Laserfiche WebLink
2021 Signature Authorization Form <br />Effective January 1, 2021 through December 31, 2021 <br />Snohomish County <br />Human Services <br />MAIL COMPLETED ORIGINAL FORM TO: Snohomish County Human Services - Attn: HSD Contracts <br />3000 Rockefeller, M/S 305 - Everett, WA 98201 <br />Or mI EMAIL SCANNED (PDF) COPY TO: HSD.Contractssnoco.orq <br />Please sign in ink, electronic signature, or both. ALL SECTIONS below must be completed. <br />SECTION 1: Official Business Name of Organization <br />Business Name: City of Everett Police Department <br />Date Submitted: 03/02/21 <br />Mailing Address: 3002 Wetmore Ave Everett <br />WA 98201 <br />Street <br />City State Zip <br />SECTION 2: Authorizing Authority <br />Signature(s) <br />Type or Print Name <br />Title <br />Cassie Franklin <br />Mayor <br />SECTION 3: Authorization to Sign Contracts / Contract Amendments <br />Signature(s) <br />Type or Print Name <br />Title <br />Cassie Franklin <br />Mayor <br />SECTION 4: Authorization to Sign Invoices / Requests for Reimbursements <br />Signature(s) <br />Type or Print Name <br />Title <br />j L. <br />Tracey L. Landry <br />Police Svcs Program Manager <br />4y,�,� L <br />Amanda Harper <br />Police Admin Coordinator <br />SECTION 5: Email Address for Contract Delivery Designation <br />Email Address(es) printed/typed <br />Type or Print Name <br />Title <br />TLandry@everettwa.gov <br />Tracey L. Landry <br />Police Svcs Program Manager <br />Rev. 12/15/20 <br />