Safety Pzoj ect is <br /> requested. <br /> 11A. PROJECT DIRECTOR 11H. ASITHORIZING OFFICIAL OF AGENCY DNIT <br /> Signature Signature <br /> Name Name <br /> Title Title <br /> Date Date <br /> To be prepared by applicant, use separate sheets as required. Form HS 3-71 Rev. 7/14/00 <br /> <br />