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14 <br /> Technical Project Number_ FL29B309003 <br /> Submission Project Identifier <br /> Cover Page <br /> Recipient' s Name: HUD Project Number: <br /> Indian River County Board of County Commissioners <br /> Check the program component/type which classifies your project: <br /> ❑ Transitional Housing (TH) <br /> ❑ Permanent Housing for Homeless Persons with Disabilities (PH) <br /> ❑ Supportive Services Only (SSO) <br /> ❑ Safe Haven (SH) <br /> ® Homeless Management Information System (HMIS) <br /> ❑ Innovative Supportive Housing (ISH) <br /> Table Of Contents <br /> (Enter the page number for each Exhibit in the space provided below. ) <br /> Exhibit 1 Project Summary <br /> Exhibit 2 Acquisition, Rehabilitation, New Construction, and Project Feasibility <br /> Exhibit 3 Real Property Leasing <br /> Exhibit 4 Supportive Services <br /> Exhibit 5 Operating Budget <br /> _15_ Exhibit 6 Homeless Management Information System <br /> Exhibit 7 Administration <br /> Exhibit 8 Leveraging <br /> Certification . <br /> Name & Title of the Person who can answer questions about this document: Phone (include area code) : <br /> Louise Hubbard, Executive Director 772-567-7790 <br /> Address: Treasure Coast Homeless Services Council, Inc. <br /> 2525 St. Lucie Avenue <br /> Vero Beach, FL 32960 <br /> I hereby certify that all the information stated herein is true and accurate. <br /> Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil <br /> penalties. ( 18 U. S . C. 1001 , 1010, 1012 ; 31 U. S. C. 3729, 3802) <br /> Name & Title of Authorized Official : Signature & Date: <br /> Caroline D . Ginn , Chairman - 2 �c�.�� ,z , 03 - 16 - 04 <br /> OMB Approval No. 2506 (exp. 8/31/2006) HUD40076-2 <br />