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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 2009 AUG 24 P 3 • _ _ __ _ ....,- - „ -- Submit an original Signature Authority Form with each contract _—� Recipient Contract # Local Government DUNS Number If Indian River County 10DB-0- 10-40-01-F13 079208989 Mailing Address (Street or Post Office Box) 180127 th Street i City, State and Zip Code Vero Beach ., Florida 32960-3388 - -- ---......_......__...._......_.._�_...__......-- Project Contact Person ! Telephone # i „ (772) 226- 1254 _.( . -...-- . .__... 6- 1254... ._. ......._.. __........_...... _..--._._. ---- ...._........._—...._..........--- --..._ Robert M . Keating, Community Development Director E- mail Address _........................._.__........_.__......... ...._.... .... ....._ bkeatin9 (d)irc ov. corn ............._...__---- .. .--__.-__..._............._... _....... -_..._._.,— _.-_..--..-�..-.._.__.. _—, __.._...................._.........._.................--- _ _.........._.......... _.._._.. Financial Contact Person Telephone # (772) 226- 1205 Diane Bernardo - Finance Director - mail Address - - --.__._._.._.._._........____.____..-......_-. E dbernardo@clerk. indian-river. org 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 Florida PAPERS. CDBG contracts require that at least one ( 1) RFFs must be submitted each quarter and should reflect all expenditures incurred during that reportir g_period . __ - - - Typed Name j Da 1 Si atur — Robert M . Keating..,..Community Dev Director _Q .-. [ X ] Check here if the above person will be the E- mail Ad ess RS user. bkeatin designated FloridaPAPEg@ircgov. com l --.--...__.... —_...._._..__.__.._...-. _ __- - . __... -. .. _. .... _ _.-.._.................._._ _..-----....._- ---.--._...__... __..._..__....._._._._ Typed Name Date Signature _._..__.._—._..._..._........._.........._..............._................... ....._--._................................- - - ......_.._ ... ---- -- - _......._.......—._ ........_........... .... . [ ] Check here if the aboveerson will be the p E- mail Address i designated FloridaPAPERS use . _ .. . .... ._._ ----- ...... .... ---- . -- - - ---- .. ...........--- ._...._ --.._..........._..._..._._ —�. I — — ..— Typed Name Date Signature [ ] Check here if the above person will be the E- mail Address designated FloridaPAPERS user. 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 B!wk Grant Program using FleridaPAPERS . Typed Name Wesley S . Davis, BCC Chairman _... ____._.___ Ug -18 8._,_._.2.._00- _,__._. .._ � . _. . ._ . �r .. ._ _._ .._..._.............._..___.__._.............__-..__..._. _ .. [X ] Check here if your local government utilizes Electronic Funds Transfer ( EFT) from the S�lorida . [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 -- _ .. _. _ . - _. __. CDBG payments to local governments using EFTare automatically deposited in the local government's general account. If the i 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/ . ........._._........_... ...... ........__..... Local governments not receiving EFT, and not working on a reimbursement basis, must establish a non-interest bearing account. t Provide account information for the financial institution ( insured by FDIC) below. All signatures on the account must be bonded . _ _ Name of Financial Institution Account Number RBC Bank { 053100850-7680027195 ---- . ._._.. ._.—._. . . . , . __. ..T.. . _.. _ _ _............ ... ....._..._....._.....-----.._.._._..._.....___ — ___ ._._...__...__......—.- - ---....__.......... _.._._.. _._..___........_._.._........._..-......_..._. Street Address or Post Office Box Telephone Number 1417 Centura Highway.. ..__........_ _ .... ... ..—_....................._. ............._..................._._....(252) 454_3557 or (800) 226-5985. •City , State and Zip Code Roc o , 0 kY .. MuntNC 2782 .__........ ... . . ..... ..__....._ ..... ...- - ....__.........._...__............ .---- _ ----- - .—__._............. ...._........ --- ---- .._._.....__........._.........__ .......... ............... .... ........................