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Attachment K Department of Community Affairs Florida Small Cities Community Development Block Grant (CDBG) Program SIGNATURE AUTHORITY FORM Submit an onginai Signature Authonty Form with each contract. _ Recipient Contract # Indian River County 08DB D3- 10-40 01 Al2 Mailing Address (Street or Post Office Box) 1801 27th Street City, State and Zip Code Vero Beach , Florida 32960-3365 Project Contact Person Telephone # (772) 226 - 1254 Robert M . Keating , AICP E-mail Address bkeating ( lrcgov com Financial Contact Person Telephone # (772) 226 - 1257 Jason Brown E-mail Address . Ibrown (cDirc oq v . com Requests for Funds (RFFs) from the Florida Small Cities CDBG Program require (check one).' [ X ] one signature [ ] two signatures of individuals authorized below. No more than two individuals can be authorized to use FloridaPAPERS. CDBG contracts require that at least one ( 1 ) RFFs must be submitted each quarter and should reflect all expenditures incurred during that reporting period . _ 1 _ _ - Typed Name Date - Signa r Robert Keating y f d /Q [ X ] Checc k here if the above person be the E-m it Ad ress designated FloridaPAPERS user. bkeatinoircgov.com Typed Name Date Signature [ ] Check here if the above person will be the E-mail Address designated FloridaPAPERS user. Typed Name Date Signature [ ] Check here if the above person will be the E-mail Address designated FloridaPAPERSuser . I certify, as the recipient's Chief Elected Official, that the above signatures are of the individuals authorized to sign Requests for Funds and to submit RFF's electronically to the Small Cities Community Development Block Grant Program using FlondaPAPERS . Typed Name Date Signature Sandra L Bowden April 29 , 2 t � of - a . K . [ X ] Check here if your local government utilizes Electronic Funds Transfer ( E from the State of Florida . [ X ] Check here if your local government will be working on a reimbursement sis. CDBG payments to local governments using EFTare automatically deposited in the local government's general account. If the account is interest bearing, the CDBG funds must be transferred to a non-interest bearing account. Please call the CDBG Program at 850/922- 1878 or 487-3644 if you have questions. You can check the status of your deposit at the Comptroller's website : htto : //flair.dbf.state.fl .us/. 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 . Name of Financial Institution Account Number RCB BANK 7680027195 Street Address or Post Office Box Telephone Number 1417 CENTURA HIGHWAY (252) 454 — 3557 or (800) 226-5985 City, State and Zip Code ROCKY MOUNT NC 27802 F: \Community Development\Users\CDBG\2007 Neighborhood Rev\Contracts\DCA Contract\Forms - Attachments\ 1Signature Authorization .doc