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► a - 18 - o7 <br /> SIGNATURE AUTHORITY FORM (07.02 ) <br /> INDIVIDUALS AUTHORIZED TO SUBMIT REQUESTS FOR PAYMENTS <br /> SUBMIT THREE ORIGINAL COPIES FOR EACH CONTRACT <br /> RECIPIENT CONTRACT # <br /> Indian River County 06DB-3C- 1 0-40-01 -W 14 <br /> MAILING ADDRESS (STREET OR POST OFFICE BOX) <br /> 1801 27th 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 : bkeating (�ircgov. com <br /> FINANCIAL CONTACT PERSON TELEPHONE # (772) 226 - 1257 l <br /> Jason Brown E-MAIL ADDRESS: IbrOWn@ rCgOV . COm <br /> REQUESTS FOR FUNDS FROM THE FLORIDA SMALL CITIES CDBG PROGRAM ( DEPARTMENT OF COMMUNITY AFFAIRS) <br /> REQUIRE (CHECK ONE) [X] ONE SIGNATURE [ ] TWO SIGNATURES OF INDIVIDUALS AUTHORIZED BELOW. <br /> TYPED NAME DATE SIGN , <br /> Robert M Keating <br /> TYPED NAME SIGNATURE a � . <br /> TYPED NAME DATE SIGNATURE <br /> TYPED NAME DATE SIGNATURE <br /> I CERTIFY, AS THE RECIPIENYS CHIEF ELECTED OFFICIAL, THAT THE ABOVE SIGNATURES ARE OF THE INDIVIDUALS <br /> AUTHORIZED TO SIGN REQUESTS FOR FUNDS FROM THE SMALL CITIES COMMUNITY DEVELOPNIENT BLOCK GRANT. <br /> TYPED NAME DATE, l SIGNATURE <br /> Sandra L . Bowden Lt -2 ( 1 . 031 03 '' <br /> FX I Check here if your local government receives Electronic Funds Transfer ( EFT) from <br /> the State of Florida . <br /> Note: CDBG payments made via EFT are automatically deposited to the local governments general 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: //flair. dbf. state.fl. us/ If ,you are not sure if year <br /> local government uses EFT , or have any questions about the process, please call the C06G section at (850 ) <br /> 922-1894 . <br /> FX I 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 /> RBC BANK 053100850-7680027195 <br /> STREET ADDRESS OR POST OFFICE BOX TELEPHONE NUMBER <br /> 1417 CENTURA HIGHWAY (252 ) 454 - 3557 or (800) 226-5985 <br /> CITY, STATE AND ZIP CODE <br /> ROCKY MOUNT, NC 27802 <br /> F'\Community Development\UsersZDBG\cdbg 20051Contract\DCA Contract\Signature Authorization - Revised 4- 18-08.doc <br /> oRlrl! KAt_ Tj 31t_L ceHu <br />