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Applicant/Grantee/Recipient Disclosure Certification continued <br /> PART III. OTHER GOVERNMENT ASSISTANCE <br /> Federal Department/State/Local Agency Name and Address Amount <br /> Program Type Requested/Provided <br /> o pp ica e <br /> PART IV. INTERESTED PARTIES <br /> List of all persons with a Financial Interest <br /> Reportable Financial Interest Type of Participation in Project ($ and %) <br /> Guardian CRM Inc. Administration $40,000 (5.33% CDBG) <br /> PO Box 189 <br /> Mascotte, FL 34753 <br /> 352-429-4570 <br /> Ph : 863-661 -6696 <br /> Fax: 863-583-0357 <br /> www.guardiancrm .com <br /> Barth Construction , Inc. Construction $690 ,000 (92% CDBG) <br /> 1717 Indian River Blvd $200 ,000 (local funds) <br /> Suite 202 A <br /> Vero Beach , Florida 32960 <br /> Ph : 772-778-3072 <br /> Fax: 772-770-3017 <br /> ity kes(dbarthconstruction .com <br /> PART V. SOURCES AND USES OF FUNDS <br /> Source Use <br /> CDBG $60,000 Grant Administration <br /> CDBG $690,000 Fire Station <br /> County (local) $50,000 Engineering <br /> County (local) $200,000 Fire Station <br /> I hereby certify that this information is true and correct. <br /> December 9 2008 <br /> Signature of Chief Elected official Wesley S . Davis, BCC Chairman Date <br />