HomeMy WebLinkAboutAuthorized Signers FormGrant Documents Authorized Signers
Please clearly print or type all sections of this form.
Community/Grantee Name: POLARCONSULT ALASKA, INC
Regular Election is held: N/A Date: SEPTEMBER 10, 2010
Authorized Grant Siqner(s):
Printed Name
Title
Term
Signature
EARLE AUSMAN
PRESIDENT
N/A
DAVID AUSMAN
VICE PRESIDENT
N/A
MICHAEL DAHL
SECRETARY/TREASURER
N/A
I authorize the above person(s) to sign Grant Documents:
(Highest ranking organization/community/municipal official)
Printed Name
Title
Term
Signature
MICHAEL DAHL
N/A
0
Grantee Contact Information:
Mailing Address:
1503 WEST 33 RD AVENUE SUITE _310
ANCHORAGE, AK 99503
Phone Number:
907-258-2420
Fax Number:
907-258-2419
E-mail Address:
MIKE@POLARCONSULT. NET
Federal Tax ID #:
0(7- 2-
Please submit an updated form whenever there is a change to the above information.
Please return the original completed form to: CED
Alaska Energy Authority ALI MAKA
813 W. Northern Lights Blvd.
Anchorage, AK 99503 =E, ENERGYAUTHORITY
Attn- Butch White, Grants Administrator
Z:\network\Proposals\2010\100909-SmallHydroRegionalRecon\F_AuthSignersForm\5 Grant_Authorized_Signers4.doc
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