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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />DESIGNATION OF AUTHORITY (AGENTS) <br />FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />Sub -Grantee: Date: <br />Boz 7: Other(Read Only Access <br />Boz 8: 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 />Boz 9: Other (Read Only Access) <br />Boz 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 />Daytime Telephone <br />E-mail Address <br />E-mail Address <br />Boz 11: Other (Read Only Access) <br />Boz 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: 1st <br />Sub -Grantee's Federal Employer's Identification Number (EIN) 59 - 6000674 <br />Sub -Grantee's Grantee Cognizant Agency for Single Audit Purposes: Florida Division of Emergency Management <br />Sub -Grantee's: FIPS Number (If Known) 061 -99061 - 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 that have <br />been listed on previous Designation forms in that the information in FloridaPA.org will be updated and the contacts listed above will replace, not <br />supplement, the contacts on the previous list. <br />33 <br />