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DocuSign Envelope ID: 927D0328-CA93-46FB-A33E-35E863E9820E <br />OMB Approved No. 1505-0271 Attachment A <br />Expiration Date: November 30, 2021 <br />U.S. DEPARTMENT OF THE TREASURY <br />CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS <br />Recipient name and address: DUNS Number: 079208989 <br />Indian River County Taxpayer Identification Number: 596000674 <br />1801 27th st Assistance Listing Number: 21.019 <br />Vero Beach, Florida, 32960 <br />Sections 602(b) and 603(b) of the Social Security Act (the Act) as added by section 9901 of the <br />American Rescue Plan Act, Pub. L. No. 117-2 (March 11, 2021) authorize the Department of the <br />Treasury (Treasury) to make payments to certain recipients from the Coronavirus State Fiscal <br />Recovery Fund and the Coronavirus Local Fiscal Recovery Fund. <br />Recipient hereby agrees, as a condition to receiving such payment from Treasury, to the terms <br />attached hereto. <br />DocuSigned by: <br />Recipient: VXIIJ& <br />Authorized Representative: Kristin Daniels <br />Title: Budget Director <br />Date signed: 5/13/2021 <br />U.S. Department of the Treasury: <br />Authorized Representative: <br />Title: <br />Date: <br />PAPERWORK REDUCTION ACT NOTICE <br />The information collected will be used for the U.S. Government to process requests for support. The <br />estimated burden associated with this collection of information is 15 minutes per response. Comments <br />concerning the accuracy of this burden estimate and suggestions for reducing this burden should be <br />directed to the Office of Privacy, Transparency and Records, Department of the Treasury, 1500 <br />Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to this address. An agency <br />may not conduct or sponsor, and a person is not required to respond to, a collection of information unless <br />it displays a valid control number assigned by OMB. <br />