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SIGNATURE AUTHORIZATION FORM <br />WASHINGTON STATE MILITARY DEPARTMENT <br />Camp Murray, Washington 98430-5122 <br />Please read instructions on reverse side before coTplefing completingthis form. <br />NAME OF ORGANIZATION I DATE SUBMITTED <br />KITTITAS COUNTY I March 1, 2016 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />Public Assistance Program, Disaster 4249 -DR -w -DR -WA <br />AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE <br />OBIE O'BRIEN COMMISSIONER <br />PAUL JEWELL COMMISSIONER <br />GARY BERNDT COMMISSIONER <br />2, OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE I PRINT OR TYPE NAME I TITLE <br />OBIE O'BRIEN i COMMISSIONER <br />MARK COOK DIRECTOR PUBLIC WORKS <br />KATHY JURGENS I PW FINANCE SYST MGR <br />SIGNAUTH — PA, Revised 11/09 <br />