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2018 Signature Authorization Form 04 <br /> Effective January 1, 2018 through December 31, 2018 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 /> Mailing Address: 3002 Wetmore Ave Everett WA 98201 <br /> Street City State Zip <br /> SECTION 2: Authorizing Authority <br /> Signature Print or Type Name Title <br /> F`tit/I' XA- Mayor y,, ��-,'l <br /> /qw7/Folz` <br /> SECTION 3: Authorization to Sign Contracts/Contract Amendments <br /> Signature Print or Type Name Title <br /> 'X Ca Mayor ;"r„ , �� <br /> ,47 <br /> SECTION 4: Authorization to Sign Invoices I Requests for Reimbursements <br /> Sinature Print or Type Name Title <br /> .--( a Id2ib,t) ___ Tracey L. Versteeg Police Budget & Finance Manager <br /> SECTION 5: Contract Delivery Designation <br /> Email Address Print or Type Name Title <br /> tversteegeverettwa.gov Tracey L. Versteeg Police Budget & Finance Manager <br /> Rev. 11/7/17 <br />