HomeMy WebLinkAboutExhibit 5EXHIBIT B — N�170RK PROGRA�Nl
ELDERLY SERVICES
1. SUBRECIPIENT understands that the National Objective is assistance to low- to
moderate income persons.
2. SUBRFCIPIENT will provide seivj'Ces to pro -Tarn participants that meet the
follo«-ing criteria:
a) Must be a resident of the City of Mianni
b) Must be a member of a lo« --to moderate income household
C) Must be at least 62 years of age
3. SUBRECIPIEINTT will submit the following information to the City of Miami
Department of Community Development to obtain certification that proposed
participant is eligible to receive program benefits and for SU-BRECIPIENT to
invoice the CITY for services provided.
a) Program Application, in a form provided by the City of Miami
Department of Community Development; signed by prospective
participant and the SUBRECIPIENT.
4. SUBRECIPIENT must keep in file proof of the information listed below
demonstrating that each program participant is eligible to receive program
benefits:
a) Proof of living in the City of Miami
b) Proof of income
C) Proof of age
This information must match the information listed by the SUBRECIPIENT in
the participant Program Application form subnnitted to the CITY. A copy of this
form must also be kept in the participant's file.
5. SUBRECIPIENT may replace program participants who stop receiving program
benefits by providing the information required in items 2 and 3 for the new
participant. SUBRECIPIENT will not invoice the CITY until the proposed
participant is certified as eligible by the CITY.
6. SUBRECIPIENT will provide Elderly Services to a minimum of
participants, on a monthly basis; at the following location(s):
Address:
SUBRECIPIENT will provide program reports for the services provided to the
participants in a form provided by the CITY.
7. Program «ill commence on October l; 2009 and v ill end on September D0, 2010.
SIGNED:
Name: Date
Executive Director
STATE OF FLORIDA
COUNTY OF
The foregoina instrument was ackno«%ledged before me this day of
200_, by
(Title),
(Name)
(Agency), a Florida
not-for-profit corporation; on behalf of the corporation. He/she is personally kno-wn to me
or has produced as identification
Si_anature of Notary
State of Florida
Type, Print or stamp name of
Notary Public