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Attachment K Department of Community Affairs Neighborhood Stabilization Program Florida Small Cities Community Development Block Grant (CDBG ) Program 44 SIGNATURE AUTHORITY FORM 2069 AUG2 �a 3Y --.... _ ..... -. — _ Submit an origins/ Signature Authority Form with each contract _ _ _ Recipient Contract # L-- focal Government DUNS Number I Indian River County 10DB-4X- 10-40-01 -F13 _ - _ _ 079208989 j Mailing Address (Street or Post Office Box) 1801 27"' Street _._._.—_.. —..._.__ ....— ..._ _._....._. _ City, State and Zip Code L.i Vero Beach , Florida 32960-3388 - Project Contact Person Telephone # i [._...(772) 226- 1254... ..........._....__......_..._......---- _...._......... _ . .............--- - _ Robert M . Keating, Community Development Director E-mail Address bkeating@ircgov. com _..._.._......._....I......................_ ......_..----.. ......................__...................__......--- __ _..-..._.................._._._ �_._.__� __ Financial Contact Person I Telephone # _._..-___ __......_.._..._._._._.._.._.......... _. _._.._.....__.__.___.._..._.._. j 772 226- 1205 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 contracts require that at least one ( 1) RFFs must be submitted each quarter and should reflect all expenditures i_ incurred during that reporting _period . n4z*Typed Name Da S._._[ojrt .M... Keating , Communi Dev Director . .. -..._I X Check here if the above person will be the E-mail Ad ess designated FloridaPAPERS user. bkeating@ircgov. com — Typed Name Date I Signature ..._..._._..._—._.._._............_........._._.....4..........................., .................__ ...._ ...__ _ ..........._.f....—..---- I� ----..__............._..-_........ ......................_...._........... - [ ] Check here if the above person will be the E-mail Address I designated FloridaPAPERS user. . ............................ -- --__..._........._-. .... ......... — ............... Typed Name DateI Signature ___ ..._.._ _. _.__.. _..._._...._.____..__ ._._..._ _- .._.._ _.. .__..._. ._._.._.._.....-_4 ._... ............. _ ..1_-_ .. [ ] Check here if the above person will be the E-mail Address _designated FloridaPAPERS user. 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 RFFs electronically to the Small Cities Community Development Block Grant Program using FloridaPAPERS , ]- Typed Name Date e ' I WesleyS . Davis BCC Chairman 200„ _,,,_,_ _._..-_-... ..._... . _. st_1$ _.._...._.._..... ............ ___._...._.. _..._..__ A� u ..,...___. . [X] Check here if your local government utilizes Electronic Funds Transfer ( EFT) from the St e of Florida . [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. __ ...... _. -- - - -._-_- ......._.d........_ CDBG payments to /oca/ 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 . i__..._...._. ......._...................._ ..._.._.—................_ - -- ...__—.._..................._.. __ ._..........._._ — .................._.. ._._.........._.__ ._ Name of Financial Institution Account Number RBC Bank _......— .......... ._.. ..............._ —__ ._.__..........--.---......__._. _. — _053100850-7680027195 _ _....._..__.--__.___. _ ............_.._....... ....._......__._ Street Address or Post Office Box Telephone Number 1417 Centura Highway __ — _ _ I 252 454-3557 or 800 226-5985 --- -...._ .. .. I....()_.. _. —_. _.-_�. ... .—__._ .. .. .... .. _ - _.... _. _. ... _ ..__ ... _. ..... ._ City, State and Zip Code ..............Rky Mount, NC 27802_ _..._......._._.—._.