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CITY <br /> 2017 Signature Authorization Form <br /> Effective January 1, 2017 through December 31, 2017 Snohomish County <br /> Human Services <br /> Submit completed original form to: <br /> Snohomish County Human Services, Attn: HSD Contracts, 3000 Rockefeller, M/S 305, Everett, WA 98201 <br /> Please print or type clearly all names and sign in blue ink. <br /> SECTION 1: Official Business Name of Organization <br /> Business Name: City of Everett Date Submitted: <br /> 2930 Wetmore Avenue Everett WA 98201 <br /> Mailing Address: Suite 8A <br /> Street City State Zip <br /> SECTION 2: Authorizing Authority <br /> Signa re Print or Type Name Title <br /> #r4'46 Ray Stephanson Mayor <br /> SECTION 3: Authorization to Sign Contracts /Contract Amendments <br /> Sign ture Print or Type Name Title <br /> 1/41416 ir <br /> Ray Stephanson Mayor <br /> SECTION 4: Authorization to Sign Invoices/Requests for Reimbursements <br /> Si•nature - Print or Type Name Title <br /> f/i _� Allan Giffen Director <br /> 7; 4. Ce' Rebecca McCrary Manager <br /> SECTION 5: Contract Delivery Designation <br /> Email Address Print or Type Name Title <br /> ramccrary@everettwa.gov Rebecca McCrary Manager <br /> rjohnson@everettwa.gov Ross Johnson Planner <br /> . .-; TO 'ok.vi AT, <br /> ST: <br /> .I Ai <br /> City Clerk <br /> Revised 11/9/16 Ll'S, City Attorney <br />