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QUALIFIED SCHOOL CONSTRUCTION BONDS PROGRAM <br />(QSCB) <br />APPLICATION FOR AUTHORIZATION <br />Submittal Date: 3116/2012 <br />Contact Person: Len Witke <br />LEA: Cabarrus County Schools <br />Title: Executive Director of Facilities <br />School: Beverly Hills Elementary School <br />Address: 4425 Old Airport Road <br />Address: 87 Palaside Dr NE <br />City: Concord, NC 28025 <br />City: Concord, NC 28425 <br />Phone/Fax: (704) 262- 5219/6211 <br />❑ New <br />0 Renovation /Add <br />E- mail: len.witke r�r <br />Certification of Eligibility <br />The Board of Education of the above -named LEA certifies, through a board resolution <br />dated 1WK 6q1Z, Zol that the QSCB proceeds will be used as fellows: <br />Note: A copy of'the resolution must accompany this application. <br />1. Construction, rehabilitation, or repair of a public school or for land acquisition for such a <br />facility (not land for a future project). <br />2. Provision of equipment to be used in the portion of the public school facility to be <br />constructed, rehabilitated, or repaired with QSCB funds (not personal computers or <br />similar technology). <br />Nate: A copy of the project description, proposed .spending plan and project schedule <br />must accompany this application. <br />SCB'S MUST BE ISSUED BY DECEMBER 31. 2012 <br />Caban•us P =hool of Education Caba us Cau y - Board Co missioners <br />Chair - Chair <br />Secretary Clerk. <br />�• Date Date <br />Please return original via certified mail post marked no later than March 16, 2012 to: <br />QSCB — Reallocation Round 1 <br />School Planning Section <br />North Carolina Department of Public Instruction. <br />6319 Mail Service Center <br />Raleigh NC 27699 -6319 <br />Attachment number 2 <br />G -3 Page 173 <br />