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SIGNATURE AUTHORIZATION FORM <br /> WASHINGTON STATE MILITARY DEPARTMENT COV <br /> CampMurray,Murra Washington 98430-5122 <br /> Please read instructions on reverse side before completing this form. <br /> NAME OF ORGANIZATION DATE SUBMITTED <br /> City of Everett <br /> PROJECT DESCRIPTION CONTRACT NUMBER <br /> Public Assistance Program, Disaster 4249-DR-V\-DR-WA D16-640 <br /> 1. AUTHORIZING AUTHORITY <br /> SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE <br /> ay Stephanson Mayor/2017 <br /> Alt ST: <br /> -JAI 4 <br /> City Clerk <br /> 2. OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS <br /> SIGNATURE PRINT OR TYPE NAME TITLE <br /> f � Matt Welborn Public Works Finance Manager <br /> Jennifer Bailey Associate Engineer <br /> SIGNAUTH—PA, Revised 11/09 <br />