HomeMy WebLinkAboutExhibit 5OFFICE OF CAPITAL 1MP O\' MENTS
AUTHORIZED SIGNATURE F09.M
Exhibit A
Date:
Grantee:
Contact Name:
•
Contact Phone 8 E.maif:
This torrn certifies the names, tities and signatures of individuals authorized by the Grantee do sign, contracts, and request: for; scope
changes, budget revisions, advances, reimbursements, and any other requests that may be 'required by the 'Board of County
Commissioners for the disbursement of funds. These signature authorizations ate retained by.the Office of Capital improvements for
auditing purposes. Entities are required to submit updates to this list as they become necessary.
a Name (please type orprinhJ
Contracts 6 Subcontracts
Requests tor Scope Changes
Requests for Budget Revisions
Title (please type or print) Siar'fature
Requests for Advances d Reimbursements
Please submit this form with or before your first request for en advance or reimbursement
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