HomeMy WebLinkAboutElfin Cove Authorized SignaturesGrant Ap h atinn - Standard Form ENA-rY
7EC50N 1.3 - AUTHORIED SIGNERS FORM
CommunityiG rantQe Marne; Comm u n ity of Ellin Cove
Regular Election is held: August of each year Date, 91V15 - -- -
Authorize Grant Sig nos),
F_
Pri need Narne Title Term S Fgnature
Jane Button Grant f�rnir«istrator j Endfs
grant dose
,ow
Mary Crump - Secretary W2016
Kelly Crump Chairman &2017 i
Dennis Meier _ Vice_Chair 8/201 F
--.. - -
1 authorize the above r #s� to sign Grant Docu , ts;
(1 4uat be authodvW y the highest ranking anizadordcvrnrnuni. 1m u n ici ai Wiicial
Printed Name I T-Fd@ Term - Signature
Kelly Cavmp , Chairman 8r.�p17
Granter Contact Inform lion;
Mali Ing Address;
Rhone Number:
E-mail Address:
Federal Tax 11)
ia0 Box 2 -
Elfin Cove, AK 99VS -�
907-239L-2225 f W7-72 14
907-239 -2221
I
ji2nedbuttan gmad.corn —
92-0089934
L_ R116ase submit an updated form whenever there is a change to the abmm inforaudon.
G mot Application - Standard Form CflrrY
SECT110N 14 — ADDITIONAL DK)CUM ENTATION AND C ERTIFICATION
SUBMtT THE FOLLCWNS DOCUMENTS W" YOUR APPUGATION:
A. ConUct inforrrkation and resumes of Applicants Project Manager, project
Accountant(s), keg staff, partners. cormultanW and suppliers per application form
Section 3.1. 3_4 and 3.6,.
Appheants ae asked W pfovkk r+esames subrr &ed wrth appficatrons rn separafe Pi1qcrrn1c
dbcum-errls if the rrdroduals do not want msunms posted to the.prqj,-ul web -silo,
B. Letters or resolution+S demonstrating local support per a ppl ication fafm Section 9,
C. For projects involving beat. Most recent invoice dernonstrati ng the cost of heati ng
fuel for the build i rg(%) impacted by the project
D_ Governing Body Resolution or other formal action taken by the applicant's governing
body or manageme rat per RFA Section 1.4 that:
- Commits the organization to provide the matching resources for project at the
match amounts indicated in the application.
- Authoriaks the individual who %6gns the appOrafion has the auth orit} to commit
the organisation to the obligations under the grarrL
- Provides as point of oontact to reprmwnt fha appf ica rot for purpous of this
app.1 creation.
- Cordflem the applicant Is in cot'r'rplia noa with applicable federal, state, and lec;a 1,
laws including existl:lg credit and fed-eral tax obligations_
E, An electronic version of the antire a ppiicaftn on CD or other a lectron i c media, per
RFA Section 1.7.
F. CERTIFICATION
The tlnderanigned certifies that this "ication for a renewable energy grant is truthful
and correct, and that the appli riont is in compliance with, and will continue tp comply
with, all federa€ and state lows i rieluding existing credit and federai tax obligations and '
that they can indeed c,on mit the entity to these obligations_
Print Name I Kelly Crump
Signature , Y �-
Title I Chaim
I