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4/I ;/ 07 Department of Community Affairsn �� _ �� q Florida Small Cities Community Development Block Grant (CDBG) Program d SIGNATURE AUTHORITY FORM Suomt an orginal Signature Authonty Form act # , each cortaet Recipient . . , . . . . . Indian River County 08DB-T3- 10-40-01 - N 25 Mailing Address (Street or Post Office Box) 1801 27th Street City, State and Zip Code i Vero Beach , Florida 32960-3365 Project Contact Person Telephone # - - - - (772) 226 - .112154 Robert M . Keating , AICP E-mail Address bkeating-aDircgov conn Financial Contact Person Telephone # (772 ) 226 - 1257 Jason Brown E-mail Address jbrowngirc ov . 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 Typed Name Date Sig ur _ Robert M . Keating [ X ] Check here if the above person will be the E-ma Addrss / � designated FloridaPAPERS user. 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_ FloridaPAPERS user. I certify, as the recipient's Chief Elected Official, that the above signatures are of the individuals autho :zed to sign ,Requests for Funds and to submit RFF's electronically to the Small Cities Community Development Block Grant Program using FleridaPAPERS . '... Typed Name Date Signatur i Sandra L Bowden 1ft � �I . 0y � [ X ] Check here if your local government utilizes Electronic Funds Transfer ( EFT) f m the State of Florida . [ X ] Check here if your local government will be working on a reimbursement basis. 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 : http : //flair dbf.state fl us/. Locaigovemments notreceiving EFT, and not working on a reimbursement basis, must establish a non- interest 11 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 RBC BANK 053100850-7680027195 Street Address or Post Office Box Telephone Number 1417 CENTURA HIGHWAY (252 ) 454 — 3557 or (800 ) 226-5985 Cityr State and Zip Code ROCKY MOUNT, NC 27802 R\Community Deve1opment\Users\CDBG\2007 Neighborhood Rev\Contracts\DCA Contract\Revised Signature Authorization Form 4-18-08. doc