HomeMy WebLinkAboutsignature formSponsor Name:
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
Authorized Signature Form
CITY OF MIAMI DEPARTMENT OF PARKS AND RECREATION
Agreement Number: 0 4— 0 8 9 9
Please type or print the names, titles, and signatures of persons authorized to sign the application,.
agreements, documents, forms and claim for re1mbursement All authorized, signers, authorized
representatives, and program contacts must be legal employees of the institution.
AUTHORIZED SIGNERS:
Ernest W. Burkeen Jr. Director
Type of Print Name Type or Print Title
Jose Matas . Principal Staff Analyst
Type of Print Name
ature
Type or Print Title Signature
Elizabeth Ott Admin. Assistant III (�,
Type of Print Name Type or Print Title. Signature
Type of Print Name
Type or Print Title Signature
I certify that the persons above are authorized to sign the claim for reimbursement.
AUTHORIZED REPRESENTATIVE:
Type or Print Name & Title of Authorized Representative Signature of Authorized Representative
Date signed
SFSP-F 15 Page 1 of 1 10/04