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<br />~~~~~ U.S. DEPft - ''-lENT OF JUSTICE AWARD CO NTH ATION <br />OFFICE 01. . ~STICE PROGRAMS SHEET <br />'II, 0 DIP [!] BIA 0 OJIDP ~ GRANT <br />0.. :&: <br />~. . <br />~~~~~ 0 BIS 0 Nil 0 OVC 0 COOPERATIVE AGREEMENT <br /> CHECK APPROPRlA TE BOX <br />PROJECT NUMBER 97LBVX320S AWARD DATE 9/30/97 <br /> <br />PAGE 6 OF 6 <br /> <br />SPECIAL CONDITIONS <br /> <br />17. By signing below, the recipient is requesting payment under the LLEBG Program. In order to ensure prompt payment and <br />compliance with new U.S. Department of Treasury requirements that all grant payments be issued electronically. the following <br />information must be completed as part of the signed accepted award documents. Failure to supply this information will delay <br />your payment. <br /> <br />Grantee Name: <br />(e.g., Ciry of. County of, Parish of, etc.) <br /> <br />Vendor or EIN Number: <br />(Please use number provided in #IA on the award document) <br /> <br />Financial Institution Name: <br /> <br />Financial Institution Address: <br /> <br />Bank Contact Name and Phone Number: <br /> <br />Nine-digit Routing Transit Number: <br /> <br />Grantee Account Number: <br />(This account should fulfill the trust fund requirement) <br /> <br />By signing these Special Conditions, the recipient is accepting the conditions and agrees to comply with them during the term <br />of the award. The recipient is also requesting payment of the LLEBG funds. <br /> <br />Signature of Chief Executive Officer <br /> <br />Date <br /> <br />OIP FORM/2 (REV. 5-87) PREVIOUS EDITIONS ARE OBSOLETE <br />