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Cal OES <br />GOVERNOR'S OFFICE <br />OF EMERGENCY SERVICES <br />Federal Funding Accounting and Transparency Act (FFATA) <br />Financial Disclosure <br />The undersigned represents that he/she is authorized to enter into this agreement for <br />and on behalf of the Applicant. <br />Subrecipient: <br />Signature of Authorized Agent: <br />Printed N me of Authorized Agent: <br />Tq Av" M <br />Title: T`t HA tJAe-, -A Date: 3 <br />Page 2 of 2 rev. August 2021 <br />