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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 Ma