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DESIGNATION OF AUTHORITY (AGENTS) <br />FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />Sub-Grantee: -�Date: <br />Box 7: Other (Read Only Access) <br />Box 8: Other Read Only Access) <br />Agent's Name <br />Randy Newlon <br />Agent's Name <br />Signature _ <br />Signature <br />Organi�at� (ficial Position <br />City, asselbeny, City Manager <br />Organization / Official Position <br />Mailing Address <br />95 Triplet Lake Drive <br />Mailing Address <br />City, State, Zip <br />Casselbenv, FL 32707 <br />City, State, Zip <br />Daytimc Telephone <br />407-262-7700 Ext. 1130 <br />Daytime Telephone <br />E-mail Address <br />mewlon ,casselbe or <br />E-mail Address <br />Box 9: Other (Read Only Access) <br />Box 10: Other (Read Only Access) <br />Agent's Name <br />Official's Name <br />Signature <br />Signature <br />Organization / Official Position <br />Organization/ Official Position <br />Mailing Address <br />Mailing Address <br />City, State, Zip <br />City, State, Zip <br />Daytime Telephone <br />E-mail Address <br />Daytime Telephone <br />E-mail Address <br />Box 11: Other (Read Only Access) <br />Box 12: Other (Read Only Access) <br />Agent's Name <br />Agent's Name <br />Signature <br />Signature <br />Organization / Official Position <br />Organization / Official Position <br />Mailing Address <br />Mailing Address <br />City, State, Zip <br />City, State, Zip <br />Daytime Telephone <br />Daytime Telephone <br />E-mail Address <br />E-mail Address <br />Sub-Grantee's Fiscal Year (FY) Start: Month: October Day: 1 _ <br />Sub-Grantee's Federal Employer's Identification Number (EIN) 59 " 1056912 <br />Sub-Grantee's Grantee Cognizant Agency for Single Audit Purposes: Florida Division of Emergency Management <br />Sub-Grantee's: PIPS Number (If Known) 117-11050 -00 <br />NOTE: This form should be reviewed and necessary updates should be made each quarter to maintain efficient communication and continuity <br />throughout staff turnover, Updates may be made by email to the state team assigned to your account. A new form will only be needed if all <br />authorized representatives have separated from your agency. Be aware that submitting a new Designation of Authority affects the contacts iltat have <br />been listed on previous Designation forms in that the hilbimation in Florid6PA,org %vill be updated and the contacts listed above will replace, not <br />supplement, the contacts on the previous list. <br />33 <br />