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Department of Economic Opportunity — Small Cities Community Development Block Grant Program <br /> ATTACHMENT L - Signature Authorization Form ao 1 a • RSA 10i1r201 1 <br /> Subm/tan orl final Signature Authorization Form with each copyof the contract. 1 O 3 1 <br /> Recipient: Contract Number: NONE Funding Source: g W- <br /> Indian River County 12DB-OH - 10-40-01 -N01 ® Small Cities CDBG <br /> see <br /> El Disaster ❑ NSP <br /> Mailing Address (Street or P.O . Box): 1801 27th Street Local Government DUNS <br /> City, State, and Zip Code: . Vero Beach , FL 32960 079208989 <br /> Project Contact Person : Telephone Number. E-mail Address: <br /> Michael C. Hotchkiss (772) 226-1821 Ext: mhotchkiss@ircgov. com <br /> Financial Contact Person : Telephone Number. E-mail Address: <br /> Edward Halsey (772) 226-1205 Ext: ehalsey@clerk. indian-river.org <br /> Other Local Government Contact: Telephone Number. E-mail Address: <br /> W. Erik Olson (772) 226-1834 Ext: eolson@ircgov.com <br /> Requests for Funds ( RFFs) require (check one): ® one signature ❑ two signatures of individuals authorized <br /> below. RFFs must be submitted via the Department's website at hftp://ecdbg . doe, myflorida.com/ (or by an <br /> alternative means specified by the Department). <br /> Name Typed : Michael C. Hotchkiss Date: !U • - f � + We <br /> nature <br /> ® Check here if above person is authorized E-mail Address: <br /> to submit RFFs. <br /> Name Typed : Art Pfeffer Date: l * 0700) • I <br /> Signature <br /> ® Check here if above person is authorizedE-mail Address: <br /> to submit RFFs. ck ? ser 4w ar @ i rc clove to ou... <br /> Name Typed : Gordon Sparks Date: 'L <br /> Si nate <br /> ® Check here if above person is authorizedE-mail Address: JS ��aV� KPS C l �'C 90y . C a vn <br /> to submit RFFs. <br /> Name Typed . Date: <br /> Signature <br /> ❑ Check here if above person is authorized .••`°""NpH N " <br /> p E-mail Address: ��1aNbip, <br /> to submit RFFs. r ' ' ' • <br /> 1 certify, as the recipient's Chief Elected Official, that the above signatures are of the indiv' , fi rized <br /> to sign Requests for Funds and to submit RFF's electronically. <br /> PP <br /> Typed Name: Gary C . Wheeler Date: 111 !511 �' <br /> Si natu • <br /> ® Check here if your local government utilizes Electronic Funds Transfer (EFT) from the State off' • Igmoose It <br /> ® Check here if your local government will be working on a reimbursement basis. °`°0-... E <br /> ❑ If this signature authority form pertains to a housing grant, check here if your local government will use an <br /> escrow account for housing activities. <br /> Moose <br /> CDBG payments to local governments using EFT are automatically deposited in the local government's general <br /> account. If the account is interest bearing , the CDBG funds must be transferred to a non-interest bearing account. <br /> Please call the CDBG Program at 850/922- 1878 or 487-3644 if you have questions. You can check the status of <br /> your deposit at the Comptroller's website: http://fIair. dbf. state.fl . us/. <br /> Local governments not receiving EFT, and not working on a reimbursement basis, must establish a non-interest bearing account. <br /> Provide account information for the financial institution (insured by FDIC) below. All signatures on the account must be bonded. <br /> Name of Financial Institution: Wells Farge Bank, N .A. Account Number: 2000044270289 <br /> Address: 1001 20th Place Telephone Number: (772) 5694500 <br /> Moose <br /> City, State and Zip Code: Vero Beach , FL 32960 <br />