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Attachment K Department of Community Affairs Neighborhood Stabilization Program Florida Small Cities Community Development Block Grant (CDBG) Program ,B �, . SIGNATURE AUTHORITY FORM 20pg AUG 2 ►� Pr`s 3 � _ _ — _ _— __ Submit an original Signature Authority Foam with each contract _ -- 2..E__._..._._... Recipient Contract # Local Government DUNS Number Indian River County ......... .................._.._......._..-.. . __._._.._..______ __loll. _ _.__._.__........_................._..........---- ...---. .._ .. .___�...___......_._.._._..----.---.____..-- 1 Mailing Address (Street or Post Office Box) 180127 th StreetCity, State and Zip Code i Vero Beach, Florida 32960-3388 0,1 __ -- _lo. .lollll._.-...... __..._.._............_......._..- - - _........_ ..- —.._—__loll__-- .................................. ......_ Project Contact Person I Telephone # i ! (772) _226- 1254 ............................. ........._ ..._.._.._.._ ._ .........._.__.__.____ .............. .................... ---.._.__..._� I Robert M . Keating , Community Development Director E-mail Address _loll........ _ _ _. _ loll_ — . —.. .............._ . _. _. .. ._bkeatin@ircgov. com..... - ..... ..._................_........... .......... ...-_._.-loll- _ loll_...--- .._._......... _ __.._.. Financial Contact Person Telephone # 772 226- 1205 ? (___._.)_____ ._._......._..-----...----._......_......__........_. .__..___.._............._._._._._..___—...._.._ i Diane Bernardo — Finance Director t E-mail Address i dbernardo@clerk_indian_river^org —_ _— 1_......_.. _._.._...___._.___._.....__.._....—_.____... __.___ —..__....__..._... _._..�--_...____..._...._._.._ _.._......_ Requests for Funds ( RFFs) 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 Si atur — Robert M . Keating,, Communi Dev Director (Z Director [ X ] Check here if the above person will be the E-mai Ad ess i designated FloridaPAPERS user . _ _ — � bkeating@ircgov. com .. Typed Name Date Signature ....._._.._.._ _._..._..__........._............._._.............__............ .... -- ._._.......__.._......_..............._._.__..._.__._..__.........._' _ _ _ .._a... ............... [ ] Check here if the above person will be the E- mail Address ...._designated... FloridaPAPERS user . --------. . ---- --- . ._._....- ..__....-...-........._._........... ...............-......-- -----..-._..............._...._.. Typed Name Date Signature ..___...._........_.__..._ _..�..._ _..._...._...._..._.�._._...._____._._.._.__....___....—__ __.___ ._...__._.___._........._...._......_.......__. . ___.............____.—___.._....._ . ____._loll._.-----.---._.._._..-- •-.--.-.___- [ ] Check here if the above person will be the E-mail Address designated FloridaPAPERS user_ __ — _ _ — _ _._._. _....._._._—_loll - ._.. ._ ... ...._. _loll ._ ..._.. . .. - - -- — --- - - - ---- 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 using FleridaPAPERS . _ ......._..._._.........._.___ _ _ __._ _---- _ _ _ __ _ ___.._........... ._.,loll.—._—..--- ------ --loll.. ____ .................._.._...__ Typed Name Date e — I Wesley S . Davis, BCC Chairman �Q 1.... _.__..._....... . ....... ............. — — — — u g u s t__18_�.....__. . ...0... __...._ ._._ loll.__ .;. . ..._... _loll — _.._..._._. _........._...... ..... — [ X] Check here if your local government utilizes Electronic Funds Transfer ( EFT) from the St e of Florida . i [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 i for housing activities . ---- loll. _ - _ __—___ _ .........__......._..__-._._-. ......... --- ---- --- -- ..._._._..._..........-- CDBG payments to local governments using EFTare automatically deposited in the local government's general account. If the j 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/ . I _................---- — - - - loll_._... _ _loll.._.. _ —_- ......................................_..loll..._ ......_-_...... ....._......... 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 . .._..._...._........_..................._._..._.__..__ ....... ..........................— — .____.—.._.................------- -- ------- —.--...........4.._.................. ........ _ ....................._.._._— _ ._ ........_..._......_...._.._..........._......._ _loll. Name of Financial Institution Account Number RBC Bank 053100850-7680027195 _._....._... .__.......-- - .........._...._....... -----............_._.. ........... _—._ .. - ........ -- - - } _ _ ._........._..._. ..._-- .._.._._._... ----......__..............---..._._._..._......_.__.._..._............. ..........._......__...__. Street Address or Post Office Box i Telephone Number 1 .. _1417 Centura...Hig_hway._ _. ...................._.............._................._.._._1......(252) 454_3557._or ..(800) ._226 -5985.... _........ ......._... - -- ......_......_. _._......_..........._..._.-....._...... City, State and Zip Code I Rocky „ Mount, NC 27802