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FLORIDA SMALL CITIES OR DISASTER RECOVERY CDBG CLOSEOUT (12.06) Closeout forms must be submitted to the Department of Community Affairs, Florida Small Cities CDBG or Disaster Recovery Program, within 45 days after the contract termination or expiration date. A Final Request for Funds should be submitted prior to, or with, the closeout since funds not requested will be deobligated at closeout. Closeout requirements can be found in Rule 96-43.0051 (11), F.A.C. Instructions All grant recipients must complete Section I. Commercial Revitalization or Neighborhood Revitalization grant recipients must complete Section II. Recipients of Commercial Revitalization or Economic Development grants must complete the relevant portions of Section III, and Housing grant recipients must complete Section IV. All grant recipients must complete the Beneficiary Data form and the Status of Accomplishments and Expenditures form. The Closeout Approval form must be signed by the Chief Elected Official. Enter the information requested or circle the response. Section I. Contract Information Contract Number: Beginning Date Ending Date : 03DB-IA-10-40-01-H12 01-29 2003 j 01-28-2007 j Recipient: Local Contact: +-Phone Number: Indian River County Gale Carmoney (772) 226- 1668 1 . Indicate how the project was carried out (administration Grantee Employees [_and actors Both aconstruction ; __— —� -- — 4 Z 5 2 . Indicate how beneficiary data was collected : -�_.--- I Census Survey - —_. N/A N/A N/A 13 . Enter the Census Tract(s) and/or Block Group(s) for service area(s): Census Trad(s) Block Group(s) N/A N/A - -4._ If location of activities chance is a map included? N/A Yes 7 - S. Is a Property Management Register included? I Yes No X � _ If an infrastructure project is an engineering certification included? N/A Yes - 7. Is the project located in a Historic District? Yes No X B. Is the rp ojed located in a Presidentially Declared Disaster Area? Yes NoX 9. Is the project a Special Assessment activity? _ Yes X 10 . Is the project a Brownfield Activity? Yes No X li , Did the local government provide the assistance (to nra t Loan Deferred, forgiveable loan or 9 ntz . _ �_ nt moA X the beneficiaries in the form of a loan — � 12 If a loan indicate: Interest Rate Monthly A Loan mourtization 13 List all other funds, alongwith the Ifo N/A - $ N/A Period in Months _ source, used to support the activities funded with this grant: _ _ Source Amount — I Local Funds (i.e. ,General Revenue) j Indian River County SHIP -- — $ 393,812. 10 Grant(s) - - -- Private Funds (i. e., Participating Party, $ etc. I Loan(s) Other (Specify) — - —14. - 1 - 1-- - - - _ _ I ` 14 . Will-the project result in program inco -me? Program incomeeamedbutnotexpended j Yes No-- before closeout must be returned to DCA. Make check payable to the Department of w X Community Affairsrs - CDBG Program and include it with the Closeout. _ • If Program income has already resulted indicate amount: -- 15, Hasa final Request for Funds been submitted? - -- ---- — Yes X� No 21 . Does the local _ _ _ ? (cannot ee - (_ _—_--- _— _._government have CDBG Funds on , hand? cannoterceed$S 0� If yes _ _ No X I -