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Pinellas CoC Organizations Hurricane Preparedness Form
Organization *
Primary Contact: Name *
Title
First Name
Last Name
Primary Contact: Cell Phone Number *
Primary Contact: Email Address *
Secondary Contact: Name *
Secondary Contact: Cell Phone Number *
Secondary Contact: Email Address *
Primary Location Information
Primary Location *
Primary Location: Evacuation Zone *
Primary Location: Address *
Address Line 1
Address Line 2
City
State
Zip
Primary Location: Phone Number *
Primary Location: Type of Location *
Overnight Shelter, Housing (scattered-site), Housing (multi-unit), Meal Site, Resource Center, etc.
Primary Location: Populations Served *
Primary Location: Current and Maximum Capacity *
Primary Location: Storm Preparedness *
Generator, Evacuation Plan, Emergency Supplies, etc.
Primary Location: Additional Information *
Special needs, on-site contacts, etc.
Additional Locations
If your organization has a second location, please provide details for that location here. Please include the same details requested in Primary Location section.
Additional Location #1 Information
Additional Location #2 Information
Additional Location #3 Information
Additional Location #4 Information
Additional Location #5 Information
Additional Information
Needs and/or Concerns *
Please list any hurricane-related concerns or needs here. If none, please write N/A.
Ability to Assist Partners During Hurricanes *
If you are able to assist partner agencies during hurricanes (i.e., meals, beds, generator, etc.), please list that information here. If this does not apply, please write N/A.

Questions for the CoC? Email VKelly@HLAPinellas.org.
Questions for Pinellas County Emergency Management? Email JGeib@Pinellas.gov.