HomeMy WebLinkAbout*Other - Emergency ManagementGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: Grant County Emergency Management DATE: 1 I2ZI2G
REQUEST SUBMITTED BY:JeSSICB Olsen PHONE:509-906-9100
CONTACT PERSON ATTENDING ROUNDTABLE: MII"eya Garcia/Jessica Olsen
CONFIDENTIAL INFORMATION: ❑YES 8 NO
❑Agreement / Contract
❑AP Vouchers
❑Appointment / Reappointment
❑ARPA Related
❑ Bids / RFPs / Quotes Award
❑ Bid Opening Scheduled
❑ Boards / Committees
❑ Budget
El Computer Related
❑County Code
❑Emergency Purchase
❑Employee Rel.
❑ Facilities Related
❑ Financial
❑ Funds
❑ Hearing
❑ Invoices / Purchase Orders
® Grants — Fed/State/County
❑ Leases
❑ MOA / MOU
❑ Minutes
❑ Ordinances
❑ Out of State Travel
❑ Petty Cash
❑ Policies
❑ Proclamations
❑ Request for Purchase
❑ Resolution
❑ Recommendation
❑ Professional Serv/Consultant
❑ Support Letter
❑ Surplus Req.
❑Tax Levies
❑Thank You's
❑Tax Title Property
❑WSLCB
oil P
i OEM
MEN=
Update State Homeland Security Program (SHSP) grant Signature Authorization
Form (SAF).
i
If necessary, was this document reviewed by legal? ❑ YES ❑ NO R N/A
DATE OF ACTION: a-7--2se
DENIED ABSTAIN
D 1:
D2:
D3:
DEFERRED OR CONTINUED TO:
WITHDRAWN:
RECEIVED
4/23/24
GRANT COUNTY COMMISSIONERS
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
Grant County Sheriff's Office, Emergency Management
PROJECT DESCRIPTION CONTRACT NUMBER
WA St. Military Dept. and the U.S. Department of Homeland Security
SHSP
1. AUTHORIZING AUTHORITY
SIGNATURE
PRINT OR TYPE NAME
TITLE/TERM OF OFFICE
9 '
Kevin R. Burgess
Commissioner, Chair
O'
Rob Jones
Commissioner, Vice Chair
uj�
Cindy Carter
Commissioner, Member
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
§jIGNATURE
PRINT OR TYPE NAME
TITLE
I jw
Joe Kriete
Sheriff
Gary Mansford
Undersheriff
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
10
SI aN P U R E-:
PRINT OR TYPE NAME
TITLE
Jessica Olsen
EM Specialist
Mireya Garcia
EM Specialist
\\NAC-1\VOL1\HOME\KARENB\....\WP\SIGNAUTH Revised 3/03
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.
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION
SUBMIT T- ED
Grant County Sheriffs Office, Emergency Management
10/29/2024
PROJECT DESCRIPTION CONTRACT NUMBER
WA St. Military Dept. and the U.S. Department of Homeland Security
E24-122
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
IGNATURE
PRINT OR TYPE NAME
Jessica Olsen
Mireya Garcia
I
MAC-1 \VOL 1 \HON1E\KARE N BV ,.\WP\S IGNAUTH Revised 31103
TITLE
EM Specialist
EM Specialist