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EXHIBIT C G1n-iIPA-R9 <br />GRANT APPLICATION FORM <br />1. Entity Information: <br />Unified Program Agency Name: City of Santa Ana Fire Department <br />GRANTEE GRANT CONTACT <br /> if different from Project Director <br />Name of Project Director, Title: Name: <br />Lori Smith, Administrative Chief / FM Chris Ciraulo, Firefi hter/HazMat Inspector <br />Street Address: Street Address: <br />1439 S. Broadway Same <br />City, Zip: City, Zip: <br />Santa Ana, Ca 92707 same <br />Phone: Phone: <br />714-647-5700 714-647-5750 <br />Fax: Fax: <br />714-647-5751 714-647-5751 <br />e-mail: e-mail: <br />IsmithO-santa-ana.orq cciraulo _santa-ana.ora <br />2. Grant Amount: $ 20.000 <br />a. Advanced payment Requested: _0 <br />(Up to 25% of the grant is authorized to be paid in advance on approval of the grant.) <br />3. Scope of Work <br />Grant funds are being applied for due to compliance requirements of AB 2286, which requires all <br />regulated businesses and Unified Program Agencies (UPA) to use the Internet to file required Unified <br />Program information electronically. <br />The City of Santa Ana Fire Department is a Participating Agency (PA) under Orange County HCA/EH <br />Certified Unified Program Agency (OC CUPA). Using EnvisionConnect, OC CUPA has created an <br />EnvisionConnnect Portal for reporting businesses of a PA to utilize for electronic reporting in lieu of <br />CERS. <br />Santa Ana intends to secure a consultant, E-Compliance, for the transition to the Portal. The software <br />used to submit electronically is called e-Submit. Data entered by regulated businesses into e-Submit <br />transfers to OC CUPA via the portal. OC CUPA uses this data to prepare the consolidated invoice. <br />The conversion to electronic reporting through the EnvisionConnect Portal began early 2010 and is now <br />complete. A transition from our current online software to e-Submit will allow regulated businesses in <br />Santa Ana to connect through the e-Submit portal with a limited learning curve. <br />All participating agencies under OC CUPA who utilize the EnvisionConnect Portal are included in the joint <br />Transition Plan submitted by OC CUPA. Each individual PA will continue to complete the milestones <br />reported to Cal/EPA document on a quarterly basis. <br />Page 1 of 3 <br />20A-11