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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 completing this form. <br />NAME OF ORGANIZATION DATE SUBMITTED <br />KITTITAS COUNTY JANUARY 3,2017 <br />PROJECT DESCRIPTION CONTRACT NUMBER <br />FEMA HAZARD MITIGATION PLANNING GRANT HMP #E17-062 <br />1. AUTHORIZING AUTHORITY <br />SIGNATURE PRINT OR TYPE NAME TITLEITERM OF OFFICE <br />OBIE O'BRIEN COMMISSIONER <br />-s--12-: 3 J.-L 8" <br />_-+ __ -...:.P~AUL JEWELL COMMISSIONER <br />() j .. (J .-. 7 .-. 1')...-3 j -1--0 <br />LAURA OSIADACZ COMMISSIONER <br />/2--.-::; (-2.L) <br />~ <br />2 . AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />'7t{ ,~ MARK COOK DIRECTOR PUBLIC WORKS <br />lAA \~I);\N'& ~II, KATHY JURGENS PW FINANCE SYSTEM MGR <br />U .I <br />3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT <br />SIGNATURE PRINT OR TYPE NAME TITLE <br />MARK COOK DIRECTOR PUBLIC WORKS <br />~~~ KATHY JURGENS PW FINANCE SYSTEM MGR <br />IINAC-1IVOL 1IH OM ~B~.IWPISIGNAUTH Revised 3/03