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Backup Documents 06/11/2013 Item #16D 1ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP I D TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Complete routing lines # I through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the of ti.e rt,airmnn °S Q1M1Afi1rP draw a line rhrnnnh rnntina lines # t thmueh #2- comniete the checklist. and forward to the County Attorney Office. Route to Addressees (List in routing order) Office Initials Date 1. Spencer Smith HHVS Initial Applicable 2. Jennifer Belpedio, ACA County Attorney Office Office located in HHVS De ment cz,� 6V 112-11 3. BCC Office Board of County Commissioners VV �G 4. Minutes and Records Clerk of Court's Office Number of Original 2 Signature Authority t2 -gym PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the .F1 ...... m —A fn rent —t staff fnr RMitinna) nr mi -mina infnrmatinn- Name of Primary Staff Spencer Smi Phone Number 252 -2995 Contact / Department appropriate. Initial Applicable Agenda Date Item was 6/11/13 V Agenda Item Number 16D1 Approved by the BCC Does the document need to be sent to another agency for additional signatures? If yes, YES Type ofDocument 2 Signature Authority Forms for 4 Different Number of Original 2 Signature Authority Attached Grants Documents Attached Forms for 4 Different signed by the Chairman, with the exception of most letters, must be reviewed and signed YES ✓ Grants (8) Forms by the Office of the County Attorney. needing original 7 All handwritten strike - through and revisions have been initialed by the County Attorney's '4tS signature PO number or account Office and all other parties except the BCC Chairman and the Clerk to the Board number if document is The Chairman's signature line date has been entered as the date of BCC approval of the YES to be recorded document or the final negotiated contract date whichever is a licable. INSTRUCTIONS & CHECKLIST I: Forms/ County Farms/ BCC Forms / Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05; Revised 11/30/12 Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes N/A (Not appropriate. Initial Applicable 1. Does the document require the chairman's original signature? YES ✓ 2. Does the document need to be sent to another agency for additional signatures? If yes, YES provide the Contact Information (Name; Agency; Address; Phone on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman, with the exception of most letters, must be reviewed and signed YES ✓ by the Office of the County Attorney. 7 All handwritten strike - through and revisions have been initialed by the County Attorney's '4tS 1�Q Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the YES document or the final negotiated contract date whichever is a licable. 6. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's YES signature and initials are required. 7. In most cases (some contracts are an exception), the original document and this routing slip YES should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 6/11/13 and all changes made during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes, if applicable. jES 9. Initials of attorney verifying that the attached document is the version approved by the BCC, all changes directed by the BCC have been made, and the document is ready for the Chairman's si ture. I: Forms/ County Farms/ BCC Forms / Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05; Revised 11/30/12 bounty, of Collier CLERK OF THE'CIR UIT COURT Dwight E. Brock COLLIER CO Y CO1tTHOUSE Clerk of Courts 3315 TAMIAMI TRL E STE 102 t; P.O. BOX 413044 NAPLES, FLORIDA �'Y ; NAPLES, FLORIDA 34112 -5324 :34101-3044 June 14, 2013 ; Florida Department of Economic Opportunity CDBG, Disaster Recovery Section Brenda Lovett, Govt. Ops. Consultant II 107 East Madison Street, MSC 400 Tallahassee, Florida 32399 -6508 16D Irl. Clerk of Courts Accountant Auditor Custodian of County Funds Re: Disaster Recovery Initiative (DRI), Disaster Recovery Enhancement Funds (DREF), Signature Authority Forms 07DB- 3V- 09- 21- 01 -ZO1 Disaster Recovery Z Grant 08DB- D3- 09- 21- 01 -A03 Disaster Recovery A Grant IODB- D4- 09- 21- 01 -KO9 Disaster Recovery K Grant 12DB- P5- 09- 21- 01 -K39 Disaster Recovery Enhancement Funds Transmitted herewith is a two (2) originals of the above referenced documents, as adopted by the Collier County Board of County Commissioners of Collier County, Florida on Tuesday, June 11, 2013, during Regular Session. Very truly yours, DWIGHT E. BROCK, CLERK Martha Vergara, Deputy C Enclosure Phone- (239) 252 -2646 Fax- (239) 252 -2755 Website- www.CollierClerk.com Email- CollierClerk(a)collierclerk.com C0#1e-r CO -Unty Public Services Division Housing, Human & Veteran Services June 11, 2013 Brenda Lovett, Government Operations Consultant II CDBG, Disaster Recovery Section Florida Department of Economic Opportunity 107 E. Madison Street, MSC 400 Tallahassee, FL 32399 -6508 Office: 850 - 717 -8438 16D IN Re: Disaster Recovery Initiative Funds (DRI) Disaster Recovery Enhancement Funds (DREF) Signature Authority Forms Dear Ms. Lovett, On June 11, 2013, the Board of Collier County Commissioners approved the modification to Collier County's Disaster Recovery Initiative and Disaster Recovery Enhancement Funds signature authority forms. This modification will grant new signature authority the follow grants: • 07DB- 3V- 09- 21- 01 -Z01 Disaster Recovery Z grant • 08DB- D3- 09- 21- 01 -A03 Disaster Recovery A grant • 10DB- D4- 09- 21- 01 -K09 Disaster Recovery K grant • 12DB- P5- 09- 21- 01 -K39 Disaster Recovery Enhancement Funds Presented to you are the modified signature authority forms with the Chairwoman's original signature. In addition the Executive Summary for the Board approved item is also included. If you have any questions or concerns please feel free to give me a call. Sincerely, Spencer Smith, Grants Support Specialist Housing, I [LUM11) WIdn Veteran,Set' !Ices Collier Cauiry 3339 Tamiami Trail East, Suite 211 • Naples, FL 34112 -5361 239 - 252 -CARE (2273) • 239 252 -HOME (4663) • 239 - 252 -CAFE (2233) • 239 - 252 -RSVP (7787) • 239 - 252 -VETS (8387) • www .colliergov.net/humanservices To: From: Date: Subject: Re: 160 i Memorandum Clerk's Minutes & Records Spencer Smith June 11, 2013 Modification to DRI/DREF Signature Authority Forms BCC meeting 6/11/2013 item #16D1 Collier County and DEO for DRUDREF Grants Signature Authority Forms Two signature authority forms for four different grants each with the Chairwoman's original signature needs to be sent to the Department of Economic Opportunity. Included with this mailing should be the attached cover letter package which includes the cover letter, executive summary and revised signature authority forms. A FedEx envelope has been pre- addressed and included for use. Please contact me if you have any questions at 252 -2995. Thanks, Spencer Smith Grants Support Specialist Housing, Human and Veteran Services Department of Housing, Human and Veteran Services Collier County 160 1" EXECUTIVE SUMMARY Recommendation to approve Four (4) signature authority forms for submittal to the Florida Department of Economic Opportunity. OBJECTIVE: Identify Collier County staff members and the chief elected official involved with administering Disaster Recovery grants funded through the Florida Department of Economic Opportunity (DEO). CONSIDERATION: The Board of County Commissioners received four federally - funded Disaster Recovery grants from the Florida Department of Economic Opportunity (DEO). The Disaster Recovery grants are administered through Collier County's Department of Housing, Human and Veteran Services (HHVS). Several hurricane hardening projects were established for funding under these agreements. The projects are at various stages of development with most being complete at this time. The older grants remain open with the grantor agency for reporting and reprogramming purposes. Due to staff changes and results of the most recent election it is necessary to update the information for specific staff members and the chief elected official for administering the grants. The DEO provides a specific Signature Authority Form for the grantee to use when identifying or updating the administrative staff. A form for each grant is being submitted at this time to update the HHVS staff currently administering the grants, the designate individuals authorized to sign Request for funds (RFF) and the current Chief Elected Official. The information and Board approval information for each grant is listed below. Disaster Recovery Grant # BCC approval date Agenda item # 07DB -3 V- 09- 21 -01 -ZO 1 5/22/2007 101, 08DB- D3- 09- 21- 01 -A03 5/14/2008 16D17 101313- 134- 09- 21- 01 -K09 2/25/2010 16D 10 12DB- P5- 09- 21- 01 -K39 7/26/2011 16D 1 Approval of this item will serve as an update to Collier County's previously submitted Signature Authority Forms with the DEO. FISCAL IMPACT: These forms have zero impact on the approved budgets for these grants and their projects. No general funds are associated with these projects. GROWTH MANAGEMENT IMPACT: There are no growth management impacts associated with this program. LEGAL CONSIDERATION: This item is approved as to form and legality and requires majority vote for approval - JAB 16D 1 STAFF RECOMMENDATION: Recommendation to approve and authorize the Chairman to sign Signature Authority Forms for Disaster Recovery Grant agreements between the Florida Department of Economic Opportunity and Collier County. PREPARED BY: Lisa Oien, Grants Coordinator, Housing, Human and Veteran Services 16D Department of Economic Opportunity — Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Recipient Board of Collier County Commissioners _ . _ Mailing Address (Street or Post Office Box) 3339 Tamiami Trail East, Suite 211 City, State and Zip Code Naples, FL 34112 an onoinal Sionature Authority Form with each contract. Contract # 07DB- 3V- 09- 21- 01 -ZO1 Funding Source [ ] Small Cities CDBG [ X] Disaster Recovery [ ] Neighborhood Stabilization _ ......... _­­_­­­­..- Local Government DUNS # 076997790 Project Contact Person Telephone # E -mail Address Lisa Oien, Grants Coordinator 239- 252 -6141 lisaoien @colliergov.net Collier County Housing, Human and Veteran Services -.. _ ......... _.... _.. . _ ...... ............ -- - ....... ............ ........ _ ... _ ._.. Financial Contact Person Telephone # E -mail Address Bendisa Marku, Supervisor 239- 252 -2689 bendisamarku @colliergov.net Accountant, Collier County Housing, Human and Veteran Services ..... _ Other Local Government Contact Telephone # E -mail Address Kristi Sonntag, Grants Manager 239- 252 -2486 kristisonntag @colliergov.net Collier County Housing, Human and Veteran Services . ......... ....._ .. ... .. .................... .... ..... ........ ........ .._..... ............. ................ .... ............. . ........ 1.11...1....... ...1...........11.....1. Requests for Funds (RFFs) require (check one); [ ] one signature [ X ] two signatures by individuals authorized below. RFFs must be submitted via the Department's website at http://ecdbq.dca.state.fl.us/ (or by an alternative means specified by the Department). Typed Name i Date 5ig Bend isa_ Mar ku, Su _ervisor Accountant O �� P _ 1111. ,.� : .............. [ X ]Check here if above person is authorized to submit RFFs mail ddress bendisamarku @colliergov.net ......... ...... ......... ......._.......... ..... _....... .. ..._ Typed Name Date Signature_ Edmond Kushi, Accountant 7 3 — 3.___......5TZ _. _ 1111 .. .. . .............................. ....�. \; _.. [ X ] Check here if above person is authorized to submit RFFs (mail Address Typed Name Date Signature LisaOien,..Grants.. Coordinator ..... _._._........._...._....__....._.......... _._......... ... ......... _ ....._....._......._._.._._S1_. � . _._i.__.._...__...._.____...__c [ ] Check here if above person is authorized to submit RFFs i E -mail Address .............................. lisaoien @colliergov.net Typed Name Dat Signature Spencer Smith, Grants Support Specialist Stto /zoi3 -.. __ [ ]Check here if above person is authorized to submit RFFs E -mail Address spencersmith @colliergov. ne I certify, as the recipient's Chief Elected Official, that the above signatures are of the individuals Fund- s and, t. o .. sub_1.m111__ it . .R. F_F. 's.electronically Typed Name Date Sign tur Georgia A. Hiller, Esq, Chairwoman Board of Collier County Commissioners I I _._ ..__ .. _ ........ [ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) rom ti [ X ] Check here if your local government will be working on a reimbursement basi Florida. 1 to sign Requests for 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: ham:/ /flair.dbf.state.fl.us /. Local govemments 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 mustTbe bonded ra' - Account Number Name of Financial Institution i �'_� Fifth Third Bank 113 -8577 _....__... .._ 1.111 .__.... . ........... . . ........1111 Street Addressor Post_DfficeF Boic Telephone Number 999 Vanderbilt Beach.Road i 2 9-591 -6397 _. --. .. � City, State and Zip C Naples. Florida 34 tSr1l.. irei T.°� �K *GItK Revised April 2011 Attest tsa o Chairman S Department of Economic Opportunity — Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an Recipient Board of Collier County Commissioners Mailing Address (Street or Post Office Box) 3339 Tamiami Trail East, Suite 211 City, State and Zip Code Naples, FL 34112 �1 Contrail # Funding Source 08DB- D3- 09- 21- 01 -A03 [ ] Small Cities CDBG _ ....... _ .... _ .... __. _ ...._ ._...... . [ X] Disaster Recovery [ ] Neighborhood Stabilization .. . -.... _ .... __ . ........ ......... .. _ ....- - - .......... . - - - -- - - - - - ........ __..... -.. Local Government DUNS # 076997790 Project Contact Person Telephone # E -mail Address Lisa Oien, Grants Coordinator 239- 252 -6141 lisaoien @colliergov.net Collier County Housing, Human Financial Contact Person Telephone # E -mail Address Bendisa Marku, Supervisor 239- 252 -2689 bendisamarku @colliergov.net Accountant, Collier County Housing, Human and Veteran Services ......... .... ........ ... .. .... ...._ _ :......_ _... _ . Other Local Government Contact Telephone # E -mail Address Kristi Sonntag, Grants Manager 239- 252 -2486 kristisonntag @colliergov.net Collier County Housing, Human and Veteran Services ......... .......... ............. .. ....... . ........ .... .............. .......... _ .. .............................._ .. . Requests for Funds (RFFs) require (check one); [ ] one signature [ X ] two signatures by individuals authorized below. RFFs must be submitted via the Department's website at httD: / /ecdba.dca.state.fl.us/ (or by an alternative means specified by the Department) Typed Name Date Sign Bendis.....Marku,_ Supervisor Accounta.nt ...................__....... ......_._....._..__.._..'....._ �` %�® ......._.............:.... ,�� [ X ] Check here if above person is authorized to submit RFFs E -mail A dress bendisamarku@collierqov.net .._ ...... ................ ..... - _....- ._...._._.. Typed Name ' Date S�tufe, Edmond Kushi, Accountant i —_3-13 _ [ X ]Check here if above person is authorized to submit RFFs E -mail Address Typed Name Date Signature Lisa Oien, Grants � r __.. _..... -TA ... .. . [ ]Check here if above person is authorized to submit RFFs E -mail ddress lisaoien @colliergov.net . .... _.. - -- -- ... Typed Name D 1 Sign Spencer Smith Grants Su rt S ialist S fso zoos ............_ ._..._...... PPO . P� !_ ...� _.__.._. .._....._ ... ._.. [ J Check here if above person is authorized to submit RFFs E-mail Address 1 spencersmith @colliergov. net . .......... ....... .. -- -... ..._.. ... I certify, as the recipient's Chief Elected Official, that the above signatures are of the individuals th rized sign Requests for Funds and to submit RFFs electronically. _ _ _........ ........_ _ ....... __ . _ ._.._... _ . _ .. .__......... Typed Name Date Signature Georgia A. Hiller, Esq, Chairwoman Board of Collier County Commissioners [ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) from 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: hhtt p: / /flair.dbf.state.fl.us /. Localgovemments 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 Name of Financial Institution �:,E; ti f r C,, Account Number Fifth Third Bank �`� 4 11 __.. _. 3 8577 ,��1' P Street Address or Post Office Boxy? � Telephone Number 999 Vanderbilt Beach Road __239-591-6397 . City, State and Zip Code_. Naples. Florida 34108 �' =� - -- , r' Leo °' [' +r �Ij ` Revised pr Attest as to Chaima IS Y: AniV_ / r 16D 14, Department of Economic Opportunity - Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an Recipient Board of Collier County Commissioners Mailing Address (Street or Post Office Box) 3339 Tamiami Trail East, Suite 211 City, State and Zip Code Naples, FL 34112 Contract # 1ODB- D4- 09- 21- 01 -KO9 Funding Source [ ] Small Cities CDBG [ X] Disaster Recovery [ ] Neighborhood Stabilization .._......_ . .__ ....._ Local Government DUNS # 076997790 Project Contact Person Telephone # E -mail Address Lisa Oien, Grants Coordinator 239- 252 -6141 lisaoien @colliergov.net Collier County Housing, Human and Veteran Services ..... .. _ _ ... ........ ............ __ .. _ ......_ ...... . . _.. .. __... _ .......... Financial Contact Person Telephone # E -mail Address Bendisa Marku, Supervisor 239- 252 - 2689 bendisamarku @colliergov.net Accountant, Collier County Housing, Human and Veteran Services ..._..._ __.. __ ..............__.._.. .. ....._... .......... Other Local Government Contact Telephone # E -mail Address Kristi Sonntag, Grants Manager 239- 252 -2486 kristisonntag @colliergov.net Collier County Housing, Human and Veteran Services .... ....... ............._........._......._.............__......._......_.._........._..... .............................._ ........._..._...._ ....................................................................................__...._.....;.._......._............................ .................._._.........- Requests for Funds (RFFs) require (check one); [ ] one -............._.........._.........._..............._................._.........._.._._........_....._............__..._..._..... signature [ X ] two signatures by individuals authorized below. RFFs must be submitted via the Department's website at http://ecdbq.dca.state.fl.us/ (or by an alternative means specified by the Department). Typed Name 1 Dale 1 Sign Bend.. Marku ..Supervisor Accountant '/1 _ . _._._ ................. .. ...� [ X ] Check here if above person is authorized to submit RFFs E -mail Address ............._........... _.._ ...........................-................................................._... ................._...........:.......... bendisamarku@colliergov.net Typed Name D to a Edmond Kushi, Accountant [ X ] Check here if above person is authorized to submit RFFs E -mail Address Typed Name Date , Signature" Lisa Oien Grants Coordinator -c 2c /sue _ ........ _.... _ .... [ ] Check here if above person is authorized to submit RFFs E -mail ddress _ lisaoien @colliergov.net ... . .... . Typed Name Datq I Si 9 natur Spencer Smith, Grants Support Specialist S to /foil ... .. _ . [ ] Check here if above person is authorized to submit RFFs E-mail Address spencersmith@colliergov.net __ _..._. 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. _ ....... _ _ ....... _ ........ _ .. , .....__.. .....IL _ _ . _ ... _ ... ... ... ... -- - Typed Name Date ign r Georgia A. Hiller, Esq, Chairwoman Board of Collier County ommissioners _. _ ............................_ _._..._......_._....____tY..... ....... ....... _...._......_.._-_--........_._....._....... ................._.._........._ _......._.....__.._...._.....__.......___........ .__......._............_.__.._. [ X ] Check here if your local government utilizes Electronic Funds Transfer ( ) f e of Florida. [ X ] Check here if your local government will be working on a reimbursement s. __... _... _ _. .... _ ... _.__. - 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: httl2:/ /flair.dbf.state.fl.us /. Local 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 bondgd. Name of Financial Institution, c Account Number Fifth Third Bank - 113 -8577 Street Address or Post Office 8gx Telephone Number 999 Vanderbilt Beach Road + 239 -591 6397 ...._ . .. .._._..... __._._ -. - __.... ....._ -..r .- -- ._..._. City, State and Zip Cod -` �; k.4ia"�'iw atl o .r:r� r, ; - Naoles. Florida 34108TTrS' _....� its =a_ Le.wl.�.,i u vy t f' r A, =q- c+ """'� " """ ' Revised April 2011 Attest as to Chairman' �` _ signature only. 3 Y 160 to" Department of Economic Opportunity — Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an onginal Signature Authority Form with each contract. __. .. ...... _ ...._ _ ........ _...... Recipient Contract # Funding Source Board of Collier County Commissioners 12DB- P5- 09- 21- 01 -K39 [ ] Small Cities CDBG _ ....................._....._.. ..__....._....._......__....._... ._....._..._....__...._.......- -- - .__....__ _._...__..........-----.._. _._....._._......._............ _........._.._......_. ..........__..._._..._....._... .__._..._._...._........, Mailing Address (Street or Post Office Box) [ X] Disaster Recovery 3339 Tamiami Trail East Suite 211 [ ]Neighborhood Stabilization _.__....___....._........._ .................__........_._____..... e._._._......_..._.. .____.._..._.....__.._....._._. _ .. —...... _. _. City, State and Zip Code Local Government DUNS # Naples, FL 34112 076997790 Project Contact Person Telephone # E -mail Address Lisa Oien, Grants Coordinator 239- 252 -6141 lisaoien @colliergov.net Collier County Housing, Human and Veteran Services ...... .. .. ....................... ...._ .......................... ...._ ..... .......... _ .......... _ ...._ Financial Contact Person Telephone # E -mail Address Bendisa Marku, Supervisor 239- 252 -2689 bendisamarku @colliergov.net Accountant, Collier County Housing, Human and Veteran Services ..... Other Local Government Contact Telephone # E -mail Address Kristi Sonntag, Grants Manager 239- 252 -2486 kristisonntag @colliergov.net Collier County Housing, Human and Veteran Services .. . ............... _ ......................... ... ..... ... .. ........ ...._..._.............. _._._............... .........._.._ .......................... __.... Requests for Funds (RFFs) require (check one); [ ] one signature [ X ] two signatures by individuals authorized below. RFFs must be submitted via the Department's website at http: / /ecdbg.dca.state.fl.us/ (or by an alternative means specified by the Department). Typed Name Bendisa Marku, Supervisor Accountant _...._.. ........ ... .. ._......_...................... [ X ] Check here if above person is authorized to submit RFFs .................................. ............ ..... ................................................ _......_.... _ ........ _ ...... _ ........... ._....................................... Typed .. Name Edmond Kushi, Accountant [ X ] Check here if above person is authorized to submit RFFs Typed Name Lisa Oien, Grants Coordinator ................ [ ] Check here if above person is authorized to submit RFFs Typed Name Spencer Smith, Grants Support Specialist ... _...... _. [ ] Check here if above person is authorized to submit RFFs �0�/3.... _. _= ............ _ /.. -mail Address benisamarku @colliergov. net _ ........................._.... ..........................._._............ . . .. ................_ .. . .................... . Date Signature E -mail Address �9 EAnno^+O Itu• N/ Cott iC«.C1W. N Date i Signature .._._....__ .._. _ E -mail Address lisaoien@collierqov.net ....... . .............. ........ ...... Date Signature S . �Le ... /. 1. E -mail Address spencersm ith @col liergov. net I certify, as the recipient's Chief Elected Official, that the above signatures are of the i i als authorized to sign Requests for Funds and to submit RFFs electronically. ... ._.... Typed Name Date Signat re Georgia A. Hiller, Esq, Chairwoman Board of Collier County Commissioners I / [ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) f m the a 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 /. Local 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. Name of Financial.Inst�tutkin° r Account Number Fifth Third Bank µ 113 -8577 . _ ... _. _. _p __._..... Street Address oi' Rost Offide T Telephone Number 999 Vanderbilt Beach Road 2 9 -591 -6397 _ _ _ aia City, State and Zip Code-. � to t�cr , Naples Florida 34}11$:____ : ✓ _ LeJ•►l��i' F"! *tea r ' _,*� - Revised April 2011 HT CK, Clerk Attest as to Chairman's A3e taut CounO Attorney ���