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Attachment K Department of Community Affairs Neighborhood Stabilization Program Florida Small Cities Community Development Block Grant (CDBG ) Program SIGNATURE AUTHORITY FORM Submit an original Signature Authority Form with each contract 2009 A UG 2 [;. i ( 20 ... 1. Recipient Contract # Local Government DUNS Number Indian River County 10D6 4X- 10-40-O1 - F13 079208989 _ . .. . 1111 ........ .... ..... . _ ......... ......... I FI Mailing Address ( Street or Post Office Box) 18FI 01 27th StreetII . ........ . ....11...11 ..... .... ..... . . ......... ......... ......... . . ............. .... ......... ......... ....... . . ..... 11 City, State and Zip Code Vero Beach , Florida 32960-3388 1111 1111 Project Contact Person I Telephone # (772) 226- 1254 FI ......... Robert M . Keating , Community Development DirectorI E- mail Address bkeatinggircgov com .....1111 . Financial Contact Person Telephone # (772) 226F1205.. ..... . ... __ .. ., ... _ .. .... ... ........ Diane Bernardo — Finance Director E- mail Address dbernardo@clerk. indian - river. org ......... ..... .... ......... ...... .. . ......... .._ ...... ..... .. .. ....... I .. : III Requests for Funds ( RFPs) from the Florida Small Cities CDBG Program require (check one): [ ] one signature [ ] two signatures of individuals authorized below . No more than two individuals can be authorized to use FloridaPAPERS . CDBG contracts require that at least one ( 1 ) RFFs must be submitted each quarter and should reflect all expenditures incurred during that reporting period . ... ....... .. Typed Name Da Sr atur Robert M . Keating , Community Dev Director )+ [ X ] Check here if the above person will be the E-mail Ad ess designated FloridaPAPERS user. bkeating@ircgov . com .. .. . _ . -- Typed Name Date Signature F . 1111 ...... ... ... .....Ill [ ] Check here if the above person will be the E- mail Address designated FloridaPAPERS user . . ............. . . . ............._ . .......... ......... ...._ ...1111. _ Typed Name Date Signature IF 1 . . ... .... . . ... .... .. ...1111. .. ......... .... ......... ...... [ ] Check here if the above person will be the E- mail Address designated FloridaPAPERS user. , 1111..... 1414_. ..1111 .. _ _. I certify, as the recipient's Chief Elected Official , that the above signatures are of the individuals authorized to sign Requests for Funds and to submit RFF's electronically to the Small Cities Community Development Block Grant Program wing FleridaPAPERS . Typed Name Date e / / Wesley S . Davis BCC Chairman AU.g.uSt 1..$ ,. 20.0 ....... �— +4 41 IF .... ... 4111_ 1111..... . [X ] Check here if your local government utilizes Electronic Funds Transfer ( EFT) from the Scatee of Florida . [X] Check here if your local government will be working on a reimbursement basis . [ ] If this signature authority form pertains to a housing grant, check here if your local government will use an escrow account for housing activities 1111......1 1 1 1 1 Ill Im I I I I I I I I I I I I I I I I I1111. . . .. .. . _. . . .1111. _ . 'IF_ . ...... CDBG payments to local governments using EFTare automatically deposited in the local government's general account. If the account is interest bearing , the CDBG funds must be transferred to a non - interest bearing account . Please call the CDBG Program at 850/922 - 1878 or 487-3644 if you have questions . You can check the status of your deposit at the Comptroller's website : http : //flair . dbf. state . fl . us/ . 11 .11. 4 . 41.1. . .... .... .... .... ......................................................I _ ... Local governments not receiving EFT, and not working on a reimbursement basis, must establish a non - interest bearing account. Provide account information for the financial institution ( insured by FDIC) below . All signatures on the account must be bonded . ............................... . dIdIIIIIIIIIII IFFIIIIII-I .. . . ..... -1........................ ......... . ........ mr-...IF- I m I....I- I rrr 1.1..._._.._ Name of Financial Institution Account Number RBC Bank 053100850- 7680027195 1 .114 _ If . ..... ... ._. ..... .11_. Street Address or Post Office Box Telephone Number 1417 Centura Highway (252) 454 3557 or (800) 226- 5985 _1111 City, State and Zip Code Rocky Mount, NC 27802 Fr I FI FII FI ..FI I .... . . ..... ... l ... l ... . . ... ...