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City of La Porte Police Department <br />STEP CMV 2020 <br />Texas Department Of Transportation - Traffic Safety <br />Electronic Signature Authorization Form <br />This form identifies the person(s) who have the authority to sign grant agreements and <br />amendments for the Grant ID listed at the bottom of the page_ <br />AuthorizingAuthority <br />The signatory of the Subgrantee hereby represents and warrants that she/he is an officer of <br />the organization for which she/he has executed this agreement and that she/he has full and <br />complete authority to enter into the agreement on behalf of the organization- I authorize the <br />person(s) listed under the section, "Authorized to Electronically Sign Grant Agreements and <br />Amendments" to enter into an agreement on behalf of the organization. <br />Name: <br />Title: <br />Signature: <br />Date: <br />6,, lo -eq <br />Under the authority of Ordinance or Resolution <br />Number (if applicable) : IZ-201q-15 <br />Authorized to Electronically Sign Grant Agreements and Amendments <br />List Subgrantee Administrators who have complete authority to enter into an agreement on <br />behalf of the organization. <br />il <br />C C+ i� ro fA <br />3. &ler 6-r,,r,4 e,- -9t-) 1,1-e g- <br />107 e -I -JI) 10rk e,-- OL V,�- <br />2020-LaPorte-S-CMV-00021 Printed On: 8/8/2019 Page 1 of 1 <br />