HomeMy WebLinkAboutsignature pagesSep 17 2013 03:06PM CityofAtka 9078392234
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Renewable Energy Fund Round VII X%_ d
Grant Application - Heat Projects Ef+1EFWAUrHORfTY
SECTION 10 — AUTHORIZED SIGNERS FORM
Community/Grantee Name:
City of Atka
Regular Election is held:
1" October of each vear
Authorized Grant Sionertal-
Date: October 1, 2013
' Printed Name
—Maly
Title
Term
10l13
Signature
�;•
Christopher
Mayor
Julie Dirks
City Administrator
NA
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name Title Term Signature
Christopher Maly Mayor 10/13
Grantee Contact_ Information:
Mailing Address:
Phone Number:
Fax Number:
E-mail Address:
Federal Tax ID #:
721 Sesame Street 2C
Anchorage, Aiaska 99503
907-522-0384
907-522-0385
dirksjuliea@gmail.corn
92-0126898
Please submit an updated form whenever them is a change to the above information.
AEA 2014-006 Grant Application
Page 20 of 21
7/2/2013
Renewable Energy Fund Round VII i4111111111111IND
�AlGrant Application Heat Projects ENERGYAUTHORITY
SECTION 11 —ADDITIONAL DOCUMENTATION AND CERTIFICATION
SUBMIT THE FOLLOWING DOCUMENTS WITH YOUR APPLICATION:
A. Contact information, resumes of Applicant's Project Manager, key staff, partners,
consultants, and suppliers per application form Section 3.1 and 3.4. Applicants
are asked to provide resumes submitted with applications in separate electronic
documents if the individuals do not want their resumes posted to the project web
site.
B. Letters or resolutions demonstrating local support per application form Section 8.
C. For heat projects only: Most recent invoice demonstrating the cost of heating fuel
for the building(s) 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. One paper copy and one electronic version of the entire application on CD or other
electronic media, per RFA Section 1.7.
F. CERTIFICATION
r 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 I Julie Dirks
Signature
Title I City Administrator
Date I September 24, 2013
AEA 2014-006 Grant Application Page 21 of 21 712/2013