HomeMy WebLinkAboutPMCF Signature PageRenewable Ener Fund. Round L im::) �- ^-- --�Y�,� _e
Grant Application - Standard Form 0115cr- ENERGY AUTHORITY
:SECTION 13 -AUTHORIZED SIGNERS FORM .
Community/Grantee Name:
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Regular Election is held: Date:
" horized,'Grants! 'ner(s): _
P rin ted Name
Signature
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l authorize the above person(s) to sign Grant Documents:
Must be authorized by the highest ranking or anizationlcommunity1municipal official
Printed Name Title Term Signature
Grantee-:Cocitact informat1on %.` -
Mailing Address:
Phone Number:
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Fax Number:
E-mail Address:
Federal Tax ID #:
;i.�r 4__Piease submit an-updated;fa��rrr v+henever there is � .changeao tie aboue' informafinn:` _
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AEA 15003 Page 24 of 25 7/8114
Renewable Energy Fund Round IX iQ09ED
COED
Grant application - Standard FormaENERGY AUTHORITY
SECTION 14"- AD ,1T�ON�4L ODiCUME�ITATl01�:�►ND OE FTIFJC�4TION
SU$M1TTHEOLLC%VUINGDQGUMEIVTStFITH'YDUi APPLIC%A71.0"N:
A. Contact information and resumes of Applicant's Project Manager, Project
Accountant(s), key staff, partners, consultants, and suppliers per application form
Section 3.1, 3.4 and 3.6.
Applicants are asked -to provide resumes submitted With applications in separate electronic
documents -if the individuals do not want theirresumes. posted to the project web site.
B. Letters or resolutions demonstrating local support per application form Section 9.
C. For projects involving heat: Most recent invoice.demonstrating the cost of heating
fuel for'the buildings) impacted by the project.
D. Governing Body Resolution or other formal action taken by the applicant's governing
body or management per RFA Section 1.4 that:
- Commits the organization to provide the matching resources for project at the
match amounts indicated in the application.
- Authorizes the individual who signs the application has the authority to commit
the organization to the obligations under the grant.
- Provides as point of contact to represent the applicant for purposes of this
application.
- Certifies the applicant is in compliance with applicable federal, state, and local,
laws including existing credit and federal tax obligations.
E. An electronic version of the entire application on CD or other electronic media, per
RFA Section 1.7.
F. CERTIFICATION
The undersigned certifies that this application for a renewable energy grant is truthful
and correct, and that the applicant is in compliance with, and will continue to comply
with, all federal and state laws including existing credit and federal tax obligations and
that they can indeed commit the entity to these obligations.
Print Name
'Q
Signature
TitleIL
N
Date
AEA 15003 Page 25 of25 7/8/14