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TREASURE COAST HOMELESS SERVICES COUNCIL , INC. CONTINUUM OF CARE <br /> MOONED <br /> Technical Project Number _ FL2911409003 <br /> Submission Project Identifier— FL 13168 <br /> (RENEWALS ONLY) <br /> Recipient' s Name : HUD Project Number: FL2911409003 <br /> Indian River County Board of County Commissioners <br /> Check the program component/type that classifies your project: <br /> ® Transitional Housing ('114) <br /> ❑ Permanent Housing for Homeless Persons with Disabilities (PH) <br /> ❑ Supportive Services Only (SSO) <br /> ❑ Safe Haven/Transitional Housing (SH/TH) — Characteristics of TH/participant not required to execute a lease <br /> ❑ Safe Haven/Permanent Housing (SH/PH) — Characteristics of PH/participant required to execute a lease <br /> ❑ Homeless Management Information System (H1VIIS) <br /> ❑ Innovative Supportive Housing (ISH) <br /> Table Of Contents <br /> (Enter the page number for each Exhibit in the space provided below . ) <br /> 3 Exhibit I Project Summary <br /> 7 Exhibit 2 Real Property Leasing, Supportive Services, HMS and Operating <br /> Budget <br /> Certification : <br /> Name & Title of the Person who can answer questions about this document: Phone (include area code) : <br /> Louise Hubbard, Exec. Director, Treasure Coast Homeless Services Council, Inc. 772-567-7790 <br /> Address : <br /> 2525 St. Lucie Avenue, 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: ignature & Date : <br /> Commissioner Thomas Lowther <br /> 1840 25" Street <br /> Vero Beach, FL 32960 <br /> -- May 3 2005 <br /> OMB Approval No. 2506-0112 (exp. 8/31/2006) HUD-40076-2 3 <br />