Date
Example
01/01/05 (date must be entered in this format)
Applicant Name
Official Title
Work Phone
Home Phone
Applicant E-mail
Fire Chiefs Name
Chiefs Phone
Your Departments NFIRS or FDID Number
(FDID must
be entered in this format)
Department Name
Department Street Address
Address2
Department City
State/Province
Zip/Postal Code
County
Department Phone
Department FAX
Federal Tax Identification
Was Your Department Formed In The Last 24 Months?
_
No
Yes
Population Base Served In Your PRIMARY Protection Area
Size Of PRIMARY Protection Area In Square Miles
Insurance Services Office (ISO) rating
List Public Lands In Your PRIMARY Protection Area
Greater Than 500 Acres (State, County, or Federal)
If you do
not know the acreage of a public property contact the property manager.
Property Name 1
Property Name 2
Property Name 3
Is the grant or
equipment requested with this application needed for an emergency situation that
jeopardizes
your ability to provide
fire protection to your primary protection area?
Is this an emergency situation?
_
No
Yes
If Yes, please briefly explain your situation below.
Would you like to add your department to the waiting list for a
compliment of handtools?
Compliment of wildland firefighting handtools includes,
6-council fire rakes, 2-collapsible broom rakes, 4-fire swatters, 2-backpack
pumps, and 2-shovels. The estimated value of these tools is $800.00.
Compliment of Handtools Requested?
_
No
Yes
Please list two additional contacts for your department
that we would be able to contact during normal business hours.
Contact 2
Contact 3
If you are applying
for the Handtool program only and do not wish to apply for FEPP or VFA
you may skip the
rest of this application.
If you do not wish to apply for FEPP you may scroll down to
the VFA Addendum.
Federal Excess Personal Property Addendum
Does your department currently have any FEPP under cooperative mutual aid
agreement with the IDNR?
_
No
Yes
U se the tables
below to find the type(s) of items you would be interested in "one item per drop
down box, choose up to 8 items"
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
_
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
Code
Description
1
Truck, 3\4 or 5\4 Ton
4X4
2
Truck, 3\4 or 5\4 Ton
2X4
3
Truck, 3\4 or 5\4 Ton W\Cargo Box
4
Truck, 2 1\2 Ton 6X6
Diesel
5
Truck, 2 1\2 Ton 6X6
Gas
6
Truck, 5 Ton Diesel
7
Truck, 5 Ton Gas
8
Truck Chassis,
Commercial
9
Tanker
10
Maintenance Truck
11
Trailer
12
Fire Engine
13
Tanks
14
Van \ Panel Truck
15
Truck, 1 Ton 4X2
16
Ladders
17
Saws (K-12, chain saw,
etc.)
18
Handtools
Code
Description
19
Water Handling
Appliances
20
Fire Extinguishers
21
Warning Lights and
Sirens
22
Ventilation Equipment
23
Lighting Equipment
24
Nozzles
25
SCBA
26
Fire Hose
27
Protective Clothing
28
Pumps
29
Compressors
30
Generator, 1.5 Kw
31
Generator, 3.0 Kw
32
Generator, >3.0 Kw
33
Other (be specific
below)
34
3\4 Ton Blazer
35
Water Buffalo, 400 Gal.
Tank, Trailer Mount, Air Brakes
36
Communications
Equipment
37
Computer
38
Forcible Entry Equipment
If you selected item code 33
(Other), type a short description of the type of item you are requesting.
ADDENDUM
VOLUNTEER FIRE ASSISTANCE (VFA)
FEDERAL GRANT APPLICATION
All fields on this addendum are required to be a valid request
for VFA
Note: Your Department
Must Be NIMS
Compliant to receive VFA
Funds.
For more information about NIMS please visit this website
http://www.fema.gov/nims/
Does your department have its fifty percent (50%) share for this
project?
_
Yes
No
Does your department train in the National Incident Management
System (NIMS)?
_
Yes
No
Does your department utilize the National Incident Management
System (NIMS)?
_
Yes
No
Is this a multi-department or multi-community proposal?
_
Yes
No
If yes please provide the names, addresses and contact
information for all departments\communities below.
Briefly describe the purpose of this proposal. (What are you upgrading or adding
to your department) Example: We would like to purchase new hose for our brush
truck to replace the existing hose.
Please write a justification statement that briefly describes why you are
submitting this proposal and how it will benefit your department. Example: We
would like to purchase new Water Handling equipment to replace our old in order
to promote firefighter safety and increase suppression capabilities.
Please provide an itemized list with estimated individual unit cost for each item.
What is the total project cost? $We will match 50/50 up to $5000.00 on your requested grant amount.
Look at your itemized list, each item should fit into one of the categories
listed in the next question.
Pick the appropriate category by the largest amount requested. Example:
Nozzles-$500.00 Portable water tank-$2000.00
2.5" Fire Hose-$1500.00 All of these items would be in
the Water Handling category.
What is the primary need requested through this grant?
_
Fire Prevention \ Education
Training
Water Handling
Organization (new departments only)
Communication (radios or pagers)
Dry Hydrants
Class A Foam
Safety (SCBA or Turn-out gear or PAS alarms etc.)
(based on largest $ amount)