HomeMy WebLinkAbout2011-028 A TRUE COPY
CERTIFICATION ON LAST PAGE
06 . 10 New Closeout Forms . doc J . K . BARTON , CLERK
DEPARTMENT OF COMMUNITY AFFAIRS '
CITIES CDBG DISASTER RECOVERY AND NEIGHBORHOOD STABILIZATION PROGRAMS Zi U
FLORIDA SMALL G
CLOSEOUT ( Revised 06 . 10 )
Instructions
Closeout forms must be submitted to the Department of Community Affairs within 45 days after
contract termination or expiration or upon completion of the project . The final Request for Funds
must be submitted with the closeout since funds not requested will be deobligated at closeout .
Any
amendment needed to close out the contract should be submitted prior to submission of a closeout .
Closeout requirements can be found in Rule 9B - 43 . 0051 ( 5 ) , F . A . C .
1 . All grant recipients must complete the following sections :
SECTION A - CONTRACT INFORMATION
SECTION E - STATUS OF ACCOMPLISHMENTS AND EXPENDITURES
SECTION F - BENEFICIARY DATA
SECTION I - CLOSEOUT APPROVAL
Section D relates to housing activities .
Section H relates only to disaster recovery program grants .
4 . Additional copies of forms may be made if there is insufficient space to enter the information
that needs to be reported .
5 . The Closeout Approval form must be signed by or ordinancee Chief Eofcted the ocallao�e governing r a member a tholtloc�ol
government staff , authorized by resolut
sign CDBG contracts and related documents .
6 . Submit only the pages applicable to your grant .
Please contact the CDBG Program at 850 / 487 - 3644 if you have questions about the closeout process .
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A TRUE COPY
CERTIFICATION ON LAST PAGE
J . K . BARTON, CLERK
- -- --FLORIDA-SMA,L.L-CI-T- IES--CDBG--DISASTER - RECOVERY AND NEIGHBORHOOD-STABILIZATION
CLOSEOUT ( Revised 06 , 10 )
Indicate Funding Source : [ ] Small Cities CDBG [ X ] Disaster Recovery [ } Neighborhood Stabilization
SECTION A - CONTRACT INFORMATION
Recipient : Contract Number : Beginning Ending Recipient ' s DUNS # :
Date : Date :
Indian River County 08DB - D3 - 10- 40 - 01A 12 6 / 26 / 08 12 / 26 / 10 079208989
Recipient ' s FEID # : County in which recipient Local Contact : Phone Number :
59 - 6000674 islocated : 772 - 226 - 1254
Indian River County Robert M . Keating
Indicate how the project was carried out ( admin andGrantee Contractors Both X
construction ) : Employees
Indicate how beneficiary data was collected: Census Survey X
If location of activities changed , is a map included ? Yes No X
Is a Property Management Register included ? Yes No X
If an infrastructure project , is an engineer ' s certification included? Yes N / A No N / A
Was assistance ( to beneficiaries ) provided in the form of a loan or Grant Deferred , forgivable
grant? loan X
Activity Purpose ( Indicate all that apply ) :
Help Prevent Homelessness? Yes No X
Help the Homeless? Yes No X
Help Those with HIV / AIDS ? Yes No X
Help Persons with Disabilities? Yes X No
Special Characteristics (Check all that apply to the location of this activity )
Presidentially Declared Major Disaster Area Yes X No
Historic Preservation Area Yes No X
Brownfield Redevelopment Area? If yes , indicate the number of acres remediated . Yes No X
Conversion from Non - Residential to Residential Use Yes No X
List all other funds used to support the activities funded with this grant : N / A
Source Amount
Local Funds ( i . e . , General Revenue ) $
Grant ( s ) $
Private Funds ( i . e . , Participating Party , etc . ) $
Loan ( s ) $
Other ( Specify ) $
Has a final Request for Funds been submitted? Yes X No
Witt the project result in program income? Unless otherwise stated in contract, program Yes No X
income must be returned to the Department of Community Affairs .
If the project has generated program income , indicate amount : $ N / A
2
A TRUE COPY
CERTIFICATION ON LAST PAGE
J . K . BARTON, CLERK
- -- --FLORIDA-SMA,L.L-CI-T- IES--CDBG--DISASTER - RECOVERY AND NEIGHBORHOOD-STABILIZATION
CLOSEOUT ( Revised 06 , 10 )
Indicate Funding Source : [ ] Small Cities CDBG [ X ] Disaster Recovery [ } Neighborhood Stabilization
SECTION A - CONTRACT INFORMATION
Recipient : Contract Number : Beginning Ending Recipient ' s DUNS # :
Date : Date :
Indian River County 08DB - D3 - 10- 40 - 01A 12 6 / 26 / 08 12 / 26 / 10 079208989
Recipient ' s FEID # : County in which recipient Local Contact : Phone Number :
59 - 6000674 islocated : 772 - 226 - 1254
Indian River County Robert M . Keating
Indicate how the project was carried out ( admin andGrantee Contractors Both X
construction ) : Employees
Indicate how beneficiary data was collected: Census Survey X
If location of activities changed , is a map included ? Yes No X
Is a Property Management Register included ? Yes No X
If an infrastructure project , is an engineer ' s certification included? Yes N / A No N / A
Was assistance ( to beneficiaries ) provided in the form of a loan or Grant Deferred , forgivable
grant? loan X
Activity Purpose ( Indicate all that apply ) :
Help Prevent Homelessness? Yes No X
Help the Homeless? Yes No X
Help Those with HIV / AIDS ? Yes No X
Help Persons with Disabilities? Yes X No
Special Characteristics (Check all that apply to the location of this activity )
Presidentially Declared Major Disaster Area Yes X No
Historic Preservation Area Yes No X
Brownfield Redevelopment Area? If yes , indicate the number of acres remediated . Yes No X
Conversion from Non - Residential to Residential Use Yes No X
List all other funds used to support the activities funded with this grant : N / A
Source Amount
Local Funds ( i . e . , General Revenue ) $
Grant ( s ) $
Private Funds ( i . e . , Participating Party , etc . ) $
Loan ( s ) $
Other ( Specify ) $
Has a final Request for Funds been submitted? Yes X No
Witt the project result in program income? Unless otherwise stated in contract, program Yes No X
income must be returned to the Department of Community Affairs .
If the project has generated program income , indicate amount : $ N / A
2
A TRUE COPY
RTIEI.CAT_i-ON_ - AS
J . K . BARTON , CLERK
SECTION B - PUBLIC FACILITIES AND INFRASTRUCTURE - - -- I'
To be completed if new or improved public facilities or infrastructure was provided.
SECTION B Not Applicable
FN07T4,a Public Facilities or Infrastructure Project Public Facilrovement?
How many were provided with improved access to this type of facility or infrastructure improvement?
How many were provided with access to facility or infrastructure that is no longer substandard?
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SECTION C - COMMERCIAL REVITALIZATION AND ECONOMIC DEVELOPMENT
*If reporting on commercial revitalization activities, respond only to items with an asterisk (`) .
*Total Number Expanding IF Number Relocating
New Businesses Assisted
Existi
Total SECTION C Not Applicable
* Num NOT a Commercial or Economic Development Project
i
* Num er of Businesses Assisted that Provide Goods or Services to Meet the Needs o
a Service Area
*Specify DUNS # for Each Business Assisted :
* Name of Business ( es ) * DUNS #
3
A TRUE COPY
RTIEI.CAT_i-ON_ - AS
J . K . BARTON , CLERK
SECTION B - PUBLIC FACILITIES AND INFRASTRUCTURE - - -- I'
To be completed if new or improved public facilities or infrastructure was provided.
SECTION B Not Applicable
FN07T4,a Public Facilities or Infrastructure Project Public Facilrovement?
How many were provided with improved access to this type of facility or infrastructure improvement?
How many were provided with access to facility or infrastructure that is no longer substandard?
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SECTION C - COMMERCIAL REVITALIZATION AND ECONOMIC DEVELOPMENT
*If reporting on commercial revitalization activities, respond only to items with an asterisk (`) .
*Total Number Expanding IF Number Relocating
New Businesses Assisted
Existi
Total SECTION C Not Applicable
* Num NOT a Commercial or Economic Development Project
i
* Num er of Businesses Assisted that Provide Goods or Services to Meet the Needs o
a Service Area
*Specify DUNS # for Each Business Assisted :
* Name of Business ( es ) * DUNS #
3
ATRUECOPY
CERTIFICATION ON LAST PAGE _
J . K . BARTON , CLERK
SECTION C - COMMERCIAL REVITALIZATION AND ECONOMIC DEVELOPMENT ( CONTINUED )
Job SECTION C Not Applicable
NOT a Commercial or Economic Development Project W / Mod
Actually Created
=Actually Retained
Number of Jobs Created
Of Jobs Created , Number of Jobs With Employer Sponsored Health Care Benefits
Of Jobs Created , Number of Persons Unemployed Prior to Taking Jobs Created Under
this Activity
Number of Jobs Retained 7F
Of Jobs Retained , Number of Jobs With Employer Sponsored Health Care Benefits
Types of Jobs Created / Retained
Job Category Number of Jobs Created Number of Jobs Retained
Officials and Managers IF IF
Professional
Technicians
Sales
Office and Clerical
Craft Workers ( Skilled )
Operatives (Semi - Skilled ) E
Laborers ( Unskilled ) IF E
Service Workers
4
ATRUECOPY
CERTIFICATION ON LAST PAGE _
J . K . BARTON , CLERK
SECTION C - COMMERCIAL REVITALIZATION AND ECONOMIC DEVELOPMENT ( CONTINUED )
Job SECTION C Not Applicable
NOT a Commercial or Economic Development Project W / Mod
Actually Created
=Actually Retained
Number of Jobs Created
Of Jobs Created , Number of Jobs With Employer Sponsored Health Care Benefits
Of Jobs Created , Number of Persons Unemployed Prior to Taking Jobs Created Under
this Activity
Number of Jobs Retained 7F
Of Jobs Retained , Number of Jobs With Employer Sponsored Health Care Benefits
Types of Jobs Created / Retained
Job Category Number of Jobs Created Number of Jobs Retained
Officials and Managers IF IF
Professional
Technicians
Sales
Office and Clerical
Craft Workers ( Skilled )
Operatives (Semi - Skilled ) E
Laborers ( Unskilled ) IF E
Service Workers
4
A TRUE COPY
---- - -- -- - -- - __ ---- - - - - __ -- --- - -- fERTiflCATION- ON LAST PAGE
SECTION D - HOUSING J . K . BARTON , CLERK
To be completed for housing activities . Accomplishments are measured by housing units ; beneficiaries are measured
by households assisted ( rather than the number of persons in a household ) . ( Race and ethnicity is determined by head
of household . )
Income Levels Owner Renter Total
Extremely Low (l'essthan7309
of� M1.)
i
Low %�Xf Y�4MI); 21 21
Moderate ;(50% , 803� ofAAAI}) 8 �8
Non - Low / Moderate
Totals 33 33
Percent Low / Mod 11 100% 11 % 1000/0
Number of units made handicapped accessible 0
Number of units occupied by the elderly 14
Number of units designated for persons with HIV / AIDS including the chronically homeless N / A
Number of permanent housing units designated for homeless persons and families N / A
Number of substandard units brought up to local code or Housing Quality Standards N / A
Number of one - for - one replacements N / A
Number of permanent displacements / relocations N / A
Number. of years that affordability is guaranteed N /A
Number of pre - 1978 units brought into compliance with lead safety requirements N / A
Number of units qualified as " Energy Star " N / A
Number of multi - family units rehabilitated N / A
Number of units created through conversion of Non - Residential to Residential Buildings N / A
Number of units designated as subsidized housing by a Federal , State or Local Program N / A
If new affordable housing units were created:
Number of units occupied by the elder) N / A
Number of households previously living in subsidized housing N / A
Number of years that affordability is guaranteed N / A
Number of One-for-One Replacement N / A
Number of units made handicapped accessible N / A
Number of units qualified as " Ener Star" N / A
5
A TRUE COPY
---- - -- -- - -- - __ ---- - - - - __ -- --- - -- fERTiflCATION- ON LAST PAGE
SECTION D - HOUSING J . K . BARTON , CLERK
To be completed for housing activities . Accomplishments are measured by housing units ; beneficiaries are measured
by households assisted ( rather than the number of persons in a household ) . ( Race and ethnicity is determined by head
of household . )
Income Levels Owner Renter Total
Extremely Low (l'essthan7309
of� M1.)
i
Low %�Xf Y�4MI); 21 21
Moderate ;(50% , 803� ofAAAI}) 8 �8
Non - Low / Moderate
Totals 33 33
Percent Low / Mod 11 100% 11 % 1000/0
Number of units made handicapped accessible 0
Number of units occupied by the elderly 14
Number of units designated for persons with HIV / AIDS including the chronically homeless N / A
Number of permanent housing units designated for homeless persons and families N / A
Number of substandard units brought up to local code or Housing Quality Standards N / A
Number of one - for - one replacements N / A
Number of permanent displacements / relocations N / A
Number. of years that affordability is guaranteed N /A
Number of pre - 1978 units brought into compliance with lead safety requirements N / A
Number of units qualified as " Energy Star " N / A
Number of multi - family units rehabilitated N / A
Number of units created through conversion of Non - Residential to Residential Buildings N / A
Number of units designated as subsidized housing by a Federal , State or Local Program N / A
If new affordable housing units were created:
Number of units occupied by the elder) N / A
Number of households previously living in subsidized housing N / A
Number of years that affordability is guaranteed N / A
Number of One-for-One Replacement N / A
Number of units made handicapped accessible N / A
Number of units qualified as " Ener Star" N / A
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HOUSING BENEFIT FORM
All grant recipients providing housing activities, including hookups , must complete this form . (Make copies of this page if necessary
to report on units addressed . )
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Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date it of Bed-
# Renter ( Last Name, First Initial ) (Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
1 Owner Grier, J 3469 44`h Street $ 12058 . 55 $ $ 1 , 058 . 55 8 / 05 / 2009 3 1
Vero Beach , Fl . 32967
2 Owner Person . S 5855 59"' Court $ 8, 618 . 25 $ $ 87618 . 25 7 / 29 / 2009 2
Vero Beach , Fl . 32967
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3 Owner Fischer, C 786597 th Court $ 11611 . 02 $ $ 1 , 611 . 02 8 / 06 / 2009 31
Vero Beach , Fl . 32967 1
4 Owner Justus, E 816 19`h Place SW $ 3 , 524. 11 $ $ 3 , 524. 11 8 / 03 / 2009 3
Vero Beach , Fl . 32962
5 Owner Baker, S 416161Street SW $ 4, 023 . 70 $ $ 4, 023 . 70 8 /05 / 2009 3
Vero Beach , FL 32962
6 Owner Walker, J 10080 90" Street $ 1 , 242 . 01 $ $ 1 , 242 . 01 7/ 28 / 2009 3
Vero Beach , Fl . 32967
7 Owner Wiliams, M 7545 th Place SW $ 14, 047 . 40 $ $ 14, 047 . 40 6 / 24/ 2009 2 .
Vero Beach , Fl . 32962
8 Owner Brown , B 397045 1h Place $ 2 , 320 . 75 $ $ 2 , 320 . 75 9 / 15 / 2009 2
Vero Beach , Fl . 32967
9 Owner Everest, R 6035 6th Place $ 31218 . 55 $ $ 3 , 218 . 55 9 / 18 / 2009 3
:.
Vero Beach , FL 32968
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10 Owner Williams, C 2302 11 `h Court SW $ 10, 294 . 80 $ $ 10, 294 . 80 9 / 18 / 2009 3
Vero Beach , Fl . 32962
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11 Owner Granito, L 1815 50" Ave . $ 2 , 276 . 10 $ $ 2 , 276 . 10 8 / 26/ 2009 3
Vero Beach , Fl . 32966
12 Owner Dunn , R 133712 1h Ave . $ 2 , 245 . 40 $ $ 2 , 245 . 40 9 / 15 / 2010 3 !
Vero Beach , Fl . 32960 �- D
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13 Owner Ewar, T 3821 44`h Street $ 4, 235 . 50 $ $ 4, 235 . 50 2 / 11 / 2010 2i n m
Vero Beach , Fl . 32967 n
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HOUSING BENEFIT FORM
All grant recipients providing housing activities, including hookups , must complete this form . (Make copies of this page if necessary
to report on units addressed . )
i
Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date it of Bed-
# Renter ( Last Name, First Initial ) (Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
1 Owner Grier, J 3469 44`h Street $ 12058 . 55 $ $ 1 , 058 . 55 8 / 05 / 2009 3 1
Vero Beach , Fl . 32967
2 Owner Person . S 5855 59"' Court $ 8, 618 . 25 $ $ 87618 . 25 7 / 29 / 2009 2
Vero Beach , Fl . 32967
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3 Owner Fischer, C 786597 th Court $ 11611 . 02 $ $ 1 , 611 . 02 8 / 06 / 2009 31
Vero Beach , Fl . 32967 1
4 Owner Justus, E 816 19`h Place SW $ 3 , 524. 11 $ $ 3 , 524. 11 8 / 03 / 2009 3
Vero Beach , Fl . 32962
5 Owner Baker, S 416161Street SW $ 4, 023 . 70 $ $ 4, 023 . 70 8 /05 / 2009 3
Vero Beach , FL 32962
6 Owner Walker, J 10080 90" Street $ 1 , 242 . 01 $ $ 1 , 242 . 01 7/ 28 / 2009 3
Vero Beach , Fl . 32967
7 Owner Wiliams, M 7545 th Place SW $ 14, 047 . 40 $ $ 14, 047 . 40 6 / 24/ 2009 2 .
Vero Beach , Fl . 32962
8 Owner Brown , B 397045 1h Place $ 2 , 320 . 75 $ $ 2 , 320 . 75 9 / 15 / 2009 2
Vero Beach , Fl . 32967
9 Owner Everest, R 6035 6th Place $ 31218 . 55 $ $ 3 , 218 . 55 9 / 18 / 2009 3
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Vero Beach , FL 32968
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10 Owner Williams, C 2302 11 `h Court SW $ 10, 294 . 80 $ $ 10, 294 . 80 9 / 18 / 2009 3
Vero Beach , Fl . 32962
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11 Owner Granito, L 1815 50" Ave . $ 2 , 276 . 10 $ $ 2 , 276 . 10 8 / 26/ 2009 3
Vero Beach , Fl . 32966
12 Owner Dunn , R 133712 1h Ave . $ 2 , 245 . 40 $ $ 2 , 245 . 40 9 / 15 / 2010 3 !
Vero Beach , Fl . 32960 �- D
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13 Owner Ewar, T 3821 44`h Street $ 4, 235 . 50 $ $ 4, 235 . 50 2 / 11 / 2010 2i n m
Vero Beach , Fl . 32967 n
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Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date # i f Bed-
# Renter ( Last Name , First Initial ) ( Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
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14 Owner Council , E 4711 30`h Ave . $4, 815 . 55 $4, 815 . 55 3 / 04 / 2010 2
Vero Beach , Ft . 32967
15 Owner Dillard , H 472628 th Court $ 7 , 041 . 85 $ $ 7, 041 . 85 4/ 13 / 2010 2 j
Vero Beach , Fl . 32967
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16 Owner Barton , L. B . 2836 4V' Court $ 2 , 097 . 05 $ $ 2 , 097. 05 1 / 26 / 2010 2
Vreo Beach , Fl . 32967
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17 Owner Simmons, J 1036 23`d Place S . W . $ 3 , 104. 60 $ $ 3 , 104. 60 2 / 17 / 2010 2
Vero Beach , Fl . 32962
18 Owner Fleming, T 4445 281h Court $ 2, 873 . 20 $ $ 2 , 873 . 20 2 / 05 / 2010 2
Vero Beach , Ft . 32967
19 Owner Johnson , M 4855 32nd Ave . $ 5 , 109 . 00 $ $ 5 , 109 . 00 6 / 01 / 2010 2
Vero Beach , Ft . 32967
20 Owner Bell, A 4540 43`d Court $ 6, 630 . 00 $ $ 6, 630 . 00 4/ 21 / 2010 2
Vero Beach , FL 32967
21 Owner Bell , L 4440 35`h Ave. $ 6, 997 . 20 $ $ 6 , 997 . 20 3 / 22 / 2010 2
Vero Beach , Fl . 32967
22 Owner Rue, J 4409 35" Ave. $ 6 , 980 . 70 $ $ 6, 980 . 70 3 / 10 / 2010 21
Vero Beach , Ft . 32967
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23 Owner Butter, S 4800 1 " Street S . W . $ 5 , 755 . 80 $ $ 5 , 755 . 80 2 / 25 / 2010 2
Vero Beach , Ft . 32968
24 Owner Johnson , S 482633 Id Ave
$ 2 , 226 . 10 $ $ 2, 226 . 10 3 / 02 / 2010 2
Vero Beach , FL 32967
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r Hinglebine, R 861597 1h Court $ 6, 155 . 70 $ $ 6, 155 . 70 2 / 22 / 2010 3 ' F-
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Vero Beach , Fl . 32967 --�
Raulerson , L 132623`d Ave . S . W . $ 2 , 120 . 70 $ $ 2 , 120 . 70 3 / 19 / 2010
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Vero Beach , Fl . 32962 o—t Cr McKinney, C 6000
8`h Street $ 51377 . 55 $ $ 5 , 377 . 55 2 / 23 / 2010 211 c -)
Vero Beach , Ft . 32968
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Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date # i f Bed-
# Renter ( Last Name , First Initial ) ( Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
I
14 Owner Council , E 4711 30`h Ave . $4, 815 . 55 $4, 815 . 55 3 / 04 / 2010 2
Vero Beach , Ft . 32967
15 Owner Dillard , H 472628 th Court $ 7 , 041 . 85 $ $ 7, 041 . 85 4/ 13 / 2010 2 j
Vero Beach , Fl . 32967
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16 Owner Barton , L. B . 2836 4V' Court $ 2 , 097 . 05 $ $ 2 , 097. 05 1 / 26 / 2010 2
Vreo Beach , Fl . 32967
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17 Owner Simmons, J 1036 23`d Place S . W . $ 3 , 104. 60 $ $ 3 , 104. 60 2 / 17 / 2010 2
Vero Beach , Fl . 32962
18 Owner Fleming, T 4445 281h Court $ 2, 873 . 20 $ $ 2 , 873 . 20 2 / 05 / 2010 2
Vero Beach , Ft . 32967
19 Owner Johnson , M 4855 32nd Ave . $ 5 , 109 . 00 $ $ 5 , 109 . 00 6 / 01 / 2010 2
Vero Beach , Ft . 32967
20 Owner Bell, A 4540 43`d Court $ 6, 630 . 00 $ $ 6, 630 . 00 4/ 21 / 2010 2
Vero Beach , FL 32967
21 Owner Bell , L 4440 35`h Ave. $ 6, 997 . 20 $ $ 6 , 997 . 20 3 / 22 / 2010 2
Vero Beach , Fl . 32967
22 Owner Rue, J 4409 35" Ave. $ 6 , 980 . 70 $ $ 6, 980 . 70 3 / 10 / 2010 21
Vero Beach , Ft . 32967
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23 Owner Butter, S 4800 1 " Street S . W . $ 5 , 755 . 80 $ $ 5 , 755 . 80 2 / 25 / 2010 2
Vero Beach , Ft . 32968
24 Owner Johnson , S 482633 Id Ave
$ 2 , 226 . 10 $ $ 2, 226 . 10 3 / 02 / 2010 2
Vero Beach , FL 32967
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t260wner
r Hinglebine, R 861597 1h Court $ 6, 155 . 70 $ $ 6, 155 . 70 2 / 22 / 2010 3 ' F-
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Vero Beach , Fl . 32967 --�
Raulerson , L 132623`d Ave . S . W . $ 2 , 120 . 70 $ $ 2 , 120 . 70 3 / 19 / 2010
2 M
Vero Beach , Fl . 32962 o—t Cr McKinney, C 6000
8`h Street $ 51377 . 55 $ $ 5 , 377 . 55 2 / 23 / 2010 211 c -)
Vero Beach , Ft . 32968
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Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date # of Bed - j
# Renter (Last Name , First Initial ) ( Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
28 Owner Bryant, A 5795 59`h Court $ 6 , 577 . 60
ry $ 6, 577 . 60 6 / 03 / 2010 3
Vero Beach , Fl . 32967
29 Owner Stevenson - Cobb , D 438523 rd Court $ 5 , 689 . 05 $ 5 , 689 . 05 6/ 14 / 2010 1
Vero Beach , FL 32967
30 Owner Carlyle, J 435733 d Ave $ 52730 . 80 $ $ 5 , 730 . 80 8/ 31 / 2010 3
Vero Beach , Fl . 32967
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31 Owner Fersch, M 351569th Street $ 11 , 818 . 55 $ $ 11 , 818 . 55 9 / 24 / 2010 2
Vero Beach , Fl . 32967 j
32 Owner Brown, W 2334 1 " Ave SE $ 8 , 361 . 65 $ $ 8, 361 . 65 9 / 29 / 2010 2
Vero Beach , Fl . 32962
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33 Owner Gillis , J 690 241h Street S . W . $ 73235 . 73 $ $ 7, 235 . 73 8 / 31 / 2010 2
Vero Beach , Fl . 32962
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Unit Owner or Name of Owner Name of Occupant Street, City and Zip Code Total Cost Total Cost of Total CDBG
Date # of Bed - j
# Renter (Last Name , First Initial ) ( Last Name, First Initial ) (if replacement, new address. ) of Rehab Replacement
Funds Invested Completed rooms
Occupied (excluding costs (excluding costs
charged to charged to
administration ) administration )
28 Owner Bryant, A 5795 59`h Court $ 6 , 577 . 60
ry $ 6, 577 . 60 6 / 03 / 2010 3
Vero Beach , Fl . 32967
29 Owner Stevenson - Cobb , D 438523 rd Court $ 5 , 689 . 05 $ 5 , 689 . 05 6/ 14 / 2010 1
Vero Beach , FL 32967
30 Owner Carlyle, J 435733 d Ave $ 52730 . 80 $ $ 5 , 730 . 80 8/ 31 / 2010 3
Vero Beach , Fl . 32967
i
31 Owner Fersch, M 351569th Street $ 11 , 818 . 55 $ $ 11 , 818 . 55 9 / 24 / 2010 2
Vero Beach , Fl . 32967 j
32 Owner Brown, W 2334 1 " Ave SE $ 8 , 361 . 65 $ $ 8, 361 . 65 9 / 29 / 2010 2
Vero Beach , Fl . 32962
i
33 Owner Gillis , J 690 241h Street S . W . $ 73235 . 73 $ $ 7, 235 . 73 8 / 31 / 2010 2
Vero Beach , Fl . 32962
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SECTION E - STATUS OF ACCOMPLISHMENTS AND EXPENDITURES
AU grant recipients must complete this form .
(A) ( 6 ) (C ) ( D ) Ri ( F) (G ) (N ) lU (J )
Service Impacted Activity Activity Name MIDIS, # V _ CDBG Current CDBG Funds Final RFF At Other
Area # Census # DCA Use ' Accomplishments CDBG Budget Received To Date Closeout Leverage
Tracts and ( If Applicable) Funds Expended
Block Proposed
Groups*
( in initial Completed
6
contract)
4
NA 21A Program NA NA $ 5 , 414 . 36 $ 5 , 414 . 36 $ NA
$ NA
Administration4Fa
NA 501 . 00 . 8 14A Rehab Single Unit 6 33 $ 171 , 454 . 89 $ 1382267 . 79 $ 33 , 146 . 73** $
NA
503 . 02 . 1 Residential m "
503 . 02 . 2 F ,
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503 , 02 . 3 "
503 . 02 . 4
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506 , 03 . 3
506 . 06 . 1
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506 . 06 . 3 i
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506 , 06 . 4 mr i
507 . 01 . 5
507 . 01 . 6M
507 . 02 . 2 kr
507 . 03 . 2
508 , 04 . 2
508 , 04 . 3
3
509 . 01 . 341, ` u
509 , 01 . 4
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TOTALS ;v 6 33 $ 176 , 869 , 25 $ 143 , 682 . 15 $ 33 , 146J3' * $
( K )Total CDBG Approved Budget (Column G) $ 176 , 869 . 25
( L )Total CDBG Funds Received To Date (Column H) $ 143 , 682 , 15
(M )Total Amount of Final RFF (Column l) $ 33 , 146 . 73 ' *
( N ) Total Amount of CDBG Funds Requested (Line L +M) $ 1762828 , 88
(0 ) If Line ( N ) is greater than Line ( K ) enter the difference Refund Due to DCA $ - - - - - - - - - - - - - - -
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( P ) If Line ( N ) is less than Line ( K ) enter the difference Amount to be Deobligated $40 . 37 Q,
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F-3 C-.1
Required field . Enter census tracts and block groups where activities took place even if census tract information was not used
to determine LMI benefito o
Indian River County submitted its final request for funds for $ 33 , 146 . 73 to DCA via e - mail on January 3 , 2011 .
As of January 26 , 2011 , the funds had not z
been wired to the County . r- o
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SECTION E - STATUS OF ACCOMPLISHMENTS AND EXPENDITURES
AU grant recipients must complete this form .
(A) ( 6 ) (C ) ( D ) Ri ( F) (G ) (N ) lU (J )
Service Impacted Activity Activity Name MIDIS, # V _ CDBG Current CDBG Funds Final RFF At Other
Area # Census # DCA Use ' Accomplishments CDBG Budget Received To Date Closeout Leverage
Tracts and ( If Applicable) Funds Expended
Block Proposed
Groups*
( in initial Completed
6
contract)
4
NA 21A Program NA NA $ 5 , 414 . 36 $ 5 , 414 . 36 $ NA
$ NA
Administration4Fa
NA 501 . 00 . 8 14A Rehab Single Unit 6 33 $ 171 , 454 . 89 $ 1382267 . 79 $ 33 , 146 . 73** $
NA
503 . 02 . 1 Residential m "
503 . 02 . 2 F ,
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503 , 02 . 3 "
503 . 02 . 4
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506 . 02 . 1 r .
506 , 03 . 3
506 . 06 . 1
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506 . 06 . 3 i
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506 , 06 . 4 mr i
507 . 01 . 5
507 . 01 . 6M
507 . 02 . 2 kr
507 . 03 . 2
508 , 04 . 2
508 , 04 . 3
3
509 . 01 . 341, ` u
509 , 01 . 4
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TOTALS ;v 6 33 $ 176 , 869 , 25 $ 143 , 682 . 15 $ 33 , 146J3' * $
( K )Total CDBG Approved Budget (Column G) $ 176 , 869 . 25
( L )Total CDBG Funds Received To Date (Column H) $ 143 , 682 , 15
(M )Total Amount of Final RFF (Column l) $ 33 , 146 . 73 ' *
( N ) Total Amount of CDBG Funds Requested (Line L +M) $ 1762828 , 88
(0 ) If Line ( N ) is greater than Line ( K ) enter the difference Refund Due to DCA $ - - - - - - - - - - - - - - -
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( P ) If Line ( N ) is less than Line ( K ) enter the difference Amount to be Deobligated $40 . 37 Q,
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F-3 C-.1
Required field . Enter census tracts and block groups where activities took place even if census tract information was not used
to determine LMI benefito o
Indian River County submitted its final request for funds for $ 33 , 146 . 73 to DCA via e - mail on January 3 , 2011 .
As of January 26 , 2011 , the funds had not z
been wired to the County . r- o
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SECTION F - BENEFICIARY DATA ( DO NOT ENTER ADMINISTRATION OR ENGINEERING ACTIVITIES ; MAKE COPIES OF THIS PAGE IF NECESSARY
, )
All grant recipients must complete this form .
Activity # 14A Activity # Activity # Activity # Activity # Activity #
Proposed Served Proposed Served Proposed Served Proposed Served Proposed Served Proposed Served
Total Beneficiaries* 30 33
Low and Moderate ( < =80% ) 30 33
Beneficiaries*
Moderate Income NA 8
Beneficiaries*
Low Income (30- 50%) NA 21
Beneficiaries*
Extremely Low (< = 30%) NA 4
Beneficiaries*
Extremely Low Beneficiaries* NA 4 j
Disabled (if known ) - - - - -
Female Head of Household (if known ) - - - - -
Elderly (if known ) - - - - - - - - - -
Enter number of persons by race and number that Total # of Total # of Total # of Total # of Total
# of Total # of
are of Hispanic ethnicity . ( Race and ethnicity for Hispanic '- Hispanic Hispanic Hispanic Hispanic Hispanic
housing should be reported by head of household . )
White 14 14
African American 19 19
Asian - - - - - - - - - -
American Indian or Alaskan Native - - - - - - - - - -
Native Hawaiian Pacific Islander - - - - - - - - - -
American Indian or Alaskan Native ft White - - - - - - - - - -
Asian Et White - - - - - - - - - -
African American and White - - - - - - - - - -
American Indian / Alaskan Native EL African - - - - -
American
Other Multi- racial
Totals ( Equal to Actual Beneficiaries ) 33 33
i
*With the last grant modification approved by DCA in April 2010 , Indian River County originally reported the total number of beneficiaries
as the total number of people occupying all of the housing units . j
Based upon recent communication with DCA staff, the County has revised the total beneficiaries to represent the total number of housing units
that benefited from the CDBG funds. An "NA" is inserted
under the "Proposed" column if the County had previously reported the number of beneficiaries to DCA as the total number of people occupying
the proposed housing units and if the County has no wa n
Mof going back and guessing what it would have
It at the time of the last grant modification . zo
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SECTION F - BENEFICIARY DATA ( DO NOT ENTER ADMINISTRATION OR ENGINEERING ACTIVITIES ; MAKE COPIES OF THIS PAGE IF NECESSARY
, )
All grant recipients must complete this form .
Activity # 14A Activity # Activity # Activity # Activity # Activity #
Proposed Served Proposed Served Proposed Served Proposed Served Proposed Served Proposed Served
Total Beneficiaries* 30 33
Low and Moderate ( < =80% ) 30 33
Beneficiaries*
Moderate Income NA 8
Beneficiaries*
Low Income (30- 50%) NA 21
Beneficiaries*
Extremely Low (< = 30%) NA 4
Beneficiaries*
Extremely Low Beneficiaries* NA 4 j
Disabled (if known ) - - - - -
Female Head of Household (if known ) - - - - -
Elderly (if known ) - - - - - - - - - -
Enter number of persons by race and number that Total # of Total # of Total # of Total # of Total
# of Total # of
are of Hispanic ethnicity . ( Race and ethnicity for Hispanic '- Hispanic Hispanic Hispanic Hispanic Hispanic
housing should be reported by head of household . )
White 14 14
African American 19 19
Asian - - - - - - - - - -
American Indian or Alaskan Native - - - - - - - - - -
Native Hawaiian Pacific Islander - - - - - - - - - -
American Indian or Alaskan Native ft White - - - - - - - - - -
Asian Et White - - - - - - - - - -
African American and White - - - - - - - - - -
American Indian / Alaskan Native EL African - - - - -
American
Other Multi- racial
Totals ( Equal to Actual Beneficiaries ) 33 33
i
*With the last grant modification approved by DCA in April 2010 , Indian River County originally reported the total number of beneficiaries
as the total number of people occupying all of the housing units . j
Based upon recent communication with DCA staff, the County has revised the total beneficiaries to represent the total number of housing units
that benefited from the CDBG funds. An "NA" is inserted
under the "Proposed" column if the County had previously reported the number of beneficiaries to DCA as the total number of people occupying
the proposed housing units and if the County has no wa n
Mof going back and guessing what it would have
It at the time of the last grant modification . zo
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SECTION G - PROPERTY MANAGEMENT REGISTER ( COMPLETE ONLY IF PROPERTY WAS PURCHASED WITH GRANT FUNDS )
Recipient Contract End Date
Contract Number Local Contact
1 2 3 4 5
Description of Property
or Type of Equipment j
Identification Number
SECTION G Not Applicable
Date of Purchase or DID NOT Purchase Property with Grant Funds
Acquisition
Total Cost of Property j
CDBG Cost
CDBG % of Total Cost
Physical Location
Condition ( New or Used )
Residual Value
i
Disposition Date
i
Disposition Amount
i
Method of Disposition
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SECTION G - PROPERTY MANAGEMENT REGISTER ( COMPLETE ONLY IF PROPERTY WAS PURCHASED WITH GRANT FUNDS )
Recipient Contract End Date
Contract Number Local Contact
1 2 3 4 5
Description of Property
or Type of Equipment j
Identification Number
SECTION G Not Applicable
Date of Purchase or DID NOT Purchase Property with Grant Funds
Acquisition
Total Cost of Property j
CDBG Cost
CDBG % of Total Cost
Physical Location
Condition ( New or Used )
Residual Value
i
Disposition Date
i
Disposition Amount
i
Method of Disposition
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ATRUECOPY
CERTIFICATION ON LAST PAGE
J . K . BARTON , CLERK
SECTION H - UNMET NEED - FOR DISASTER RECOVERY GRANTS ONLY
Activity # Activity Name Units Needed Funds Needed Funds Available
NA NA NA NA NA
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ATRUECOPY
CERTIFICATION ON LAST PAGE
J . K . BARTON , CLERK
SECTION H - UNMET NEED - FOR DISASTER RECOVERY GRANTS ONLY
Activity # Activity Name Units Needed Funds Needed Funds Available
NA NA NA NA NA
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12
r S1;A;f w Of FLORIDA
INUTAN RIVI€R COUNTY —
ffil § IS TO CERTIFYTHAT THIS IS
TN@ ® CF
RICINA AN FILE IN THIS
� � FIOR
SECTION I - CLOSEOUT APPROVAL JRF REY K. TON , a.ERIs
All grant recipients must complete this form . R� �^ DOC *
I certify that , to the best of my k ;- s�un er aken by the Recipient with funds
under this grant agreement hav'e - been carried out ain_ accordance with the grant agreement , that
proper provision has been made .for 06., .ayrnent bf, alt paid costs identified ; that the State
of
Florida is under no obligation to make further payment .-to the Recipient under the grant agreement
in excess of the amount identified 6n Line .1K4 , bf° the STATUS OF ACCOMPLISHMENTS AND
EXPENDITURES form submitted with th.is.clos,66utt package.; that every statement and amount set
forth in this instrument is true and tcrrect 9,of %6his date ; that all required audits as of this date
have been submitted and approved ; and I acknowledge that the DCA reserves the right to recover
any disallowed costs identified in an audit completed after this closeout .
Chief Elected Official
S� 0��`— •° move
00 • • , / 9
Signature
O • 3
O • 3
Bob Solari , Board of County Commissioners Chairman OR a Q
Name and Title
Indian River County • • z �
Local Government ``R RCO °
°puN4UNUMUa = i I VEE AS TO FORM
2 - I at�44 LEGAL FF IE CY
Date
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4YP Fiet9. 33x41`. 691®® +��7® A®
,�GI ,� IP COLIN t S' ATTORNEY
For DCA use only ,
Approval of this Closeout Package authorizes the deobligation of unexpended CDBG contract funds in the
amount of $
Division of Housing and Community Development DCA Finance and Accounting Section
Name and Title Name and Title
Date Date
F : \Community Development\CDBG\ DRI Wilma\Closeout\ FINAL Closeout 8 Amendment Form s\CloseoutDocum ents for IRC Hurricane Wilma CDBG . docx
13
i
i
r S1;A;f w Of FLORIDA
INUTAN RIVI€R COUNTY —
ffil § IS TO CERTIFYTHAT THIS IS
TN@ ® CF
RICINA AN FILE IN THIS
� � FIOR
SECTION I - CLOSEOUT APPROVAL JRF REY K. TON , a.ERIs
All grant recipients must complete this form . R� �^ DOC *
I certify that , to the best of my k ;- s�un er aken by the Recipient with funds
under this grant agreement hav'e - been carried out ain_ accordance with the grant agreement , that
proper provision has been made .for 06., .ayrnent bf, alt paid costs identified ; that the State
of
Florida is under no obligation to make further payment .-to the Recipient under the grant agreement
in excess of the amount identified 6n Line .1K4 , bf° the STATUS OF ACCOMPLISHMENTS AND
EXPENDITURES form submitted with th.is.clos,66utt package.; that every statement and amount set
forth in this instrument is true and tcrrect 9,of %6his date ; that all required audits as of this date
have been submitted and approved ; and I acknowledge that the DCA reserves the right to recover
any disallowed costs identified in an audit completed after this closeout .
Chief Elected Official
S� 0��`— •° move
00 • • , / 9
Signature
O • 3
O • 3
Bob Solari , Board of County Commissioners Chairman OR a Q
Name and Title
Indian River County • • z �
Local Government ``R RCO °
°puN4UNUMUa = i I VEE AS TO FORM
2 - I at�44 LEGAL FF IE CY
Date
tfi �
4YP Fiet9. 33x41`. 691®® +��7® A®
,�GI ,� IP COLIN t S' ATTORNEY
For DCA use only ,
Approval of this Closeout Package authorizes the deobligation of unexpended CDBG contract funds in the
amount of $
Division of Housing and Community Development DCA Finance and Accounting Section
Name and Title Name and Title
Date Date
F : \Community Development\CDBG\ DRI Wilma\Closeout\ FINAL Closeout 8 Amendment Form s\CloseoutDocum ents for IRC Hurricane Wilma CDBG . docx
13
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i
A TRUE COPY
CERTIFICATION ON LAST PAGE
06 . 10 New Closeout Forms . doc J . K . BARTON , CLERK
DEPARTMENT OF COMMUNITY AFFAIRS '
CITIES CDBG DISASTER RECOVERY AND NEIGHBORHOOD STABILIZATION PROGRAMS Zi U
FLORIDA SMALL G
CLOSEOUT ( Revised 06 . 10 )
Instructions
Closeout forms must be submitted to the Department of Community Affairs within 45 days after
contract termination or expiration or upon completion of the project . The final Request for Funds
must be submitted with the closeout since funds not requested will be deobligated at closeout .
Any
amendment needed to close out the contract should be submitted prior to submission of a closeout .
Closeout requirements can be found in Rule 9B - 43 . 0051 ( 5 ) , F . A . C .
1 . All grant recipients must complete the following sections :
SECTION A - CONTRACT INFORMATION
SECTION E - STATUS OF ACCOMPLISHMENTS AND EXPENDITURES
SECTION F - BENEFICIARY DATA
SECTION I - CLOSEOUT APPROVAL
Section D relates to housing activities .
Section H relates only to disaster recovery program grants .
4 . Additional copies of forms may be made if there is insufficient space to enter the information
that needs to be reported .
5 . The Closeout Approval form must be signed by or ordinancee Chief Eofcted the ocallao�e governing r a member a tholtloc�ol
government staff , authorized by resolut
sign CDBG contracts and related documents .
6 . Submit only the pages applicable to your grant .
Please contact the CDBG Program at 850 / 487 - 3644 if you have questions about the closeout process .
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