HomeMy WebLinkAboutWashington State Military Department ILA for All Hazards Alert Broadcast (AHAB) Siren Agreement Face SheetHas the original contract boilerplate language been modified? Yes No
If yes, specify which sections have been modified:
Description
of Services:
Type of Contract: (GR) Grants (I) Intergovernmental Agreement (L) Lease Agreement
Project/Bid/RFP No:
(S) Purchase of Services (W) Public Works (O) Other
Effective Date: Completion Date:
Originator: Routed by:
Department/Division: Date:
Name of Consultant/Contractor:
CONTRACT TITLE:
Total Amount of Contract:
Budget # Amount: Budget # Amount:
Budget # Amount: Budget # Amount:
Budget # Amount: Budget # Amount:
Are there sufficient funds in the current budget to cover this contract? Yes No
Remarks:
Authorization Level:
Project Manager
Risk Management/Budget
City Attorney
Consultant/Contractor
Other
City Council Approval Date (if applicable)
Mayor
City Clerk
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CONTRACT ROUTING FORM
No.
(City Clerk Use Only)
1/17/2023
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION DATE SUBMITTED
City of Edmonds 01/10/2023
PROJECT DESCRIPTION CONTRACT NUMBER
All Hazards Alert Broadcast (AHAB) Siren E22-168 Revised
AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
o v~
Charles Wallace Safety & Disaster Coordinator
2.AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
Charles Wallace Safety & Disaster Coordinator
Mike Nelson Mayor
3.AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE p4 PRINT OR TYPE NAME TITLE
Charles Wallace Safety & Disaster Coordinator
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