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The undersigned represents that he/she is authorized to enter into this agreement for and on behalf of <br />the said Applicant. <br />Applicant: <br />Signature of Authorized Agent: <br />Printed Name of Authorized Agent: <br />Title: <br />Date: <br />Homeland Security Grant Program — 2016 Grant Assurances Page 11 of 11 <br />initials <br />