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FY 2005 CommunitY Services Performance Contract <br /> <br />Exhibit G: Local Government Acceptance of Funds and Board Approval of <br />Community Services Performance Contract <br /> <br /> as the Board's Fiscal Agent: D,~ ~ ~ <br /> <br />3. Name of the Fiscal Agent's City Manager or County Administrator or Executive: <br /> <br />4. Name of the Fiscal Agent's County/City Treasurer or Director of Finance: <br /> <br />5. Name of the Fiscal Agent offidal to whom checks should be electronically transmitted: <br /> <br />Address: <br /> <br />6. The Board's board of directom certifies that, to the best of its knowledge and bellef, the data <br /> .. and information in this performance contract are true and correct and that its entry into this <br /> contract has been duly authorized by a formal vote of the board of directors in an open, public <br /> meeting of the board. This signature affirms the board's approval of this performance contract. <br /> <br />Signatur~oard Chairman <br /> <br />Date <br /> <br />7. This signature indicates receipt of a Board-approved copy of this performance contract and an <br /> agreement by the Board's Fiscal Agent to accept state and federal funds from the Department <br /> that are included in this contract. <br /> <br /> trator or' - ~' ~ v ' ' Manager <br /> <br />37. ~-30-2004 <br /> <br /> <br />