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Home My WebLink About2007-124.B COPY INDIAN RIVER COUNTY NR CDBG APPLICANT/GRANTEE/RECIPIENT DISCLOSURE CERTIFICATION PART I . APPLICANT/GRANTEE/RECIPIENT INFORMATION n ica e w e er is is an ni ial-Repo—t=fir an Updates _ — A. Applicant/Grantee Name, Address and Telephone (include area code) Indian River County 1801279' Street Vero Beach, Florida 32960 (772) 226-1237 B . Participating Party Name, Address, and Telephone (include area code)(for economic development component only) N/A C . Project Location Address Indian River County 362049th St Vero Beach, Florida 32967 D . Type of Assistance Requested/Provided Amount of Assistance Requested/Provided Community Development Block Grant $750,000.00 Neighborhood Revitalization Gifford Fire Station 08-DB-T3-10-40-01 -N25 PART II. THRESHOLD DETERMINATION (Applicant/Grantee only) Have you received , or can you reasonably expect to receive (including this CDBG contract, an aggregate amount of CDBG funds in excess of $200, 000 for the current fiscal year. Yes X No If "yes" , Parts III through V must also be completed . All applicants must certify that the information provided is true by signing below. INDIAN RIVER COUNTY / Printed Name of ApplicanVGrantee/Recipient Ignature of ief Elected Official December 9 , 2008 Wesley S. Davis, BCC Chairman Date Printed Name & Title of Chief Elected Official Applicant/Grantee/Recipient Disclosure Certification continued PART III. OTHER GOVERNMENT ASSISTANCE Federal Department/State/Local Agency Name and Address Amount Program Type Requested/Provided o pp ica e PART IV. INTERESTED PARTIES List of all persons with a Financial Interest Reportable Financial Interest Type of Participation in Project ($ and %) Guardian CRM Inc. Administration $40,000 (5.33% CDBG) PO Box 189 Mascotte, FL 34753 352-429-4570 Ph : 863-661 -6696 Fax: 863-583-0357 www.guardiancrm .com Barth Construction , Inc. Construction $690 ,000 (92% CDBG) 1717 Indian River Blvd $200 ,000 (local funds) Suite 202 A Vero Beach , Florida 32960 Ph : 772-778-3072 Fax: 772-770-3017 ity kes(dbarthconstruction .com PART V. SOURCES AND USES OF FUNDS Source Use CDBG $60,000 Grant Administration CDBG $690,000 Fire Station County (local) $50,000 Engineering County (local) $200,000 Fire Station I hereby certify that this information is true and correct. December 9 2008 Signature of Chief Elected official Wesley S . Davis, BCC Chairman Date REQUEST FOR AMENDMENT (07.02) (NO CHANGE IN BUDGET OR ACCOMPLISHMENTS) Recipient: Indian River County Amendment Request Number: 1 Date: April 29, 2008 Contract Number: 08DB-T3-10-40-01 -N 25 R le in Effect for This Grant: IFFY 2007 Local Government Authorization : _ BCC Chairman MM7V 13 2008 DCA Authorization (Authorized Signature) n ra en ( Date Signed) (Authorized Signature) (Date Approved) Budget Information (CDBG only) Activity Accomplishments ACo'dey Activity Name Original Budget Current Budget Proposed Budget Original Contract Current Contract Proposed Contract (before this (before this amendment) amendment 1 2 3 4 5 6 7 8 21A Administration $609000.00 $60,000.00 $60,000.00 na na na 21B Engineering $0.00 $0.00 $0 .00 na na na Fire Protection 030 $690 ,000.00 $690,000.00 $690 ,000.00 1 Firehouse 1 Firehouse 1 Firehouse S F Totals $750 ,000 $750,000 $7509000 ( o � O � t � J Beneficiaries Total Beneficiaries Low & Moderate Income Very Low Income Activity Activity Original Current Proposed Original Proposed Original Proposed Code Name 21A Administration n/a nla n/a n/a nla nla nla na na na na 21B Engineering n/a nla n/a n/a nla n/a n/a na na na na 030 Fire Protection 8,262 85262 8,262 7 ,000 84.73 79000 84.73 3,855 46.66 3,855 46.66 W�v S „ IMP, Original Proposed 20. Total # Unduplicated Beneficiaries 89262 8.262 21 . Total # Unduplicated LMI Beneficiaries 71000 7.000 22 . Total # Unduplicated VLI Beneficiaries 3.855 3.855 23 . Total # Unduplicated LMI Households 2.318 2.318 24 . Does this amendment reduce ANY other project funds previously committed as leverage from local or other sources? YES NO X ( If YES , you MUST complete and attach Source and Use of Funds form . ) 2