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36 <br />DESIGNATION OF AUTHORITY (AGENTS) <br />FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />IB <br />Sub -Grantee: [ --h Date: I <br />ox 7: Other (Read Only Access) <br />Box 8: Other (Read Only Access) <br />Agent's Name <br />_10R ei\eNVIA�> <br />Agent's Name <br />Signa <br />Signature <br />ganizati n / fficia osition S J.S, " NA <br />Organization / Official Position <br />W mg Address <br />10 It's% <br />Mailing Address <br />ity, State, Zip L ' <br />City, State, Zip <br />DDaimeTelephone <br />Daytime Telephone <br />m'I Address <br />�'�)N�C \ � uL <br />E-mail Address <br />Box 9: Other (Read Only Access) <br />Box 10: Other (Read Only Access) <br />Agent's Name <br />Official's Name <br />Signature <br />Signature <br />Organization / Official Position <br />Organization / Official Position <br />Mailing Address <br />Mailing Address <br />City, State, Zip <br />City, State, Zip <br />Daytime Telephone <br />Daytime Telephone <br />E-mail Address <br />E-mail Address <br />Box 11: Other (Read Only Access) <br />Box 12: Other (Read Only Access) <br />Agent's Name <br />Agent's Name <br />Signature <br />Signature <br />Organization / Official Position <br />Organization / Official Position <br />Mailing Address <br />Mailing Address <br />City, State, Zip <br />City, State, Zip <br />Daytime Telephone <br />Daytime Telephone <br />E-mail Address <br />E-mail Address <br />Sub -Grantee's Fiscal Year (FY) Start: Month: (� `,� Day: 1 <br />Sub -Grantee's Federal Employer's Identification Number (EIN) , -0-4 84 <br />Sub -Grantee's Grantee Cognizant Agency for Single Audit Purposes: Florida Division of Emergency Management <br />Sub -Grantee's: FIPS Number (If Known) OF)(D - 'ZMa 00 <br />NOTE: This form should be reviewed and necessary updates should be made each quarter to maintain efficient communication and continuity <br />throughout staff turnover. Updates may be made by email to the state team assigned to your account. A new form will only be needed if all <br />authorized representatives have separated from your agency. Be aware that submitting a new Designation of Authority affects the contacts that have <br />been listed on previous Designation forms in that the information in FloridaPA.org will be updated and the contacts listed above will replace, not <br />supplement, the contacts on the previous list. <br />REV.09-09-2017 DISCARD PREVIOUS VERSIONS <br />