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SUB -RECIPIENT AGREEMENT CHECKLIST <br />DIVISION OF EMERGENCY MANAGEMENT <br />MITIGATION BUREAU <br />SUB -RECIPIENT REPRESENTATIVE POINT OF CONTACT <br />REQUEST FOR REVIEW AND APPROVAL <br />SUB -RECIPIENT: <br />Indian River County <br />PROJECT #: <br />4283-95-R <br />PROJECT TITLE: <br />Wild Fire Mitigation <br />CONTRACT #: <br />H0259 <br />MODIFICATION #: <br />_ <br />I NA <br />SUB -RECIPIENT REPRESENTATIVE POINT OF CONTACT <br />COMPLETE ----- ---- ------ <br />Ms. Beth Powell, Assistant Director <br />This form is required to be included with all Reviews, Approvals, and Submittal <br />Parks & Conservation Resources <br />Two (2) Copies printed for Approval <br />Indian River County <br />Printed Single -sided (If your policy is to copy two-sided please contact me and I will <br />550077 th Street <br />send you two original one-sided copies for signature) <br />Vero Beach, Florida 32967 <br />Enclosed is your copy of the proposed contract/modification between Indian River County and <br />the Florida Division of Emergency Management (FDEM). <br />----- <br />COMPLETE ----- ---- ------ <br />❑ <br />This form is required to be included with all Reviews, Approvals, and Submittal <br />❑ <br />Two (2) Copies printed for Approval <br />❑ <br />Printed Single -sided (If your policy is to copy two-sided please contact me and I will <br />send you two original one-sided copies for signature) <br />❑ <br />Reviewed and Approved <br />❑ <br />Signed and Dated by Official Representative (blue ink) <br />❑ <br />Copy of the organization's resolution or charter that specifically identifies the <br />person or position that is authorized to sign, if not Chairman, Mayor, Chief <br />❑ <br />Attachment I - Federal Funding Accountability and Transparency Act (FFATA) <br />completed, signed, and dated (❑ N/A for Modifications) <br />❑ <br />Two Signed and dated Originals mailed to FDEM - Tallahassee <br />Florida Division of Emergency Management <br />Mitigation Bureau — HMGP <br />2555 Shumard Oak Boulevard <br />Tallahassee, Florida 32399-2100 <br />Attention — Grant Specialist —Veronica S. Ash, FCCM, Office 330-B <br />If you have any questions regarding this contract, or who is authorized to sign it, please contact <br />your Project Manager at (850) 815-4570 or email me at Holly.swift(@em.myflorida.com. <br />127 <br />