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
)
STATE OF CALIFORNIA
GOVERNOR’S OFFICE OF EMERGENCY SERVICES
Cal
OES
130
-
Instructions
Cal
OES
Form
1 30 Instructions
A Designation of Applicant’s Agent Resolution for Non
-
State Agencies is required
of all Applicants to be eligible to
receive funding.
A new resolution must be submitted if
a previously submitted Resol
ution is older than three (3) years
from the last date of approval, is invalid or has not been submitted.
When
co
m
p
leting
the
Cal
OES
Form
130,
Applicants
should
fill
i
n
the
blanks
on
page
1. The
blanks
are
to
be
filled
in
as
follows:
Resolution
Section:
Governing
B
o
d
y
:
This
is
t
h
e
gro
u
p
responsible
for
a
p
point
i
ng
and
approvi
n
g
the
Authorized Agents.
Exa
m
ples
include: Board
of
D
i
rectors,
City
Council,
Bo
a
rd
of
S
u
perv
i
sors,
Board of Education, etc.
Name of Applicant
:
The public entity
established under the laws of the State of California.
Examples include:
School
District, Office of Education, Ci
t
y
, Coun
t
y or
Non
-
profit
agenc
y
that
has
ap
p
lied
for
the
grant
, such as:
City
of
San Diego
,
Sacra
m
ento
Count
y, Burbank Unified School Dist
rict, Napa County Office of Education
, University Southern California
.
Authorized Agent
:
These
are
the
individuals
that
are
a
u
thorized
by
the
Governing
Body
to
eng
a
ge
with the Federal Emergency
Management Agency and
the
Governor’s Office of Emergency
Services
regarding
grants
applied
for
b
y
the
Applican
t.
There
are
t
w
o
wa
y
s
of
co
m
p
l
e
ting
this
section:
1 .
Titles
Onl
y
:
If
the
Governing
Body
so
c
hooses,
the
ti
t
les
of
the
Authorized
Agents
w
ould
be entered
here,
not
their
names.
This
allows
the
do
c
u
m
ent
to
re
m
a
in
valid
(for 3 years)
if
an
Au
t
horized
Agent leaves
the
position
and
is
r
e
placed
by
another
individual in the same title
.
If
“Titles
Only”
is
the
chosen
method,
this docu
m
ent
must
be
accompanied
by
a
c
over
letter
naming
the
Au
t
horized
Agents
by
na
m
e
a
n
d
title.
This
cover
letter
can
b
e
c
o
m
p
leted
by
any
a
u
t
ho
r
ized
person
within
the
agency
and
does
not
require
t
h
e
Governing Bo
d
y
’s
signa
t
u
re.
2 .
Names
and
Titles:
If
the
Governing
Body
so
cho
o
ses,
the
names
a
n
d
titles
of
the
Authorized
Agents
would
be
listed.
A
new
Cal
OES
Form
1 30
will be required
if
any
of
t
h
e
Authorized
Agents
are replaced,
leave
the
position
listed
on
the
document or their title changes.
Governing Body
Representativ
e
:
These
are
the
na
m
e
s
and
titles
of
the
approv
i
ng
B
oard
M
e
mbers.
Exa
m
ples include
:
Chai
r
m
an
o
f
the
Board,
Director,
Superintendent,
etc.
The names and titles
cannot
be
one
of the
designated Autho
r
ized Agents, and a minimum of
two or more
approving board members need to be listed.
Certification
Section:
Name and
Titl
e
:
This
is
the
indiv
i
dual
that
was
in
attendance
and
recorded
the
Resolution
creation
and
approval.
Exa
m
ples
i
nclude:
Ci
t
y
Clerk,
Secretary
to
the
B
o
ard
of
Directors,
Coun
t
y
Clerk,
etc.
This
person
can
n
o
t
be
one
of
the
designated
Authorized
Agents
or Approving Board Member (if a person holds two positions such as City Manager and Secretary to the Board and the City Manager is to be listed as an Authorized Agent, then the same person holding the
Secretary position would sign the document as S
ecretary to the Board (not City Manager)
to
eli
m
i
n
ate
“Self
C
e
rtification.”
Pa
g
e 2
Cal
OES
130 (
Rev.
9 /13
)