HomeMy WebLinkAboutExhibit 16-Exhibit A
OFFICE Of CAPITAL IMPROVEMENTS
AUTHORIZED S)CNATitRE FORM
Date:
Grantee:
Contact Name:
Contact Phone4 E-mail:
This form certifies the names, litres and signatures of individuals authorized by the Grantee to sign contracts, and requests for; scope
changes, budget revisions, advances, reimbursements, and any other tequests that may be required 'by Ito beard of County
Commissioners for the disbursement al funds. These signature authorizations are retained by the•Office of Capital improvements for
auditing purposes. Entities are required to submit updaate5 to this Mist as they become necessary. •1
Marne please Type or print
Contracts E Subcontracts
Title (please type or print) Signature
Requests for Scope Changes
Requests for Budget Revisions
Requests for Advances 8 Reimbursements
Fife se submit this form wirh or before your first requesr for an srYvence or reirnbursern�enf.
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