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Designation of Applicant's Agent
Resolution
RESOLUTION NO. 19-09
Be it resolved by the
Board of County Commissioners
(Governing Body)
Frank Gifford, Public Works Director
(Name of New Agent) (Title)
representative, and Monte Reinders. P.E.
(Name of Alternate Agent)
the designated alternate, for and in behalf of
of Jefferson County that
(Public of Agency)
is hereby designated the authorized
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 emerqency 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 .l\rY'i 1
, 20-D2
Certification
I, LnRMIt t:eutNeY, 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 p~d and
approved by the BOCC of Jefferson County on the,JC-day
1\ D. . ~ () (Governing Body) (Public Agency)
of ~ ,20f:ft.
Date: 1-10 -(') 1
~ ~,40Ji3GaJ)
(Offici oSition)
(~cYM1a ~. J:Jo Q-AM't
(Signature) .
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completin this form.
NAME OF ORGANIZATION DATE SUBMITTED
Jefferson County Department of Public Works
PROJECT DESCRIPTION
Public Assistance Program
1825-DR-WA
CONTRACT NUMBER
1. AUTHORIZING AUTHORITY
PRINT OR TYPE NAME
TITLE/TERM OF OFFICE
Chair
Board of County Commissioners
David W. Sullivan
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
:::;t~ flIWc--{ Frank Gifford
Public Works Director
<'
~
Monte Reinders, P.E.
County Engineer
3.
AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME
TITLE
,g~,( Jill <^4(
Frank Gifford
Public Works Director
/
-----
./
Monte Reinders, P.E.
-.-.-"
Department of Public Works
o Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To:
Board of Commissioners
Philip Morley, County Administrator
From:
Frank Gifford, Public Works Director ":161..tJ
Agenda Date:
April 6, 2009
Subject:
Designation of Applicant's Agent Resolution and Signature
Authorization Form, December, 2008 Severe Winter Storm and
Record Snow, Declaration No. 1825-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 December, 2008 Severe Winter
Storm and Record Snow, Declaration No. 1825-DR-WA. Jefferson County Public Works
has applied for disaster assistance totaling $55,000.
Analysis/Strategic Goals/Pro's ft 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 $55,000. 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.
Department Contact: Monte Reinders, County Engineer, 385-9242.
Reviewed By:
'3 /5/ ~;
Date