STATE OF CALIFORNIA
GOVERNOR’S OFFICE OF EMERGENCY SERVICES
Cal
OES
130
Cal
OES
ID No:
______________________
DE
S
IG
N
A
T
ION OF
APPLI
C
ANT
'
S
AGE
N
T
R
ESOLU
T
I
O
N
FOR N
O
N
-
STATE
A
G
EN
C
IES
B
E IT
RESOL
V
E
D
B
Y
TH
E
OF
TH
E
(Gover
n
ing
Bod
y
)
(N
a
m
e
of
Applicant)
T
H
AT
,
OR
(Title
of
Authoriz
e
d
Agent)
,
OR
(Title
of
Authoriz
e
d
Agent)
(Title
of
Authoriz
e
d
Agent)
is
h
ere
b
y a
u
thorized
t
o
e
x
ec
u
t
e f
o
r and
on
b
e
h
alf
o
f t
h
e
, a
p
ub
lic entity
(N
a
m
e
of
Applic
an
t
)
esta
b
lis
h
ed un
d
er t
h
e laws
o
f t
h
e
State
o
f
C
alif
o
r
n
ia,
t
h
is a
p
p
lication
a
n
d
to
file it
with t
h
e
California
Governor’s Office of Emergency
Services
f
o
r
t
h
e
pu
r
p
o
se
o
f ob
t
a
i
n
i
ng cer
tai
n
f
e
deral
f
i
n
an
c
i
al ass
i
s
t
ance
u
n
d
e
r
P
ublic Law
9 3
-
2 8
8 a
s a
m
end
e
d
by
t
h
e
R
o
be
r
t T.
S
t
a
ff
o
r
d
D
i
saster
Relief
and
E
m
er
g
ency Assista
n
ce Act
o
f 19
8 8, a
n
d
/
or state
fin
a
n
c
ial assistance
und
e
r
t
h
e California
Disaster Assistance
Ac
t
.
T
H
AT t
h
e
_________________________
______________________
_
, a
p
ub
l
i
c e
n
tity est
a
b
lis
h
e
d
u
n
d
er t
h
e
laws
o
f
t
h
e State
o
f Calif
o
r
n
i
a,
(N
a
m
e
of
Applic
an
t)
h
e
re
b
y a
u
th
o
r
i
zes its a
g
e
n
t(s) to
p
r
o
v
ide
t
o
t
h
e
Governor’s Office of Emergency Services
for all
m
a
tters perta
i
ning to
s
u
ch state disaster
a
s
sistance the
as
s
u
r
a
nces and
a
g
re
em
ents requir
ed
.
Please check the appropriate box below
:
This is a universal resolution and is effective for all open and future disasters up to three (3) years following the date of approval be
low.
This is a disaster specific resolution and is effective for only disaster number(s) ________________________ Passe
d
an
d
app
r
o
v
e
d
t
h
i
s
d
ay
o
f
,
2 0
(N
a
m
e
and
T
itle
of
Gover
n
ing
Body
Representative)
(N
a
m
e
and
T
itle
of
Gover
n
ing
Body
Representative)
(N
a
m
e
and
T
itle
of
Gover
n
ing
Body
Representative)
CERTIFI
C
A
TI
ON
I,
,
du
l
y
ap
po
i
n
te
d
an
d
o
f
(N
a
m
e)
(Titl
e
)
,
do he
r
e
b
y ce
r
ti
f
y that t
h
e abo
v
e is
a t
ru
e
and
c
o
rrect c
op
y
of
a
(N
a
m
e
of
Applic
an
t)
R
e
s
o
l
u
ti
o
n
p
asse
d
a
n
d
app
r
o
v
e
d
b
y
t
h
e
o
f
t
h
e
(Gover
n
ing
B
od
y
)
(N
a
m
e
of
Applicant)
o
n
t
h
e
d
ay
o
f
,
2 0
.
(Titl
e
)
Pa
g
e 1
(Signature)
Cal
OES
130 (
Rev.
9 /13
)