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12 <br />Designation of Agent Form <br />As County Manager of Orange County I designate the following <br />person: <br />Name: <br />Title: <br />Address: <br />City & Zip: <br />Telephone: <br />Fax: <br />Nick Waters <br />Emergency Management Director <br />P.O. Box 8181 <br />Hillsborough 27278 <br />919-968-4066 <br />Email: nwatersCco.oranae.nc.us <br />to be my Designated Agent for the DHS FY2003 SHSCP Part 11. The above-listed person may <br />sign and submit documents related to this grant. <br />Restrictions (If none, write none): <br />None <br />NCEM recommends that the County Emergency Manager be identified as the Designated <br />Agent. <br />DHS FY2003 SHSGP Part H Annex B: Subgrant Forms 2 of 7