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Signature of Signatory <br />Date: <br />Print Name rgna tory <br />Contractor's Address <br />606 W 3'd Ave <br />El.tensburg, WA 98926 <br />Project Gontact <br />Name Susan Grindl.e <br />Titte cEo <br />Chair a <br />V atrman <br />C mrsstoner <br />e Board <br />Approved as to Form <br />Deputy Prosecuti ng Attorney <br />County's Address <br />205 West 5'h Ave, Suite 108 <br />Ettensburg, WA 98926 <br />Project Contact <br />Name Chel,sey Loeffers <br />Titl.e Publ,ic Heal.th Director