HomeMy WebLinkAboutApplicant Agent DesignationKittitas County, Washington
BOARD OF COLTNTY COMMISSIONERS
District One
Cory Wright
District Two
Laura Osiadacz
District Three
Brett Wachsmith
June 16,20X)
Mr Chris Ptrlit
Washington Military Department
Fire Manageffent Assistance Grant Progranr
MS" T,e.-20 Building 2tr8
Camp Murray. WA 98430-5122
Re: Designated Applicant Agent
Dear Mr" Polit:
The pu,rpose of this letter is to designate the Applicant Agent and Alternate authorized
representatives for
Disaster, FM-5?5LWA RlqrasscoubeF*e
Applicant Kittitas. County of
Applicanl AEent Judy Phss
Altemate Applicant Jerry Petlit
The purpose of this designation as the authorized representatives as to obtain
federal andlor Shte Emergency sr Major Disaster Assistance funds.
These representatives are authorized tn execule all contacts, certify conrplelion of
pro1ects, request payments, and prepare all required documentation for funding
req,uirements,
Sineerety"
Sretl
County Cs,mrnissbner
Kittitas County Courthouse 205 West 5hAvenue, STE 108 . Ellensburg, WA9S926
(s09)e62-7s08 FAx(s09')962-7679
Designation of Applicant's Agent
Resolution
Be it resolved by Board of County Commissioners Of Kittitas, County of
Judy Pless
(Governing Body)
Budget Finance Officer
(Public Agency)
is hereby designated the authorized
paymen
Passed
(Name of New Agent) (Title)
represe ntative and Jerry Pettit County Auditor is designated
(Name of Alternate)
the alternate for and in behalf of Kittitas, countvor
(Title)
a public
(Public Agency Name)
agency established under the laws of the state of Washington.
The purpose of this designation as the authorized representative is to obtain federal andior state
emergency or disaster assistance funds. These representatives are authorized on behalf of the
Board of County Commissioners to execute all contracts, certify completion of projects, request
ts, and prepare all requ ired documentation for funding
16 day O1 June
c County Commissioner County Commissioner
(Title)
County Commissioner
(Title)
nature (Title)(Signature)(Title)
(Signature)(Title) (Signature)
Certification
(Title)
Julie Kjorsvik duly appoi ntgd and Clerk of the Board O; Kittitas, County of
(Name)(Title)(Public Agency)
do hereby certify that the above is a true and correct copy of a resolution passed and approved by
16" Board of County Commissionen Of Kittitas, Couniy of on the tu _ d"y of June 202020
(Governing Body) (Public Agency)
Date: June 16,2020
Clerk of the Board
requirements.
202020
lt
S
t
1/Wt'lL
il
(Official Position)(Signature)
12t10t09
STATE FIRE MANAGEMENT ASSISTANCE APPLICATION DEM - 131
Application ldentifier:State Number: D19-1004
Federal Disaster Number: FM-5253-WA
Federal Catalog Number: 97.046 Title: Fire Management Assistance Grants
Declaration Date: JulY 10' 2a18
Applicant's FEMA Project Application Num ber: 037-99037-00
Legal Applicant Recipient:
Applicant's Name: Kittitas, County of
Street Address: 205 W Sth Ave Ste 105
Mailing Address:
City: Ellensburg State: WA
County: Kittitas
Zip Code: 98926-2887
Applicant Agent:
Name: Judy Pless
Contact Information:
phone: 509-962-7502
Tile: Budget Finance Officer Fax:509-962-7687
E-mail: judy.pless@co.kittitas.wa.us
Signature:
Alternate App
Date: June 16,2020
lica ent:
Name: Jerry Pettit phone: 509-962-7557
Tile: County Auditor Fax:509-962-7687
E-mail: jerry.pettit@co.kittitas.wa.us
Signature Date: June 16,2020
Type of Appli ca nt:
A - State
B - County
C - City
D - School District
E - Special Purpose District
F
G
H
I
- Higher Educational lnstitution
- lndian Tribe
- Private NonProfit
- Other (Specify)
Enter Appropriate Letter B
Congressional District Number:
State Legislative District Number:
I
13
Governor's Authorized Representative:
Date:
NOTE: Shaded blocks for WA EMD use.
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
Kittitas, County of
DATE SUBMITTED
June 16, 2020
PROJECT DESCRIPTION
Fire Management Assistance Grant Program, .FM-s253-wA
CONTRACT NUMBER
D19-1004
1. AUTHORIZINGAUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLEiTERM OF OFFICE
Brett Wachsmith County Commissioner
Laura Osiadacz County Commissioner
Cory Wright County Commissioner
2. OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
Judy Pless Budget Finance Manager
Jerry Pettit County Auditor
SIGNAUTH - PA, Revised 1'll09