2009-228E - Laserfiche WebLink

Home Browse Search

Attachment K Department of Community Affairs Neighborhood Stabilization Program COPT ee Florida Small Cities Community Development Block Grant (CDBG ) Program 6 � O P PYA� � SIGNATURE AUTHORITY FORM 2009 AUG 24 Phi _........... ........ __. _..__..._............ _. _...___Submit an original Signature Authority Form with each contract _........_..._. _..__...__..._._............. ..._.._......_...._....__3."...2...6._...._........._........ I I .. . ..... ....... .. . .. ... . Recipient Contract # Local Government DUNS j Number Indian River Coun 101) 6-4X- 10-40-01 -1` 13 079208989_ ' __.. ........ ..I ...- ... tY... . _... .__.. ... _.. ........._. _. _._ I_ .... . . . _ Mailing Address (Street or Post Office Box) th - . Street I _.._........_..._......_.._......- _ .....................4.......... .. __.._......._...._.... .__.........._................._. . ...... ....._._...._. _ _ ........ ..... . ............................ _ _ _ _ _ .. _ _ . ..... .. ..._... . _.._......... . . _.._........-............ ............_............. ......... ....._... ......... ...._....... ....... .........._... ... .........__.._........._..__..._ ..... 180127 .........__._._..., I City, State and Zip Code j Vero Beach, Florida 329.60-3388 .II ...._ _ I.II _....._. II._. ... _ _ I .. ..III_. ... . ._ .. ._.-..I............II. ... . . ......I.._ ... . .. ..- . .... _... .. . _ ...... _....... .._.._... _. .—...... . ..... ....._..... . .. . .... _..-_ . . ... . __._ .. ; Project Contact Person I Telephone # 1 .. ..(772 226- 1254 ... . . ........._ ............._................. ..... .. . ....... _ _ . .. ..... _ .. .............. . ..... ........._................_ ....._._ __ __...._... . _ .........._............... _.__. . Robert M . Keating , Community Development Director E- mail . . _ . Address i _ . . bkeati naov_ com.. .._................................................._......... .. ................................_......................... ...._......... .._..............._..... .............. ........................... ................_......................-...........-............................. . . __......-_ ._ Financial Contact Person Telephone # j !_..(772)..226-1205 ................... . . __.............................._............... ........... ...............................III ..._......._......................._... 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 Florida PAPERS . CDBG I contracts require that at least one ( 1) RFFs must be submitted each quarter and should reflect all expenditures incurred during that reporting...period. - -- - --.._III........._......_. _.._ .. .._.. ... .. ..... ... ........ ... ._ .... ........... . ...._.............. _..._ .._.. ..... ......... _... _........_ ...._..__ ... ........ . _.. __.._.., Typed Name i Da !i Si atur ..._Robert...M .114....i<eating , Commu41 rrity_Dey Director_... ._ ... ... .. .._..... _ ..._.. . �� Q... ... . 1. ._. ._ �`l J...._ .. _ [ X ] Check here if the above person will be the E-mail Ad ess desi nated FloridaPAPERS user. bkeating@ircgov. com„ .... . g. . .. . . _ . ...... .. ... .. _ ..—..---.. .. ._........ ..._..... . ._ ...... .................... ._. .............................. ... .. .............. ....... . . .... ..._._ .. _. . _ _ ._.. .. . ......... _.... __ ._ ... .. Typed Name Date Signature _. .......... .._._. ........... ................ ................III........ ...... ................. .... ...__.._... ............................... ....._......... ................... ................. ......_........._..__.._._...._......... ....._...-_................,..._............_................. . ...._........._.._.............._...... . ..... . ..._ ._... ........... .._...._........_........._......._........._........_.._....... .... ............. [ ] Check here if the above person will be the E- mail Address desi nated FloridaPAPERS user . _.......g....... ..........................................---._._._.._........................ ...... .......... ..........-..._............__............--............_ ..__...._._....._................................_.........._..__....................... .._.. ..........._................. . .._ ........__._.....__...._.............._....................... . ._ ........_..._....__._..............._........._........._._ ........ � i Typed Name Date Signature . . ..._. .......... ...... ...... .....__......... _...........__.........._................._....... ...............—........... .I................._.... _...... .._......._......_..............................._....................._.. ... .-.._.............. ........... ..... ........ ............ ................ _..__..__._...._..._..._....._._.._.._._...._._..._.__. ..__.........__..._ } [ ] Check here if the above person will be the E-mail Address designated FloridaPAPERS_ user. _ I _.... _..._ ._.. ..... .. . .. ............ .__ .III ..._..._.._................................ . . ....... . .... ...- - .. ._.... . ...III.II ...._ ..__..._.._ ..._ . .._. . __...._... ._ .._..... ....._........_ . _ .. .._........i I certify, as the recipient's Chief Elected Official , that the above signatures are of the individuals authorized to sign Requests for I Funds and to submit RFF's electronically to the Small Cities Community Development Block Grant Program using FloridaPAPERS . Typed Name Date e / WesleyS . Davis BC C Chairman August . .. _........ ._. _ I [ X] Check here if your local government utilizes Electronic Funds Transfer ( EFT) from the Statee of Florida . I [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 for housing activities . _ ....._............. .......... .... _......._......— -._..._... ........._..._ ... . ._.._.._........._. .._-...__..........._...._..........._ ........ ........................- ..._.... ................._ ........ .._..._.....__.............._.............._.............................. .... CDBG payments to local governments using EFT are automatically deposited in the local government's general account. If the I account is interest bearing , the CDBG funds must be transferred to a non - interest bearing account. Please call the CDBG j Program at 850/922- 1878 or 487- 3644 if you have questions . You can check the status of your deposit at the Comptroller's i website : http : //flair. dbf,state .fl . us/ . .................._............_....,....,............_..................._............................_.................._...._...._.................................._............._-...- ......._...............................................................,...III................._.._.........III............ .................................._........................................ .........._........._........__..__........_..._._............._.i Loca/ governments 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 . j G..............._........ __... .......................... . ..........._.. .......... ................_.._............ ---.------.................................._..... ......._........_........-..._..._._.___..__ . ._.._.._. ..._.... ............_...................--._....._.....___...__......_..._._.............._....._....._._._..._.... .._................. ..._. ..................... .. ... .............. . ..._.._....._............ i i Name of Financial Institution Account Number i RBC Bank _ ..._.......__.._..... ................_..._........__.............._..........._. 053100850-7680027195 .................__ . . _._. ._.- . _.-}. _.- t.. ........ _. ... . . __. _. . . . ._. _ _. .........._......__... ...._............. ........_..............._........_...._........._._.......... ..._._........._........._.................._......._; I Street Address or Post Office Box Telephone Number j 1417 Centura Highway _...._.1_....(25,2) 454-3557 or (800).._226-5985................_........._.... ......_..._........... _ ........................ ..................._..I g............_._. . ........_--_................ ...._......._...................__......_.. .......... City, State and Zip Code i Roc Mount NC 27802 .......__..........ky.............-..............[.................._._......... ...... ...............__...._.....................--..............._.._.._...__. - ................ _.__..............._....__................................_._.._..__...._........._.__.......__.. ............._..... ... . ..................._................_................................. ..........._...._...._.._._.....__..._._.............._._...__._..: