Orange County NC Website
Browse       Search
RES - 202M55 <br /> DESIGNATION OF APPLICANT ' S AGENT <br /> AND APPLICANT ASSURANCES <br /> FOR PUBLIC ASSISTANCE <br /> ORGANIZATION NAME (HEREAFTER NAMED ORGANIZATION) <br /> Orange County <br /> PRIMARY AGENT SECONDARY AGENT <br /> FAGENYT ' S NAME 71 AGENT ' S NAME <br /> Pascal Moore Sarah Pickhardt <br /> ORGANIZATION ORGANIZATION <br /> Finance and Administrative Services Emergency Services <br /> OFFICIAL POSITION OFFICIAL POSITION <br /> Accountant EOC Manager COVID - 19 <br /> MAILINGADDREsS405 Meadowlands Dr MAILINGADDRESS510 Meadowlands Dr <br /> CITY , STATE, Zip Hillsborough , NC 27278 CITY ' STATE, ZIP Hillsborough , NC 27278 <br /> DAYTIME TELEPHONE 919 -245 -2455 DAYTIME TELEPHONE 919 -245 -6138 <br /> FACSIMILE NUMBER FACSIMILE NUMBER <br /> PAGER OR CELLULARNUMBER PAGER OR CELLULAR NUMBER <br /> THE ABOVE PRIMARY AND SECONDARY AGENTS ARE HEREBY AUTHORIZED TO EXECUTE AND FILE APPLICATION FOR <br /> PUBLIC ASSISTANCE ON BEHALF OF THE ORGANIZATION FOR THE PURPOSE OF OBTAINING CERTAIN STATE AND FEDERAL <br /> FINANCIAL ASSISTANCE UNDER THE ROBERT T. STAFFORD DISASTER RELIEF & EMERGENCY ASSISTANCE ACT, (PUBLIC <br /> LAW 93 -288 AS AMENDED) OR OTHERWISE AVAILABLE. THIS AGENT IS AUTHORIZED TO REPRESENT AND ACT FOR THE <br /> ORGANIZATION IN ALL DEALINGS WITH THE STATE OF NORTH CAROLINA AND THE FEDERAL EMERGENCY MANAGEMENT <br /> AGENCY FOR MATTERS PERTAINING TO SUCH DISASTER ASSISTANCE REQUIRED BY THE AGREEMENTS AND ASSURANCES <br /> rmED ON THE SECOND ATTACHED PAGE. <br /> CHIEF FINANCIAL OFFICER CERTIFYING OFFICIAL <br /> 7 FOFFICiAL' SNANIE <br /> David Hunt <br /> ORGANIZATION ORGANIZATION <br /> Board of County Commisioners <br /> OFFICIAL POSITION OFFICIAL POSITION Deputy Clerk to the Board <br /> MAILING ADDRESS FMAtLINGDRESS <br /> CITY STATE, ZIP , ZIP <br /> DAYTIME TELEPHONE DAYTIME TELEPHONE <br /> 919 -245 -2126 <br /> FACSIMILE NUMBER FACSIMILE NUMBER <br /> PAGER OR CELLULAR NUMBER PAGER OR CELLULAR NUMBER <br /> APPLICANT' S STATE COGNIZANT AGENCY FOR SINGLE AUDIT PURPOSES (IF A COGNIZANT AGENCY IS NOT ASSIGNED, PLEASE INDICATE) : <br /> APPLICANT' S FISCAL YEAR (FY) START <br /> MONTH * DAY: <br /> APPLICANT' S FEDERAL EMPLOYER' S IDENTIFICATION NUMBER 3 r <br /> � �IVYt/YL.JI <br /> APPLICANT' S STATE PAYEE IDENTIFICATION NUMBER `•' <br /> CERTIFYING OFFICIAL ' S SIGNATURE <br /> 4/7/2020 North Carolina Division of Emergency Management - Designation of Applicant ' s Agent Page I of 2 <br />