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Page 9 of 9 Florida Department of State Minority Appointment Reporting Form for Calendar Year 2016 (Section 760.80, Florida Statutes — Form due NLT December 1, 2017) Appointing Authority:* Indian River County Board of County Commission Contact Person: Doris E. Roy Address: 1801 27th Street Phone: 772-226-1408 City/State/zip: Vero Beach, FI 32960-3388 Entity (Name of Board. Commission, Council, or committee): Community Development Block Grant Does this entity have multiple appointing authorities? Yes ❑ No (] The entity's total membership as of 12/31/16, regardless of appointing authority: 5 (Note: This figure is the denominator to be used in calculating percentages below; the numerator for calculating the percentages is the number in the second column, i.e., "Total membership as of 12/31/16".) Appointed by Total Race Appointed Total Gender Race Authority' in Membership % Gender by Authority' Membership as 2016, only as of 12/31/16 in 2016, only of 12/31/16 African-American 5 100 Mal 5 100 Asian -American Hispanic -American Native -American Caucasian Not Known — Total 0 e Female Not Known Total n Appointed by Total Disability Disability Authority' Membership in 2016, only as of 12/31/16 Physically 0 0 Disabled — 'Figures are to reflect appointments made only by this Appointing Authority. Please complete all sections. Entity (Name of Board, Commission, Council, or Committee): Does this entity have multiple appointing authorities? Yes ❑ No ❑ 1] r, The entity's total membership as of 12/31/16, regardless of appointing authority: (Note: This figure is the denominator to be used in calculating percentages below; the numerator for calculating the percentages is the number in the second column, i.e., "Total membership as of 12/31/16") Appointed by Total Race Appointed Total Gender Race Authority' in Membership % Gender by Authority` Membership as % 2016, only as of 12/31/16 in 2016, only of 12/31/16 African-American Male Asian -American Female Hispanic -American Not Known Native -American Total Appointed by Total Disability Caucasian Disability Authority` Membership % in 2016, only as of 12/31/16 Not Known Physically Total Disabled — ~Figures are to reflect appointments made only by this Appointing Authority. Please complete all sections. Return to: Department of State, The R. A. Gray Building, Room 316, 500 South Bronough Street, Tallahassee, FL 323W0250 DS -DE 143 (rev. 08/2017) 44