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Designation of Applicant's Agent
Resolution No. 18-09
Board of County Commissioners of Jefferson County that
(Governing Body) (Public of Agency)
Frank Gifford, Public Works Director is hereby designated the authorized
(Name of New Agent) (Title)
representative, and Monte Reinders, P.E.
(Name of Alternate Agent)
the designated alternate, for and in behalf of
Be it resolved by the
County EnQineer
(Title)
Jefferson County Public Works
(Public Agency)
agency established under the laws of the State of Washington.
is
, a public
The purpose of this designation as the authorized representative is to obtain federal and/or
state emerQencv or disaster assistance funds. This representative is authorized on behalf
of the Board of County Commissioners to execute all contracts, certify completion of
projects, request payments, and prepare all required documentation for funding
requirements.
day of March
,202.
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Certification
I, LOANA L (h~L1i}JI#, duly appointed Clerk of the Board of Jefferson County,
(Name) (Title) (Public Agency)
do hereby certify that the above is a true and correct copy of a resolution passed and
approved by the BOCC of Jefferson County on the~ay
.' . f} (Governing Body) (Public Agency)
of lY) ~-d1- , 2od.
Date: 0!-d.3!DY'
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(Offi al PosItion)
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(Signature) cj-
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before com letin this form.
NAME OF ORGANIZATION DATE SUBMITTED
Jefferson County Department of Public Works
PROJECT DESCRIPTION
Public Assistance Program
1817-DR-WA
CONTRACT NUMBER
1.
AUTHORIZING AUTHORITY
SIG PRINT OR TYPE NAME
David W. Sullivan
TITLEfTERM OF OFFICE
Chair
Board of County Commissioners
Phil Johnson
Member
Board of County Commissioners
John Austin
Member
Board of County Commissioners
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE
PRINT OR TYPE NAME
TITLE
;:j/YA
Frank Gifford
Public Works Director
County Engineer
3.
AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNA T PRINT OR TYPE NAME
TITLE
Frank Gifford
Public Works Director
Monte Reinders, P.E.
ineer
~
Department of Public Works
o Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
From:
Board of Commissioners
Philip Morley, County Administrator
Frank Gifford, Public Works Director ..::!()!J
To:
Agenda Date:
March 23, 2009
Subject:
Designation of Applicant's Agent Resolution and Signature
Authorization Form, January 2009 Severe Winter Storms,
Declaration No. 1817-DR-WA
Statement of Issue: The attached Designation of Applicant's Agent Resolution, and
Signature Authorization Form are required by the Washington State Military
Department in order to obtain FEMA funding for the January 2009 Severe Winter
Storms, Declaration No. 1817-DR-WA. Jefferson County Public Works has applied for
disaster assistance totaling $25,000.
Analysis/Strategic Goals/Pro's & Con's: The Designation of Applicant's Agent
Resolution, and the Signature Authorization Form give authority to the Public Works
Director and the County Engineer to execute the Grant Agreement with the
Washington State Military Department, request payments, and prepare documentation
required for funding requirements. This project supports Strategic Goals 1, 3, and 9.
Fiscal Impact/Cost Benefit Analysis: Jefferson County's total disaster assistance
request is $25,000. It is anticipated that funding will be 12.5% local, 12.5% state, and
75% FEMA.
Recommendation: The Board is requested to sign the Designation of Applicant's
Agent Resolution, and the Signature Authorization Form, and return to Public Works
for further processing.
Reviewed By:
3fr'6~7'
Date