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SIGNATURE AUTHORIZATION FORM <br />WASHINGTON STATE MILITARY DEPARTMENT <br />CAMP MURRAY, WASHINGTON 98430-5122 <br />NEW FORM WILL REPLACE PREVIOUS FORMS <br />NAME OF ORGANIZATION <br />Kittitas County <br />PROJECT DESCRIPTION <br />FY16/17 E911 County Equipment Contract <br />11. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME <br />r-......~---....,..,.rme O'Brien <br />DATE SUBMITTED <br />6/21/2016 <br />CONTRACT NUMBER <br />E16-216 <br />TITLE/TERM OF OFFICE <br />Chairman Board of Co <br />Commissioners <br />01-2015/12-31-2018 <br />Vice-Chaiman Board of Co <br />01 - <br />Commissoners 01- <br />12. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME <br />\ <br />Obie O'Brien <br />Jewell <br />13 . AUTHORIZED TO SIG N REQ UESTS FOR REIMBURSEMENT (A-19) <br />01-2013/12-31-2016 <br />TITLE/TERM OF OFFICE <br />Chairman Board of Co <br />Commissioners <br />01-2015/12-31-2018 <br />Vice-Chaiman Board of Co <br />Commissoners <br />01-2013/12-31-2016 <br />01- <br />01- <br />SIGNAT URE PRINT OR TYPE NAME TITLE/TERM OF OFFICE <br />Darlene Mainwarin <br />Jud Pless <br />Please com · te fo rm with any new contract or any time personnel changes. <br />Submit one original to State E911 Office <br />Director, Kittcom <br />Bud et and Finance Mana er