Laserfiche WebLink
Attachment A <br />FY05 Homeland Security Grant Program <br />Application Cover Sheet for Cities with UASI and MMRS Allocations (Page 1 of 2) <br />Applicant (city) <br />Authorized Agent Information: <br />Mailing Address <br />City, State, Zip Code <br />Maximum Amount Authorized (from Appendix A) <br />UASI Amount Requested $ <br />MMRS Amount Requested $ <br />Total Amount Requested (from ISIP) <br />Total Equipment Amount Requested for all Programs <br />From ISIP <br />From Equipment Worksheet <br />Contact Information: <br />Name/Title <br />Area Code /Office Telephone <br />E -Mail Address <br />Statement of Certification - City Authorized Agent - UASI and MMRS <br />By signing below, 1 hereby certify that I am the duly appointed Authorized Agent and have the authority to <br />apply for the FY 2005 Homeland Security Grant Program, and the City's application represents the needs for <br />the Urban Areas Security Initiative and Metropolitan Medical Response System program. <br />Signature of Authorized Agent Printed Name <br />Title <br />Date <br />FY05 Homeland Security Grant Program Page <br />