Loading...
Backup Documents 12/10-11/2013 Item #16D10ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1601 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. h'Y..a .., huti.ti'a a Complete routing lines # I through #2 as appropriate for additional signatures, dates and/or information needed. If the document is already complete with the exception of the Chairman's signature, draw a line through routinglines # 1 through #2, complete the checklist, and forward to the L; Attorney umce. Route to Addressees (List in routing order) Office Initials Date 1. Lori Fisher HHVS 5�F is -)0-1 3 2. Jennifer Belpedio County Attorney Office Approved by the BCC I.Z112,) 1 3. BCC Office Board of County Commissioners Type of Document Z \3 4. Minutes and Records Clerk of Court's Office Attached Original document has been signed/initialed for legal sufficiency. (All documents to be 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 ,AA.—.. .., —A t� —t—t staff fnr additinnal or missino infnrmatinn aLLLLI\rJJYYJ A Name of Primary Staff ..wv vw.. .... �� Lori Fisher Phone Number 239-252-2995 Contact / Department appropriate. Initial) Applicable) Agenda Date Item was December 10 2013 Agenda Item Number 16D 10 Approved by the BCC Does the document need to be sent to another agency for additional signatures? If yes, Type of Document Grant Modification DREF Grant # Number of Original 2 dt i Attached Original document has been signed/initialed for legal sufficiency. (All documents to be Documents Attached PO number or account Needs Grantor Signature (DEO) number if document is , lv JU/ to be recorded All handwritten strike -through and revisions have been initialed by the County Attorney's INSTRUCTIONS & CHECKLIST jbe,w„ti,1J� 101 ;t 0 13 I: Forms/ County Forms/ 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? 2. Does the document need to be sent to another agency for additional signatures? If yes, provide the Contact Information(Name; Agency; Address; Phone)hed 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 by the Office of the County Attorney. 4. All handwritten strike -through and revisions have been initialed by the County Attorney's 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 document or the final negotiated contract date whichever is applicable. 6. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. 7. In most cases (some contracts are an exception), the original document and this routing slip should be provided to the County Attorney Office at the time the item is input into SIRE. _ Qy 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 and all changes made during the meeting have been incorporated in the attached ocument. The County Attorney's Office has reviewed the changes, if a licable. 9. Initials of attorney verifying that the attached document is the Ikersion approved by the BCC, all changes directed by the BCC have been made, and a document is ready for the Chairman's signature. jbe,w„ti,1J� 101 ;t 0 13 I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05; Revised 11/30/12 16D10 1 MEMORANDUM Date: December 16, 2013 To: Lori Fisher, Grants Support Specialist Housing, Human & Veteran Services From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Certified Signature Forms for DRI K Grant #IODB-D4-09-21-01- K09 Attached is an certified copy of the document referenced above, (Item #16D10) approved by the Board of County Commissioners on December 10, 2013. The second original will be held on file in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment 16010 Memorandum To: Clerk's Minutes & Records From: Lori Fisher Date: December 10, 2013 Subject: Signature Authority forms approval BCC meeting 12/10/2013 item #16D10 Re: Collier County and DEO for DRI K Grant #10DB-D4.09.21.01-K09 �. Y Two uthoriV for Signature forms each with the Chairwoman's original signature One °r� needs to be sent to Monique Kabitzke at DEO. One original is for your records. I would like a certified copy back please for our records. *Note* There are four forms for signature one form for each grant A, Z DRI K & DREF and two copies a total of 8 pages for signature. Please contact me if you have any questions at 252-2995. Thanks You > Lori Fisher Grants Support Specialist Housing, Human and Veteran Services Department of Housing, Human and Veteran Services Collier County 16010 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 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 HHV S 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 5/13/2008 16D17 101313-134-09-21-01-K09 2/23/2010 16D 10 12DB-P5-09-21-01-K39 7/26/2011 16D1 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 no impact on the approved budgets for these grants and related 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 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 to maintain efficiency and timely operations in the HHVS Department. PREPARED BY: Lori Fisher, Grants Support Specialist, Housing, Human and Veteran Services 16D10 Department of Economic Opportunity — Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an original 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 ...... ...... _...................................................---......................................._..._.................._............................_........................................................._............._...._............................._..__............-------...._..._............................................._._.._..,...............--.._...........-... -......................... ................... __..... _........... 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 i n ture �7 3....._..._...... DRv..s X ] Check here if above person is authorized to submit RFFs and Veteran Services _.._................. _._..._.... _............................... ----..... _......... ......... _............................. ....................................... _............... -----.................................. _............................. _....................... _._..................... .............. .. .............................................................................................. _.._............... _................................... Financial Contact Person ,..................... Telephone # E-mail Address Bendisa Marku, Supervisor 239-252-2689 bendisamarku@colliergov.net Accountant, Collier County Date Signature ..:.:_....^.._�_3............................... ._.....%._L�.�.. [ ]Check here if above person is authorized to submit RFFs Housing, Human and Veteran j Services_...................__ --..._...................._......................................................................_..........._......................._........... . . ._..........._...................................................._........................_....._............ - ..._......._..._ ......_....._......................................................_.._..._...__....................................................................._............_.._._.._.... Other Local Government Contact Telephone # E-mail Address Kristi Sonntag, Grants Manager 239-252-2486 kristisonntag@colliergov.net Collier County Housing, Human andVeteran 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). Typ11 ed Na11 me Bendisa__Marku... Supervisor Accountant 1 Date 1 Si n /1 ......................_9 . [ X ] Check here if above person is authorized to submit RFFs E- ail Address bendisamarku@colliergov.net _...... __..__.............._........._............ ........... ................ ..._......._................................................................................__...._........._.........................__..._._......................._.................._._.: Typed Name TBD, Housing, Human and Veteran Services Accountant_.; i n ture �7 3....._..._...... DRv..s X ] Check here if above person is authorized to submit RFFs Eil ddress i .......... ..... _......................... ...................... _................................................................................. ._.._... _.._...................................... _................................. Typed Name ............................................. _...................... _........................ __..... _............ _ Date Signature Lisa Oien, Grants Coordinator......_........................................._... _..................... _._................................ .. ._.........._.....".:.....................-.........._..................................................... [ ]Check here if above person is authorized to submit RFFs E-mail Address lisaoien@colliergov.net ............................. ......................................................................... .._...................................................................... Typed Name LoriFisher,.._Grants..SupPort Specialist........................................................................................%_ Date Signature ..:.:_....^.._�_3............................... ._.....%._L�.�.. [ ]Check here if above person is authorized to submit RFFs E-mail Address Lori.fisher@colliergov.net r; I certify, as the recipient's Chief Elected Official, that the above signatures are the Funds and to submit RFFs electronically. _ _................................................... _......................_........................ ................... _... _ _... Typed Name Date Si natui Georgia A. Hiller, Esq, Chairwoman 2 loi L3 Board.._of..Collier County._Commissioners..................................._........................_.................................................................................................r i M... [ X ] Check here if your local government utilizes Electronic Funds Transfer (EF -f 4c [ X ] Check here if your local government will be working on a reimbursement basis. the State of Florida. to sign Requests for ........................................ .............. .... ................... ...................... .................... ............................. ........................ ................... ... ..................... ............................ -...................................................................... CDBG payments to /oca/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: httpl/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 sinatures on the account must b.e_bonded..........................................................._..................... ............. ................................. _........ ................... _................... ---........................................... .._... _....................... ......... _.................... __................................................ Name of Financial Institution Account Number FifthThird Ban . _......................................................._.. ......... ... ........................................................t. ........ . Street Address or Post Office Box Telephone Number F 999 Vanderbilt Beach Road 1239-591-6397 .' , t`4•_ ::.:; ....................__........ ................................................ ....................................................................-......................._...................................................................................................................:..............................................................._.. _. City, State and Zip Code Approved as to form and legality ` ........................................................................ �i` AEtse April DWt T E• ..,. Asst nt Coonty A ey 9y. of Economic Department Opportunity — Small Cities Development Block Grant Program 16DIi, p PPo tY ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an o�igina/Signature Authoity Form with each contract: .................................... ............ ,........................................................................... __................................................................ Recipient Contract # Funding Source Board of Collier County Commissioners 08DB-D3-09-21-01-A03 [ ]Small Cities CDBG ...... ......... .............. ................................................. _........................................................._...................................._._......................._.._......................................._.................................................................... _............ ......................................................... Mailing Address (Street or Post Office Box) [ x] Disaster Recovery 3339 Tamiami Trail East Suite 211 [ ]Neighborhood Stabilization .......................................................................... .............................................................................................................................................................................................................._.............................................................................................................................._..._............................................................................................................ City, State and Zip Code Local Government DUNS # Naples, FL 34112 076997790 Project Contact Person ; Telephone # Lisa Oien, Grants Coordinator 239-252-6141 Collier County Housing, Human and Veteran Services ;................................. ...._........................ ..... .................... ................................................................. .............................................................. Financial Contact Person Telephone # Bendisa Marku, Supervisor 239-252-2689 Accountant, Collier County Housing, Human and Veteran E- ails E-mail Address lisaoien@colliergov.net E-mail Address bendisamarku@colliergov.net ........... ................. .... ......._._........... ....___----_ Other Local Government Contact Telephone # I E-mail Address Kristi Sonntag, Grants Manager 239-252-2486 kristisonntag@colliergov.net Collier County Housing, Human and Veteran Services i __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 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...................................................................................._1�, i Date .�......s.....3......._..................... Signa ...................................................... �.... X Check here if above person is authorized to submit RFFs [ ] P j E -(hail Rddress _...... _.... _.......... I...._bendisamarku @colliergov. net...................._............................_........._............. .. ................. _.............. _...... .... ....... _.__......................................................................... _............. ._.................. __I......._. Typed Name j Dat Si natur � Edmond Kushi�...._Accountant......................................................................................................_..._......._. ................................ �...._....... .......�i ...�%S4res [ X ] Check here if above person is authorized to submit RFFs E- ails TYped...Name......................................................................................................................................................................................:....Date .......................................................................................................................................... I/-S-i�_.........._......_..---......_.........._.._ :............... _.............. Signature Lisa Oien Grants Coordinator._...................._....._.._................................. ,_._.............................._.................................._,........................................................... _ ........................ [ ]Check here if above person is authorized to submit RFFs E-mail Address lisaoien@collierqov.net ..................................................................................................................................................................... Typed Name Date ; 1 Signature— , �.. Lori..._Fisher,.._Grants._Support Specialist......................._..__................................_......_...............1..(?__.. .....-._��..............._............._..................................................._......................................_.................. [ ]Check here if above person is authorized to submit RFFs E-mail Address .................... _.._.............................................. _._........... ..... _.._... _.......... ........................................................ _... _............................ _........... _._.... ,................ _....................... _....... _-.._.... _............... _...... _............... I certify, as the recipient's Chief Elected Official, that the above signatures are o e individual authorized to sign Requests for Fundsand to submit RFFs electronically........................................................................................................................................................................................................................................................................................................................................................... Typed Name Date gna re Georgia A. Hiller, Esq, Chairwoman ; ' Z 11 Q 15 1 Boardof Collier CountyCommissioners / J..............................1...................................................................................................................................................................... ................... ...............................................................................................................................................................:............................................................................................. [ X ] Check here if your local government utilizes Electronic Funds Transfer ( e State of Florida. [ X ] Check here if your local government will be working on a reimbursement sis. ................................................................................................................................................................................................................................................................................................................................................................. CDBG payments to local governments using EFTare automatically deposited in the local governments 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 sinatures on the account must be bonded._.........................._......_..........................._..._..............,..............................................................................................................................._..............................._........._........._..__=....:,............................................. 9 ............................ Name of Financial Institution Account Number Fifth Third Bank 113-8577 _.._._ry.:.._.,. _..._:..................:................._................ ............................................................ ........_............................._........................._.._._............................_.._......................._.._........._..._....._..............._....................,..._...._.._...._.................._........_... Street Address or Post Office Box Telephone Number'";; 999 Vanderbilt Beach Road 239-591-6397 s : ......:.......... ............. ;..:................ .::..._f .................. ......... City, State and Zip Code APPtoved as to forth and legaiit�..................... ATTEST: Naples, Florida 34108 -.................. .._...._........... _._.__.................................. _....................... ....... ........................................... _......................... +tflrrru4 Assiataat Coun ttomey _ a..... ^nlu 201 16010 Department of Economic Opportunity — Small Cities Development Block Grant Program ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an origins/Signature Authonly Form with each contract. _ ..... _..---..............................-- ......................._.. ._............ ......... ............... _..... _........ _......................... . Recipient Contract # Funding Source Board of Collier County Commissioners 10D6 -D4 -09-21-01-K09 [ ] Small Cities CDBG ..._...................................................................................................................................................................................................................................................................................................................................................... [ Mailing Address (Street or Post Office Box) X ] Disaster Recovery 3339 Tamiami Trail East, Suite 211 [ ]Neighborhood Stabilization ...............................................--................................_..... _...................................................................__._..........._..._._...._......__..__......._................._.._..__..._..............................................................----.................................._._._..................i..... ............ _._................ _......... ---........................ .... _._...................... . City, State and Zip Code Local Government DUNS # Naples, FL 34112 076997790 Project Contact Person Telephone # 1 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 i 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 andVeteran 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 aWrX, Bendisa„ Marku,.._Supervisor Accountant...................................................................................1......... [ X ] Check here if above person is authorized to submit RFFs E-maiddress .net Typed Name L)i Edmond Kushi, Accountant .............................%/.. ....................................................... ............. ._ (X ]Check here if above person is authorized to submit RFFs E- .. ..................................... _..... __........................... _.................... ......____----_-____ Typed Name Date - , Signature ~ Lisa Oien Grants Coordinator J..r_-.'......_'..................._...............................__.._.._...........:k.:�._._ .... _.......`-._................................................................... .... ..................................... ....._..._._....................................................................................................................................................... [ ] Check here if above person is authorized to submit RFFs E-mail Address ......................................................................................... . j...._I isaoien @col I iergov.net...................................._.._................... Typed Name 1 Date Signature �� i ........................................................... YP - 1. ' Lori Fisher Grants Support Specialist ............................,..........._..._............... _._. )_" 3 c [ ]Check here if above person is authorized to submit RFFs E-mail Address .............................................................. Lri. f Sher@col l iergov. net .................................. I certify, as the recipient's Chief Elected Official, that the above signatures are of th individuals au horized to sign Requests for Funds and to submit RFFs electronically._._...................._...........--. _......................._..._...... ............_........__ ..._......,- --..................................................... Typed Name Date ign tur Georgia A. Hiller, Esq, Chairwoman Board of Collier County Commissioners (Z l0 13 ..... ...._._.._................---.................................................... ...... ................................ .................................................... ........................... _.........._...._.......................................................... f ..................................................... _.................._........................................................................... [ X ] Check here if your local government utilizes Electronic Funds Transfer (EFT) ro a tate of Florida. [ X ] Check here if your local government will be working on a reimbursement basi . ...... .... _.................... .................. .................................................................................................................... ........... ................................... _............................... _.._................................................................................. 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 (insurgd,,by,F�DIC) below. All ,; -... sinatures on the account must..be..bonded.............................................................................................,............................................................................................................................................................._.......:........_..._._.......................... Name of Financial Institution Account Number. Fifth Third Bank 113-8577 � '� .._......._:............._.................. .._..._...~....._........._............ _..............._...._..................__..._....._...................._...................................................................................................,.........................................__......._................................_.__._...........3.._..... _ Street Address or Post Office Box Telephone Number 999 Vanderbilt Beach Road 239-591-6397" ......................:...:....s........... . ................................................ City, State and Zip Code Approved ATTEST: Naoles. Florida 34108 pp edas_to_fQIIIL.3i�..lESx.:A.!.A.L.L ............................_ e�.�s�rsa�T- -w B Assistant County A ncy Department of Economic Opportunity - Small Cities Development Block Grant Program 16010 ATTACHMENT L - SIGNATURE AUTHORITY FORM Submit an ori ina/ Si nature Authori Form with each contract:_ 9.................................... k'..._.................................._......._..................................................._...........................-................................................................................... Recipient Contract # Funding Source Board of Collier County Commissioners 07DB-3V-09-21-01-Z01 [ ]Small Cities CDBG ..................................................................._..........................__.._._....._................................. [ X] Disaster Recovery Mailing Address (Street or Post Office Box) 3339 Tamiami Trail East Suite 211 [ ]Neighborhood Stabilization ..........._........................................................................................................................... i.....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 j bendisamarku@colliergov.net Accountant, Collier County Housing, Human and Veteran Servicesi ... ........ .................... ............. ........ ............... .._.... ..... .......... ................................... ........ ................. ._.,._._................................... ....................................................................................................._............ ................ _..... __.............._.........................................................................................................................._.__................................_.__._. 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 1 Date` Si e l Bendisa Marku Supervisor Accountant cl 7�..................i.............G:.................................................... ,. p......... ll�.............,�..........�� [ X ] Check here if above person is authorized to submit RFFs-mai rAddress .............. _......... ...... ......... _....... _...................................................... _...... .---.... _......... __._.�.._...... _.....................................bendisamarku@colliergov.net............_.........._._.._._.__....._.........__.......__..........................._............ ___.... _......... ......... - - Typed Name 1 Date, Si a re Edmond Kushi Accountant R' /� �rc- .. l S .......... [ X ] Check here if above person is authorized to submit RFFs E- ail Address '- --..._._............................................_............_._._._................... ---..................................__._....__................................_'..._................................................... _._................................... _.._...__.........X'_!.............................._.._........_.................................- ---..................__..._._.....__ Typed Name Date Signature �— r` .......1 �'— Lisa Oien Grants Coordinator [ ] Check here if above person is authorized to submit RFFs E-mail Address lisaoien@colliergov.net _.. ..............................................................................._...................................................................................._._...................._.__.._._._._..........................;..__.._......_..................................................__.._..._......._... T .__._.._........_.... Typed Name D to Signature Lori Fisher Grants Su ort S ecialist i ' .......................................... . [ ]Check here if above person is authorized to submit RFFs E-mail Address Lori.fisher@collierqov.net _ ...._.... .... _.......................................... ....... _................._....._....__..�_................................................._....._...._...._............._...._........._..................._.....:.._..-_.........._............................ - ............... ........................ I certify, as the recipients Chief Elected Official, that the above signatures are of the individuals authorized to sign Requests for Fundsand to submit RFFs electronically...............................................................................................................................................:. Y.�......................................................................................................................_......... ............................... Typed Name Date Si at Georgia A. Hiller, Esq, Chairwoman Z .County .. ............ ... .........................._..............................................................__......._................................1..........._............... ...................... [ X ] Check here if your local government utilizes Electronic Funds Transfer (E om the tate 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 governments 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 anon-interest bearing account. Provide account information for the financial institution (insured by FDIC) below. All sinatures on the account must be bonded.__,.....:_..:..:._............_. ..... g................................................................................................... ........................ ........ .._._.............................................................................................__......................_........................_.................................._.... -_.._....._.............._._.................... Name of Financial Institution ;Account Number Fifth Third Bank .......................113-8577 4 ';;� ........................................................................ ......................................................................................................................................................................................................................Zt .... p Street Address or Post Office Box ! Tele hone Number. , ti 999 Vanderbilt Beach Road 239- ... .......... _ ..._........_..._,. �__....................._._. ... �:.... City, State and Zip Code Approved as to form and legality ATTEST t- Naples, Florida 34108 p.............................................................................................................................................................................................................................................................................1IA/i ....-.....$ i'�i�9i.......................R d April 2011 Ass nt County rn ' ey . --,`