2009-228D - Laserfiche WebLink

Home Browse Search

Attachment K Department of Community Affairs Neighborhood Stabilization Program ^r%p rFlorida Small Cities Community Development Block Grant(CDBG)Program LOLJ SIGNATURE AUTHORITY FORM ........... .......... Signature A Form with each contract 2009 AUG 24 PM 3: 26 .......................................................... .................................. Authority_............contract........ Recipient Contract# Local Government DUNS Number Indian River Cou 10DB-4X-10-40-01-F13 079208989 Mailing Address(Street or Post Office Box) 1801 27th Street City, State and Zip Code YeLo_peaqh,Florida..32,.9..6.0-..3388 ....... Project Contact Person Telephone# 226-1254 Robert M. Keating,Community Development Director E-mail Address bkeatingal[ggg ............ .......... ............. ------ ............................ ................................... Financial Contact Person Telephone # 77_2)226-1205 Diane Bernardo—Finance Director E-mail Address dbernardo@clerk.indian-river.org ................... ....... ........— Requests for Funds(RFFs)from the Florida Small Cities CDBG Program require (check one):[ ]one signature [ ]two signatures of individuals authorized below. No more than two individuals can be authorized to use FlondaPAPERS. CDBG contracts require that at least one(1) RFFs must be submitted each quarter and should reflect all expenditures 1 incurred duringthat reporting_period. Typed Name Da Si atur Robert M. Keati Community Dev Director .. ............................. X] Check here if the above person will be the designated FloridaPAPERS user. ... bkeating@ircgov.c ...... ...... Typed Name Date Signature ............................................ ....................................... ...................................... .......... ............. Check here if the above person will be the E-mail Address FloridaPAPERS user. ..... .....I.......................... .................................. ...................................................... ............. Typed Name Date Signature ........................ ........... ................-----------.........eck here if the above person will be the E-mail Address ......... Check .................... 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 RFFs electronically to the Small Cities Community Development B!oCk Grant Program using FloridaPAPERS. ............................................... ....................... ...................... ....................... . ........" Typed Name Date Wesley S.Davis,BCC Chairman U ............ .................... ...... [X]Check here if your local government utilizes Electronic Funds Transfer(EFT)from the St e of Florida. [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 fo housinq activities. .......... ..........................................................'........'.......... .......... ........ ............................................ CDBG payments to local governments using EFTare automatically deposited in the local government's general account. If the account is interest bearing,the CDBG funds must be transferred to a non-interest bearing account. Please call the CDBG Program at 850/922-1878 or 487-3644 if you have questions. You can check the status of your deposit at the Comptroller's 1 website: http://flair.dbf.state.fl.us/. ..................... ............ ..................................................... ..................—------ ......... Localgovernments 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 Account Number . . RBC Bank 053100850-7680027195 Street Address or Post Office Box Telephone Number 1417 Centura Highway 2 �5 (800)226-5985 ............ ............... ................................................................................................................ City",'State and Zip Code Rocky Mount,,NC 27802 ...........I...... ....... ....2............................................. ......................................................................................................--.. ...............I.......... ................ .........................