HomeMy WebLinkAboutWashington State Military Department for Snow Creek Road - 022024 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
Jefferson County
PROJECT DESCRIPTION CONTRACT NUMBER
Jefferson County Snow Creek Road Culvert Upsizing
Hazard Mitigation Grant Program D21-031
1. AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
Excused Absence Kate Dean Commissioner Dist. 1 , 1/21-12/24
Heidi Eisenhour Commissioner Dist. 2, 1/21-12/24
Greg Brotherton Commissioner Dist. 3, 1/23-12/26
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SI RE PRINT OR TYPE NAME TITLE
Monte Reinders Public Works Director
Eric Kuzma Asst. Public Works Director
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
Mark Thurston Engineer IV, Project Manager
Eric Kuzma Asst. Public Works Director
\\NAC-1\ OL1\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.
Department of Public Works
0 Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Mark McCauley, Interim County Administrator
From: Monte Reinders, P.E., Public Works Director/County Engineer
Agenda Date: February 20, 2024
Subject: Hazard Mitigation Grant Agreement with the Washington State
Military Department for
Snow Creek Road MP 0.84 Culvert Replacement
County Project Number 18020310
Statement of Issue: Execution of the attached Signature Authorization Form is
necessary to obtain hazard mitigation funds for the Snow Creek Road MP 0.84 Culvert
Replacement project.
Analysis/Strategic Goals/Pro's £t Con's: The culvert replacement at Snow Creek Road
Milepost 0.84 was completed in October 2023 but Jefferson County still needs to close
out the project and receive the remaining grant reimbursements. The original grant
agreement was executed in 2021, but has expired and become obsolete due to changes
in the Washington State Military Department's contract language. Therefore, the
Washington State Military Department is requiring that a new grant agreement be
executed in order to complete the project. By executing the attached Signature
Authorization Form, the Board wilt authorize the Public Works Director to sign the grant
agreement.
Fiscal Impact/Cost Benefit Analysis: The project has a total cost of approximately
$1,333,000. The FEMA Hazard Mitigation grant is providing $997,500 in federal funding
and $166,250 in state funding.
Recommendation: The Board is requested to sign the Signature Authorization Form and
return to Public Works for further processing.
Department Contact: Mark Thurston, Project Manager, 385-9210.
Reviewed By:
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Mark McCauley ounty Administrator Dat