HomeMy WebLinkAboutSection 10 and 11Renewable Energy Fund Round 6
Grant Application
I SECTION 10-AUTHORIZED SIGNERS FORM
Community/Grantee Name: City of Galena
~R_e_g_u_la_r_E_Ie_c_ti __ o_n_is_h_e_ld_: __________________ J[oare_: __________________ ~
Authorized Grant Si
Printed Name Title Term
March Runner Tribal Administrator
Phil Koontz Project Coordinator
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name Title t Term r Signature~ l
_ G~Hr+<Z· . Russ Sweetsir Mayor
Grantee Contact Information:
Mailing Address: P.O. Box244
Galena, AK 997 41
Phone Number: 907-656-1711
Fax Number: 907-656-1716
E-mail Address: Phil.koontz@gmail.com
Federal Tax 10 #: 92-0081515
Please submit an updated form whenever there is a change to the above information.
AEA 13-006 Application 7/3/2011
Renewable Energy Fund Round 6
Grant Application
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. Ap~11icants
are asked to separate resumes submitted with applications, if the individuals do
not want their resumes posted.
B. Letters demonstrating local support per application form Section 8.
C. An electronic version of the entire application on CD per RFA Section 1.7.
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 authc1rity 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. 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 Greg Moyer
Title City Manager
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Date 8/28/2012
AEA 13-006 Grant Application Page 2 of2 7/3//2012
Renewable Energy Fund Round 6
Grant Application I ~ A' MiSt
~ENERGY AUTHORITY
SECTION 11-ADDITIONAL DOCUMENTATION AND CERTIFICATION
SUBMIT THE FOLLOWING DOCUMENTS WITH YOUR APPUCATION:
A. Contact infonnation, resumes of Applicant's Project Manager, key staff, partners,
consultants, and suppliers per application form Sectioo 3.1 and 3.4. Applicants
are asked to separate resumes submitted with applications, if the individuals do
not want their resumes posted.
B. Letters demonstrating local support per application form Section 8.
C. An electronic version of the entire application on CD per RFA Section 1.7.
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. CERTIFICATION
The undersigned cerl:ifles 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 c:ommlt the entity to these obligations.
Print Name ),.
Signature
title
Date
AEA 13-006 Grant Application City Of Galena Round 6 Page 38 of38
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