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Signature Authorization Form <br /> PURPOSE <br /> The Signature Authorization Form identifies the person(s) who has the authority to sign contracts, <br /> amendments and invoices/requests for reimbursement. The form also designates the email address for <br /> the authorized recipient(s) of contracts and amendments from the Human Services Department. <br /> It is important that the signatures on file with the Department are current. Whenever there is a change <br /> in an authorized signor, a new Signature Authorization Form must be completed. The new form <br /> supersedes the previous form. Additional forms may be requested by sending an email to <br /> or by contacting your program staff. <br /> INSTRUCTIONS <br /> Please print the Signature Authorization Form on white paper. Complete each section where indicated <br /> and sign in blue ink. Make a copy of the form for your records and return the signed original form to the <br /> address below. Electronic or photocopied forms are not accepted. <br /> Snohomish County Human Services <br /> Attn:HSD Contracts <br /> 3000 Rockefeller Avenue, M/S 305 <br /> Everett, WA 98201 <br /> SECTION 1: Official Business Name of Organization <br /> Complete organization name, mailing address and date form is submitted. <br /> SECTION 2: Authorizing Authority <br /> This section is to be completed by the person(s)who has the authority to authorize the person(s) entered <br /> in Section 3 and Section 4 to represent your organization for these actions. Usually this person(s) will be <br /> the board president, chair, director, CEO or other person(s) delegated by the ruling body of the <br /> organization to act on its behalf. <br /> SECTION 3: Authorization to Sign Contracts/Contract Amendments <br /> Complete this section with the name of the person(s) authorized by your organization and/or board of <br /> directors to sign contracts and contract amendments for all programs. <br /> SECTION 4: Authorization to Sign Invoices/Requests for Reimbursements <br /> Complete this section with the name of the person(s) authorized by your organization and/or board of <br /> directors to sign invoices requesting reimbursement of costs and services from the Snohomish County <br /> Human Services Department for all programs. <br /> SECTION 5: Contract Delivery Designation <br /> Complete this section with the name, title and email address of the person(s) who should receive <br /> contracts (via email) for your organization. <br /> Note: This form is not write-protected. Add additional lines to any section if needed. <br /> Include all appropriate signors to cover ALL contracts with the Human Services Department. <br /> Rev. 12/2/19 <br />