Florida Traffic Safety Information Systems Federal Fiscal Year 2014 Request for Section 405 Funding Supplemental Information Request Form Project Title: Agency Name: Provide the total number of crashes reported by your agency: In 2012: Provide the total number of citations reported by your agency in 2012: Is your agency currently submitting electronically? Yes No If yes, how many crash reports were submitted electronically in 2012: If yes, how many citation reports were submitted electronically in 2012: If awarded Section 405 funding, do you anticipate your electronic submissions to increase? Yes No If yes, please provide estimated increase: Do you have an executed contract agreement with an eCrash vendor? Yes No If requesting grant funding for equipment, check the appropriate box: (Note: If equipment is outdated and cannot be upgraded to allow electronic submission, please check the “New equipment” box) New equipment Replacement equipment If awarded Section 405 funding to purchase equipment, who will use the equipment? Number of patrol officers issued with a laptop: Number of traffic officers issued with a laptop: