HomeMy WebLinkAboutSH18-050 FFY18 HSGP - Signature Authorization (2)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
DATE SUBMITTED
PROJECT DESCRIPTION
CONTRACT NUMBER
1. AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
\\NAC-1\VOL1\HOME\KARENB\….\WP\SIGNAUTH Revised 3/03
INSTRUCTIONS FOR SIGNATURE AUTHORIZATION FORM
This form identifies the persons who have the authority to sign contracts, amendments,
and requests for reimbursement. It is required for the management of your contract with
the Military Department (MD). Please complete all sections. One copy with original
signatures is to be sent to MD with the signed contract, and the other should be kept with
your copy of the contract.
When a request for reimbursement is received, the signature is checked to verify that it
matches the signature on file. The payment can be delayed if the request is
presented without the proper signature. It is important that the signatures in MD's files
are current. Changes in staffing or responsibilities will require a new signature
authorization form.
1. Authorizing Authority. Generally, the person(s) signing in this box heads
the governing body of the organization, such as the board chair or mayor. In
some cases, the chief executive officer may have been delegated this
authority.
2. Authorized to Sign Contracts/Contract Amendments. The person(s) with
this authority should sign in this space. Usually, it is the county
commissioner, mayor, executive director, city clerk, etc.
3. Authorized to Sign Requests for Reimbursement. Often the executive
director, city clerk, treasurer, or administrative assistant have this authority.
It is advisable to have more than one person authorized to sign
reimbursement requests. This will help prevent delays in processing a
request if one person is temporarily unavailable.
If you have any questions regarding this form or to request new forms, please call your
MD Program Manager.