HomeMy WebLinkAboutWAStateMilitaryDeptSignatureAuthFormKITTITAS COUNTY
DEPARTMENT OF PUBLIC WORKS
AGENDA ITEM STAFF REPORT
AGENDA DATE: January 3, 2017
ACTION: Sign Washington State Military Department Signature Authorization Form
for Hazard Mitigation Planning FEMA Grant Agreement E17-062
Z Routine
❑ Public Hearing
BACKGROUND: On November 15, 2016 the Board of County Commissioners signed
Resolution No. 216-148 to authorize the Director's signature on
Washington State Military Department Hazard Mitigation Planning FEMA
Grant Agreement E17-062. As a part of the grant agreement, the county
must provide a Signature Authorization Form.
REQUEST: The Department of Public Works requests the Board of County
Commissioners sign the Signature Authorization Form
INTERACTION: Return two (2) original Signature Authorization Forms to Public Works
HANDLING: Department of Public Works
ATTACHMENTS: Signature Authorization Form
LEAD STAFF: Kathy Jurgens, Finance System Manager
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION I DATE SUBMITTED
KITTITAS COUNTY I JANUARY 3, 2017
PROJECT DESCRIPTION CONTRACT NUMBER
FEMA HAZARD MITIGATION PLANNING GRANT HMP #E17-062
1. AUTHORIZING AUTHORITY
SIGNATURE
PRINT OR TYPE NAME
TITLE/TERM OF OFFICE
OBIE O'BRIEN
COMMISSIONER
�Ct`4b l vY�
PAUL JEWELL
COMMISSIONER
LAURA OSIADACZ
COMMISSIONER
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE
PRINT OR TYPE NAME
TITLE
MARK COOK
DIRECTOR PUBLIC WORKS
�Ct`4b l vY�
KATHY JURGENS
PW FINANCE SYSTEM MGR
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE
PRINT OR TYPE NAME
TITLE
MARK COOK
DIRECTOR PUBLIC WORKS
KATHY JURGENS
PW FINANCE SYSTEM MGR
\\NAC-1\VOL7\HOME\KARENB\.... MMSIGNAUTH Revised 3/03