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6/2/2014 Application Number: EMW-2011-FF-00724 Entire Application Overview * Are you a member, or are you currently involved in the management of the fire department or organization applying for this grant with this application? Yes, I am a member/officer of this applicant If you answered No, you must please complete the preparer information below. If you answered Yes, please skip the Preparer Information section. Note: Fields marked with an * are required. Preparer Information *Preparers Name *Address 1 Address 2 *City *State *ZIP In the space below please list the Primary Contact your organization has selected to be the point of contact for this grant. This should be a Chief Officer or long time member of the organization who will see this grant through completion. The Primary Contact, as listed below, is the person for which all exchanges of information will be made relative to the application. If you are not the person to be contacted please provide the appropriate person's contact information below. In addition to the Primary Contact information, you will be asked to provide two (2) Altemate points of contact on the next page. The Alternate contacts should also be able to answer any questions relative to this application in the event that Primary Contact is unavailable. When you are finished, click the Save and Continue button below. Reminder: If there are changes to any of the contact information (i.e., names, phone numbers, etc.) provided after submittal of the application please update this information. Please list only phone numbers where we can get in direct contact with the point of contact. Primary Point of Contact *Title Fire Chief Prefix Mr. *First Name Jerry Middle Initial *Last Name Streich *Primary Phone 651-792-7901 Ext. work *Secondary Phone 763-286-0288 Ext. cell Jptional Phone Ext. Select Primary Fax *Email jeny.streich@centennialfire.org https://eservices.fema.gov/FemaFireGrant/firegrant/jsp/safer2011/application/print app.jsp?print=true&app_number= EMW-2011-FF-00724 1/33