HomeMy WebLinkAboutSignature FormFLORIDA DEPARTMENT OF EDUCATJON
FOOD AND NUTRITION MANAGEMENT
SITMAMV R FOOD SERVICE PROGRAM FOR CHILDREN
uthorized Signature Foran
Sponsor Name: City of Miami Parks and Recreation Department
Agreement Number:
04-0899
Please type or print the names, titles, and signatures of persons authorized to sign the application,
agreements, documents, forms and claim for reimbursement. All authorized signers, authorized
.representatives, and program contacts must be legal employees of the institution. 'These individuals cannot
be FSMC employees.
AUTHORED SIGNE, RS:
f �
Ernest W. Burkeen Director
Type of Print Name Type or Print Title ' S gaature
1 Juan A. Pascual nP „t n;, -o, -t-,
Type of Print Name Type or Print
Elizabeth Ott Asministrative Assistant 11
Type of Print Name Type or Print Title Signatu e
Jose Matas Principal Staff Analyst - {
Type of Print Name Type or Print Title Signature
I certify that the persons above are authorized to sign the claim for reimbursement.
AUTHORED RE? PRE, SENTATI'E:
Type or Print Name & Title of Authorized Representative
Date s
Signature of Authorized Representative
SFSP-f75 Paoe l of 1 12129108