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Attachment K Department of Community Affairs Neighborhood Stabilization Program Florida Small Cities Community Development Block Grant (CDBG ) Program C 0 w .. SIGNATURE AUTHORITY FORM 1009 AUG 2 � Pry 3 � _ _ _ _—Submit an original Signature Authority Form with each contract ..... __. Recipient - Contract # Local Government DUNS Number I Indian River County 10DB- 4X- 10-40-01 -F13 079208989 _._.._._ — ....... .........._..._._ _._..__......_._........_..........•....._._..._._._. .....- — i Mailing Address (Street or Post Office Box) 1801 27t ' Street City, State and Zip Code Vero Beach, Florida 32960- 3388 Project Contact Person I Telephone # I 1......(.772) 226- 1254...__. ........... - .............. .-._._.. _..........__. .............. - Robert M . Keating, Community Development Director E- mail Address I bkeatingC� ircgov. com ...._..............._...............__........_. ...................._.. ........__ ......._.........__ ._.._. _ - - - --- - _ _ _ .._..... ...._....._... - -.._ ._-._ _._........-. __ _ _. _...................._...._............................._.. .......-.....-.......... ...._. Financial Contact Person I Telephone # (772) 226-1205 Diane Bernardo - Finance Director E-mail-Address dbernardo@clerk. indian-river.orQ -..._.._._._ ... _____,._ —.....__....__.... -_._._......_.__._ 1 Requests for Funds ( RFFs) from the Florida Small Cities CDBG Program require (check one): [ ] one signature [ ] two 1 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 . _Keatin91. Community Dev Director . ............... — . � [ X ] Check here if the above person will be the E-mail Ad ess designated FloridaPAPERS user_ _ bkeating@ircgov. com . 9 _ _ _._ ._..... .. _.. .__ __. .. _ .----. . ..._. — _. _ . _._...- - --- _ _.__.. - Typed Name j Date Signature ._-.._._..__. ..._.._.........._-._......_.._...........__........... .. ...___._.__..........-_.._..................._.._......-...._.__...---....._..... ...-__— ___._..---___.__._i_. _................ ........ ....._ ............. _.__. —...__..__..__..__--____._..__.._._ [ ] Check here if the above person will be the E- mail Address �... designated_ ---F....l_o.._r._d._aP_.APERS user. ........... .. .... _ ........... ._.. ......._.._....._ ._ - Typed Name Date { Si:g---n-.a._t._.u_.r_e I _. __. . . __erson will be the E-mail Address [ ] Check here if the above p ss i 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 Block Grant Program using FloridaPAPERS . Typed -Name. .. — ypedName — Wesley„S . Davis, BCC Chairman _.... _......_._ uguSt.__�8_,__ QQ. '/ _.._ [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 for housing activities . _ — ...... CDBG payments tolocal 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 l 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/ . _......—_.....__._.._... ...-.._.................- --------------------------—......_._.._ _ — ._.-......._.—_—._ --...........--........_...._.._....... _.....__._..._ _...__._..... _._.__...._._.. -- __ ----......_.. Loca/ 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 . _........_.........__.._......... ... .__._...-----. ... ... .... ...... ...............-__............___....._...........- .. _-- - - _ _ _ .._..........._.......-_ ..._..__ . — _._._............— -- ---- -.............._.__..._.._...._......_.__..._ _... Name of Financial Institution TAccount Number 1. RBC Bank ' _053100850-76800271.9. 5 _ Street Address or Post Office Box j Telephone Number ;...._14,17 Centura Highway ----..................._..._.. ....... -.. —.._................ .... .__....._................................_._�_..�2) 4543557 or (800) 226-5985.......__..._. _........_._ —_......_. ...__..........- ......_.. ........ -'I I City , State and Zip Code fRocky Mount, NC 27802