HomeMy WebLinkAboutSAFSIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
CAMP MURRAY, WASHINGTON 98430-5122
NEW FORM WILL REPLACE PREVIOUS FORMS
NA M E OF O R~A NIZATI O N DATE SU BMITTED
Kittitas County
PROJECT DESCRIPTION CONTRACT NUMBER
SFY17 E911 County Basic Service Operations E17 -021 Contract
11. A UTHORI Z1NG A UTH GRITY I
SIGNATU~ ___ PRINT OR TYPE NAME TITLEITERM OF OFFICE
~-~ Chairman Board of County
Paul Jewell Commissioners, Jan 1, 2017 -----Dec 31, 2Q20
~ Vice Chair Board of County
J Laura Osiadacz Commissioners , Jan 1, 2017 -
Dec 31,2020
L....-/ "" 12 . AU TH O R IZED TO S IG N CO NTRAC TS/CONT RACT A M E NDME NT S I
SIGNA~ PRINT OR TYPE NAME TITLEITERM OF OFFICE
~ Chairman Board of County
Paul Jewell Commissioners, Jan 1, 2017 -
Dec 31,2020
IV~~-) Vice Chair Board of County
Laura Osiadacz Commissioners, Jan 1, 2017 -
! "") {<-.. Dec 31,2020
'--"'" ~
3. A UTHO RIZED T O SIG N REQ UESTS FOR REIM B URSE MENT (A-19)
SIGNATURE PRINT OR TYPE NAME TITLEITERM OF OFFICE
~
Directdr/E911 Coordinator of ~Cl'dlr\~40ln~k Darlene Mainwaring KITICOM, appointed
/', ?)u v
~~\.p a<V" Judy Pless Kittitas County Budget &
Finance , appointed
P l~1e cO :Plete form with any new contract or any time personnel changes .
Submit one original to State E911 Office