2004/06/02 Council Agenda Packet

8 SNOHOMISH COUNTY HUMAN SERVICES . 2777 rolhy Avenue, Suite 104,Everett,WA 98201 • Instruction for Completion of Signature Authorization Form The Signature Authorization Form contains two identical sections. Both sections are to be completed. The lower section is to be retained at the Agency for their records and the upper section is to be returned to Snohomish County Human Services. A new Signature Authorization From should be completed whenever Agency personnel changes occur so that the most current authorized signatures are on file with Snohomish County Human Services. PLEASE TYPE ALL NAMES AND SIGN IN "BLUE" INK. PENCIL ENTRIES ARE NOT ACCEPTABLE. SECTION I Official Business name of Agency/Contractor Date Submitted: Self-explanatory. Name of Project: Name of project from the Contract Face Sheet Contract Number: Number of current contract. Complete ONE FORM for EACH CONTRACT in the case of multiple contracts with Snohomish County Human Services. SECTION II Authorized to Sign Contracts/Contract Modifications: Complete this section with the names of persons authorized by your Agency or Agency Board of Directors, to sign contracts and contract modifications. SECTION III Authorized to Sign Invoices: Complete this section with the names of persons authorized by your Agency Board of Directors to sign invoices requesting reimbursement of costs and services from the Snohomish County Human Services Department. SECTION IV Authorization Authority: This section is to be completed by the person who has the authority to authorize the persons entered in Section II and Section III to represent the Agency for these actions. Usually this person will be the Board President, the Agency Director or other person(s) delegated by the ruling bcly of the organization to act on its behalf.