Laserfiche WebLink
DESIGNATION OF AUTHORITY (AGENTS) <br />FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM <br />LORIDA DIVISION OF EMERGENCY MANAGEMEN <br />Sub -Grantee: C fyac <br />& <br />Box 1: Authorized Agent (Full Access) <br />Box 2: Primary A ent (Full Access) <br />Agent's Name <br />f i5� <br />Agent's Name <br />'S� <br />Signature <br />S, <br />Signature <br />Organization / Offi ;al Position, <br />CY <br />Or aniza n /Official Posi;on up�A <br />IF'tS$15N11i <br />Mailing Address <br />5 <br />_xpainC O 1� 1 N5 J�iVe1Q <br />Mailing Address <br />C <br />City, State, ZipCity, <br />b0 <br />State, Zip <br />eta• � �� 1-, �L l tv4 <br />Daytime Tel hone /1 y <br />._ <br />Daytime Telephone <br />E-mail Ad ess <br />('`��e�, <br />E-mail Address <br />Box 3: Alternate Agent (Full Access)Box <br />4: Other-Finance/Point of Contact (Full Access) <br />A e is Name <br />EmeQtA-teaM i1 <br />Official's Name <br />--t <br />Official <br />, State, <br />Address <br />--a lilt -1P <br />Agent's Name Agent's Name <br />Signature Signature <br />Organization / Official Position Organization / Official Position <br />Mailing Address Mailing Address <br />City, State, Zip City, State, Zip <br />Daytime Telephone Daytime Telephone <br />E-mail Address E-mail Address <br />The above Primary and Alternate Agents are hereby authorized to execute and file an Application for Public Assistance on behalf of the Sub -grantee for the <br />purpose of obtaining certain Grantee and Federal financial assistance under the Robert T. Stafford Disaster Relief & Emergency Assistance Act, (Public Law <br />93-288 as amended) or otherwise available. These agents are authorized to represent and act for the Sub -Grantee in all dealings with the State of Florida, <br />Grantee, for all matters pertaining to such disaster assistance previously signed and executed by the Grantee and Sub -grantee. Additional contacts may be <br />placed on page 2 f this document for read only access by the above Authorized Agents. <br />4�< �04 ;e4, <br />Sub-Grantee'AuThoflized Agent Signature <br />Date <br />