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SIGNATURE AUTHORITY FORM (07 . 02) x w <br /> INDIVIDUALS AUTHORIZED TO SUBMIT REQUESTS FOR ' PAYME`Od <br /> + . r <br /> SUBMIT THREE ORIGINAL COPIES FOR EACH CONTRAaJ ` s° rii 17 ' ' O <br /> RECIPIENT CONTRACT # h ` <br /> Indian River County 06DB-3C - 10-40-01 -W 14 ' ` <br /> MAILING ADDRESS (STREET OR POST OFFICE BOX) <br /> 184025 th Street <br /> CITY , STATE AND ZIP CODE <br /> Vero Beach , Florida 32960-3365 <br /> CONTACT PERSON TELEPHONE # ( 772 ) 226 — 1254 <br /> Robert M . Keating , AICP E -MAIL ADDRESS : bkeatinmt ircgov . com <br /> FINANCIAL CONTACT PERSON TELEPHONE # (772 ) 226 — 1257 <br /> Jason Brown E- MAIL ADDRESS : Ibrown (LDircgov . com <br /> REQUESTS FOR FUNDS FROM THE FLORIDA SMALL CITIES CDBG PROGRAM ( DEPARTMENT OF COMMUNITY AFFAIRS ) <br /> REQUIRE (CHECK ONE [ ] ONE SIGNATURE [ X TWO SIGNATURES OF INDIVIDUALS AUTHORIZED BELOW . <br /> TYPED NAME DA ESI AT R <br /> Robert M . Keating , AICP g f/ <br /> TYPED NAME &ATE <br /> SI ATUR <br /> V I L� <br /> Jason Brown <br /> TYPED NAME SIGNAT E <br /> TYPED NAME DATE SIGNA UR <br /> I CERTIFY , AS THE RECIPIENT'S CHIEF ELECTED OFFICIAL , THAT THE ABOVE SIGNATURES ARE CSF THE" INPIVI-DUALS <br /> AUTHORIZED TO SIGN REQUESTS FOR FUNDS FROM THE SMALL CITIES COMMUNITY DEVELOPMENT BLOCK GRANT . <br /> TYPED NAME DATE SIGNATOR <br /> Thomas S . Lowther 18 / 11 / 0 �< ` < <br /> FX I Check here if your local government receives Electronic Funds Transfer (fr3Tp #rora <br /> the State of Florida . <br /> Note : CDBG payments made via EFT are automatically deposited to the local governm°entsgeneral account . <br /> If this account is interest bearing it must be transferred to a non - interest bearing account . You can check on <br /> your deposit through the State Comptroller's website at http ://f lair . dbf. state . fl . us/ If you are not sure if your <br /> local government uses EFT, or have any questions about the process , please call the CDBG section at (850 ) <br /> 922 - 1894 . <br /> Check here if your local government will be working on a reimbursement basis . <br /> For local governments not receiving EFT and not working on a reimbursement basis , a non - interest bearing <br /> account must be established . Please list the account information for the financial institution ( insured by the <br /> FDIC ) below . All signatures on this account must be bonded . <br /> NAME OF FINANCIAL INSTITUTION ACCOUNT NUMBER <br /> INDIAN RIVER NATIONAL BANK 0189298301 <br /> STREET ADDRESS OR POST OFFICE BOX TELEPHONE NUMBER <br /> 95820TH PLACE ( 772 ) 569 — 9200 , ext . 2992 <br /> CITY , STATE AND ZIP CODE <br /> VERO BEACH , FL 32960 <br />