5/12/2016 2:04:18 PM
9/30/2015 10:42:25 PM
Official Document Type
Agenda Item Number
Community Development Block Grant Neighborhood Revitalization
Applicant/Grantee Recipient Disclosure Certification
Gifford Fire Station
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COPY <br /> INDIAN RIVER COUNTY NR CDBG <br /> APPLICANT/GRANTEE/RECIPIENT DISCLOSURE CERTIFICATION <br /> PART I . APPLICANT/GRANTEE/RECIPIENT INFORMATION <br /> n ica e w e er is is an ni ial-Repo—t=fir an Updates _ — <br /> A. Applicant/Grantee Name, Address and Telephone (include area code) <br /> Indian River County <br /> 1801279' Street <br /> Vero Beach, Florida 32960 <br /> (772) 226-1237 <br /> B . Participating Party Name, Address, and Telephone (include area code)(for economic development <br /> component only) <br /> N/A <br /> C . Project Location Address <br /> Indian River County <br /> 362049th St <br /> Vero Beach, Florida 32967 <br /> D . Type of Assistance Requested/Provided Amount of Assistance <br /> Requested/Provided <br /> Community Development Block Grant $750,000.00 <br /> Neighborhood Revitalization <br /> Gifford Fire Station <br /> 08-DB-T3-10-40-01 -N25 <br /> PART II. THRESHOLD DETERMINATION (Applicant/Grantee only) <br /> Have you received , or can you reasonably expect to receive (including this CDBG contract, an <br /> aggregate amount of CDBG funds in excess of $200, 000 for the current fiscal year. <br /> Yes X No <br /> If "yes" , Parts III through V must also be completed . <br /> All applicants must certify that the information provided is true by signing below. <br /> INDIAN RIVER COUNTY / <br /> Printed Name of ApplicanVGrantee/Recipient Ignature of ief Elected Official <br /> December 9 , 2008 Wesley S. Davis, BCC Chairman <br /> Date Printed Name & Title of Chief Elected Official <br />
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