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DESIGNATION OF AUTHORITY(AGENTS) FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM FLORIDA DIVISION OF EMERGENCY MANAGEMENT Sub-Grantee: Date: Box 7: Other (Read Only Access) Box 8: Other (Read Only Access) Agent's Name Agent's Name Signature Signature Organization/Official Position Organization/Official Position Mailing Address Mailing Address City,State,Zip City,State,Zip Daytime Telephone Daytime Telephone E-mail Address E-mail Address Box 9: Other (Read Only Access) Box 10: Other (Read Only Access) Agent's Name Official's Name Signature Signature Organization/Official Position Organization/Official Position Mailing Address Mailing Address City,State,Zip City,State,Zip Daytime Telephone Daytime Telephone E-mail Address E-mail Address Box 11: Other (Read Only Access) Box 12: Other (Read Only Access) Agent's Name Agent's Name Signature Signature Organization/Official Position Organization/Official Position Mailing Address Mailing Address City,State,Zip City,State,Zip Daytime Telephone Daytime Telephone E-mail Address E-mail Address Sub-Grantee's Fiscal Year(FY)Start: Month: Day: Sub-Grantee's Federal Employer's Identification Number(EIN) - Sub-Grantee's Grantee Cognizant Agency for Single Audit Purposes Florida Division of Emergency Management Sub-Grantee's FIPS Number(If Known) - NOTE. This form should be reviewed and necessary updates should be made each quarter to maintain efficient communication and continuity 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 authorized representatives have separated from your agency Be aware that submitting a new Designation of Authority affects the contacts that have been listed on previous Designation forms in that the information in FloridaPA.org will be updated and the contacts listed above will replace,not supplement,the contacts on the previous list. REV 10-04-16 DISCARD PREVIOUS VERSIONS Attachment "D" page 2 of 2