Loading...
087-19 - Department of Enterprise Services - ContractIV V AUTHORIZED REPRESENTATIVES LEGAL NAME & MAILING ADDRESS OF APPLICANT ORGANIZATION: City of Port Orchard Name of Organization 216 Prospect Street,Port Orchard, WA Mailing Address same as mailing addresss Street Address/Location (If different from mailing address) Kitsap County (360) 876-4407 Telephone Number Federal Tax ID Number (TIN) 91-6001487 98366 Zip (360)895-9029 Email Address brinearson@cityofportorchard.us THE FOLLOWING REPRESENTATIVES ARE DESIGNATED TO: MAcquire Federal Property 1-11/ Acquire State Property; By signing below each representative confirms they have read the terms and conditions involved with Federal Guidelines and agree to fulfill them. Certifying Officials must keep their lists up to date and Surplus Operations is not responsible for the actions of outdated personnel. �✓ NEW DESIGNATIONS ADDITIONAL DESIGNATIONS ONLY (Delete all previous authorizations) (Add to previous authorization) REPRESENTATIVES: Name/Title Matt Brown, Police Chief Email Address m brown @cityofportorchard. us Brandy Rinearson, City Clerk brinearson@cityofportorchard.us Marc Fournier Public Works Employee mfournier@cityofportorchard.us Tony Lang, Operations Manager tlang@cityofportorchard.us Chris Esguerra, Public Works Foreman cesguerra@cityofportorchard.us Dale Schuster, Deputy Police Chief dschuster@cityofportorchard. CERTIFICATION 12/17/201 c Date Signature of Your Certifying Official Title Signature STATE OF WASHINGTON SURPLUS OPERATIONS APPLICATION FOR ELIGIBILITY I. LEGAL NAME AND MAILING ADDRESS OF APPLICANT ORGANIZATION: Vame of Organi. alion Federal ID Number (TIN) City of Port Orchard 91-6001487 'Fame of Executive Director h.-mail. Id(hvss Telephone Number Robert Putaansuu brinearson@cityofportorchard.us (360) 876-4407 t kiilin� r ('antuci l:-,nail Addres.� Comm, Brandy Rinearson brinearson@cityofportorchard.us Kitsap I lailing Address Zip Code 216 Prospect Street,Port Orchard, WA 98366 II. APPLICANT STATUS: IPublicAgency III. TYPE OF ORGANIZATION: Local Other IV. PROVIDE A WRITTEN DESCRIPTION OF PROGRAMS, SERVICES OFFERED, FACILITIES OPERATED AND A LIST OF MATERIALS YOU WISH TO PROCURE. Vehicles for police and public works department and equipment for police and public works department. V. SOURCE OF FUNDING: (You may be asked to attach supporting documentation) Tax Supported VI. HAS THE ORGANIZATION BEEN DETERMINED TO BE TAX-EXEMPT UNDER SECTION 501 OF THE INTERNAL REVENUE CODE OF 1954? IF YES CONFIRMATION LETTER FROM IRS IS REQUIRED. No VII. IS THE ORGANIZATION APPROVED, ACCREDITED OR LICENSED? IF YES, COPY IS REQUIRED. ELIGIBILITY WILL ALSO BE CONTINGENT TO LICENSE BEING CURRENT. If YES, BY WHAT AUTHORITY? N/A Date Signature of Authorized Official 12/17/2019 *************************FOR STATE AGENOVUSE ONLY******************************* Eligibility: [ ] Eligible for Federal & State [ ] Conditionally Eligible [ ] Eligible for State ONLY [ ] Eligible for Federal ONLY Organization Approved As: 3040: Date Surplus Program Manager Eligibility Expires Non -Discrimination Certification LEGAL NAME & MAILING ADDRESS OF APPLICANT ORGANIZATION: City of Port Orchard Name of Organization 216 Prospect Street,Port Orchard, WA Mailing Address (PO Box #, Street, City & State) same as mailing addresss Street Address/Location (If different from mailing address) Zip Code Kitsap (360) 876-4407 (360) 895-9029 County Telephone Number Fax Number The "Donee" hereby agrees that the program for or in connection with which any property is donated will be conducted in compliance with, and the donee will comply with and will require any other person (any legal entity) who, through contractual or other arrangements with the donee, is authorized to provide services or benefits under said program to comply with, all requirements imposed by or pursuant to the regulations of the General Services Administration (41 CFR 101-6.2) issued under the provisions of Title VI of the Civil Rights Act of 1964, Section 606 of Title VI of the Federal Property and Administration Services Act of 1949, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, Title IX of the Education Amendments of 1972, as amended, and Section 303 of the Age Discrimination Act of 1975, to the end that no person in the United States shall, on the ground of race, color, natural origin, sex or age, or that no otherwise qualified handicapped person shall solely by reason of the handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which -the donee received Federal Assistance from the General Services Administration, and hereby gives assurance that it will immediately take any measures necessary to effectuate this agreement. The donee further agrees that this agreement shall be subject in all respects to the provisions of said regulations, that this agreement shall obligate the donee or the period during which it retains ownership or possession of any such property, that the United States shall have the right to seek judicial enforcement of this agreement, and this agreement shall be finding upon any successor in interest of the donee and the word "donee" as sued herein includes any such successor in interest. 12/17/2019 Date 't, 4:f::) - --- (Signature of ALkhorized Official) M(�N- Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion For Lower Tier Covered Transactions LEGAL NAME & MAILING ADDRESS OF APPLICANT ORGANIZATION: City of Port Orchard Name of Organization 216 Prospect Street,Port Orchard, WA Mailing Address (PO Box #, Street, City & State) Street Address/Location (If different from mailing address) Kitsap County (360) 876-4407 Telephone Number * * * * * (Please Check One) * * * * * 98366 Zip Code Fax Number The Applicant Organization certifies, by submission of this application, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from: 7 Participation in this transaction by any Federal department agency F] The Applicant Organization is unable to certify any of the statements in this certification and shall attach an explanation to this proposal. Additionally, signing below certifies that the Applicant Organization must immediately notify Washington State Surplus Operations if there is any change to the status of eligibility with any Federal department agency, regardless of reason. 12/17/2019 Date (SignatureM(t�Df of Au horized Official) TERMS AND CONDITIONS (A) THE DONEE CERTIFIES THAT: (1) It is a public agency or a nonprofit institution or organization exempt from taxation under Section 501 of the Internal Revenue Code of 1954 within the meaning of Section 2030) of the Federal Property and Administrative Services Act of 1949, as amended, and the regulations of the Administrator of General Services. (2) If a public agency, the property is needed and will be used by the recipient for carrying out or promoting for the residents of a given political area one or more public purposes, or, if a nonprofit, tax-exempt institution or organization, the property is needed for and will be used by the recipient for educational or public health purposes, including research for such purpose, or for programs for older individuals. The property not being acquired for any other use or purpose, or for sale or other distribution, or for permanent use outside the State, except with prior approval of the State Agency. (3) Funds are available to pay all costs and charges incident to donation. (4) This transaction shall be subject to the nondiscrimination regulations governing the donation of surplus personal property issued under Title VI of the Civil Rights Act of 1964, Section 606 of Title VI of the Federal Property and Administrative Services Act of 1949, Title IX of the Education Amendments of 1972, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, and Section 303 of the Age Discrimination Act of 1975. (B) THE DONEE AGREES TO THE FOLLOWING FEDERAL CONDITIONS: (1) All types of property shall be placed in use for the purpose(s) for which acquired within one year of receipt and shall be continued in use for such purpose(s) for one year from the date the property was placed in use. In the event the property is not so placed in use, or continued in use, the donee shall immediately notify the State agency and, at the donee's expense, return such property to the State agency or otherwise make the property available for transfer or other disposal by the State agency, provided the property is still usable as determined by the State agency. (2) Such special handling or use limitations as are imposed by General Services Administration (GSA) on any item(s) of property listed hereon. (3) In the event the property is not so used or handled as required by (B) (1) and (2), title and right to the possession of such property shall at the option of GSA revert to the United States of America and upon demand the donee shall release such person as GSA or its designee shall direct. (C) THE DONEE AGREES TO THE FOLLOWING CONDITIONS IMPOSED BY THE STATE AGENCY. APPLICABLE TO ITEMS WITH A UNIT ACQUISITION COST OF $5,000 OR MORE AND PASSENGER MOTOR VEHICLES, REGARDLESS OF ACQUISITION COST, EXCEPT VESSELS 50 FEET OR MORE IN LENGTH AND AIRCRAFT. (1) The Property shall be used only for the purpose(s) for which acquired and for no other purpose(s). (2) There shall be a period of restriction which will expire after such property has been used for the purpose(s) for which acquired for a period of 18 months from the date the property is placed in use, except for such items of major equipment, listed hereon, on which the state agency designates a further period of restriction. (3) In the event the property is not so used as required by (C) (1) and (2) and Federal restrictions (B) (1) and (2) have expired, then the title and right to the possession of such property shall at the option of the State agency revert to the State of Washington and the donee shall release such property to such person as the State agency shall direct. (D) THE DONEE AGREES TO THE FOLLOWING TERMS, RESERVATIONS, AND RESTRICTIONS: (1) From the date it received the property listed hereon, and through the period(s) of time the conditions imposed by (B) and (C) above remain in effect, the donee shall not sell, trade, lease, bail, cannibalize, encumber or otherwise dispose of such property, or remove it permanently for use outside the State, without prior approval of GSA under (B) or the State agency under (C). The proceeds from any sale, trade, loan, bailment, encumbrance, or other disposal of the property, when such action is authorized by GSA or by the State agency, shall be remitted by the donee to GSA or the State agency, as the case may be. (2) In the event any of the property listed hereon is sold, traded, leased, loaned, bailed, cannibalized, encumbered, or otherwise disposed of by the donee from the date it receives the property through the period(s) of time the conditions imposed by (B) and (C) remain in effect, without the prior approval of GSA or the State agency, the donee, at the option of GSA or the State agency shall pay to GSA or the State agency, as the case may be, the proceeds of the disposal or the fair market value or the fair rental value of the property at the time of such disposal, as determined by GSA or the State agency. (3) If at any time, from the date it received the property through the period(s) of time the conditions imposed by (B) and (C) remain in effect, any of the property listed hereon is no longer suitable, usable, or further needed by the donee for the purposes(s) for which acquired, the donee shall promptly to the State agency, lease the property to another donee or another State agency, department, or agency of the United States, sell or otherwise dispose of the property. The proceeds from any sale shall be remitted promptly by the donee to the State agency. (4) The donee shall make reports to the State agency on the use, condition, and location of the property listed hereon, and on other pertinent matters as may be required from time to time by the State agency. (5) At the option of the State agency, the donee may abrogate the conditions set forth in (C) and the terms, reservations, and restrictions pertinent thereto in (D) by payment of an amount as determined by the State agency. (E) THE DONEE AGREES TO THE FOLLING CONDITIONS, APPLICABLE TO ALL ITEMS OR PROPERTY LISTED HEREON. (1) The property acquired by the donee is on an "as is, where is" basis, without warranty of any kind. (2) Where a donee carries insurance against damages to or loss of property due to fire or other hazards and where loss of or damage to donated property with unexpired terms, conditions, reservations, or restrictions occurs, the State agency will be entitled to reimbursement from the donee out of the insurance proceeds of an amount equal to the unamortized portion of the fair value of the damaged or destroyed donated items. (F) TERMS AND CONDITIONS APPLICABLE TO THE DONATION OF AIRCRAFT AND VESSELS (50 FEET OR MORE IN LENGTH) HAVING AN ACQUISITION COST OF $5,000 OR MORE, AND OTHER ITEMS OF PROPERTY REQUIRING SPECIAL HANDLING OR USE LIMITATIONS, REGARDLESS OF THE PURPOSE FOR WHICH ACQUIRED: The donation shall be subject to the terms, conditions, reservations and restrictions set forth in the Conditional Transfer Document executed by the authorized donee representative. Definitions ACCREDITED: Approved by a recognized accrediting board/association on a regional, state or national level. ADULT DAY CARE: A program of services provided under health leadership in an ambulatory care setting for adults who do not require 24-our institutional care and yet, due to physical and/or mental impairment, are not capable of full-time independent living. Participants in the day care program are referred to the program by their attending physician or by some other appropriate source such as an institutional discharge planning program, a welfare agency, etc. The essential elements of a day care program are directed toward meeting the health and maintenance and restorative needs of participants. APPROVED: Recognition and approval by the State Department of Education, State Department of Health or other appropriate authority exists for the purpose of making an accreditation. For an education institution or an educational program, approval must relate to academic or instructional standards established by the appropriate authority. An educational institution or program may be considered approved it its instruction and credits are accepted by three accredited or state -approved institutions, or if it meets the academic or instructional standards prescribed for public schools in the state; i.e., the organizational entity or program is devoted primarily to approved academic, vocational (including technical or occupational) or professional study and instruction, which is operated primarily for educational purposes by a full-time staff of qualified instructor. For a public health institution or program, approval must relate to the medical requirements and standards for the professional and technical services of the institution established by the appropriate authority. A health institution or program may be considered as approved when a state body having authority under law to establish standards and requirements for public health institutions renders approval thereto whether by accreditation procedures or licensing or such other method proscribed by state law. in the absence of an official state approving authority for a public health institution or program or educational institution or program, the awarding of research grants to the institution or organization by a recognized authority may constitute approval. CHILD CARE CENTER: A public or nonprofit facility where educational, social, health and nutritional services are provided to children through age 14 or as prescribed by state law, and which is approved or licensed by the state or other appropriate authority as a child day care center. CLINIC: An approved public or nonprofit facility organized and operated for the primary purpose of providing outpatient public health services. COLLEGE: An approved or accredited public or nonprofit institution of higher learning offering organized study courses and credits leading to baccalaureate or higher degree. ECONOMIC DEVELOPMENT: A program carried out or promoted by a public agency for public purposes which involves, directly or indirectly, efforts to improve the opportunities of a given political area for the successful establishment or expansion of industrial, commercial or agricultural plants or facilities and which otherwise assists in the creation of long term employment opportunities in the area or primarily benefits the unemployed or those with low incomes. EDUCATIONAL INSTITUTION: An approved, accredited or licensed public or nonprofit institution, facility, entity or organization conducting educational programs. EDUCATIONAL RADIO STATION: A radio station licensed by the Federal Communications Commission and operated exclusively for noncommercial educational purposes and which is public or nonprofit and tax- exempt under Section 501 of the Internal Revenue Code of 1954. EDUCATIONAL TELEVISION STATION: A television station licensed by the Federal Communications Commission and operated exclusively for noncommercial educational purposes and which is public or nonprofit and tax-exempt under Section 501 of the Internal Revenue Code of 1954. FEDERAL FINANCIAL ASSISTANCE: Aid provided by a federal agency in the form of grants, contracts, cooperative agreements, loans, loan guarantees, property, interest subsidies, insurance or direct appropriations, but not including direct federal cash assistance to individuals. It includes awards received directly from federal agencies or indirectly through other units of state and local government. HEALTH CENTER: An approved public or nonprofit facility utilized by a health unit for the provision of public health services. HOSPITAL: An approved or accredited public or nonprofit institution providing public health services primarily for inpatient medical or surgical care of the sick and injured, including related facilities such as laboratories, outpatient departments, training facilities and staff offices. LIBRARY: A public or nonprofit facility providing library services free to all residents of a community, district, state or region. LICENSED: Recognition and approval by the appropriate state or local authority approving institutions or programs in specialized areas. Licensing generally relates to established minimum public standards of safety, sanitation, staffing and equipment as they relate to the construction, maintenance and operation of a health or educational facility, rather than to the academic, instructional or medical standards for these institutions. Licensing may be required for educational or public health programs such as occupational training, physical or mental health rehabilitation services or nursing care. Licenses must be renewed periodically. LOCAL GOVERNMENT: A government or administration of a locality within a state or possession of the US. MEDICAL INSTITUTION: An approved, accredited or licensed public or nonprofit institution, facility, entity or organization the primary function of which is the furnishing of public health and medical services to the public at large or promoting public health through the conduct of research for any such purposes, experiments, training or demonstrations related to cause, prevention and methods of diagnosis and treatment of diseases and injuries. The term includes but is not limited to hospitals, clinics, alcoholic and drug abuse treatment centers, public health or treatment centers, research and health centers, geriatric centers, laboratories, medical schools, nursing schools and similar institutions. The term does not include institutions primarily engaged in domiciliary care, although a separate medical facility within such a domiciliary institution may qualify as a "medical institution". MUSEUM: A public or private nonprofit institution which is organized on a permanent basis essentially for educational or esthetic purposes and which, using a professional staff, owns or uses tangible objects, whether animate or inanimate; cares for these objects; and exhibits them to the public on a regular basis (a minimum of 1000 hours) either free or for a nominal charge. The term "museum" includes, but is not limited to, the following institutions, if they satisfy all other provisions of federal regulations: aquariums and zoological parks, botanical gardens and arboretums, museums relating to art, history, natural history, science and technology and planetariums. An institution uses a professional staff if it employs full time at least one qualified staff member who devotes his or her time primarily to the acquisition, care or public exhibition of objects owned or used by the institution. This definition does not include any institution which exhibits objects to the public if the display or use of the objects is only incidental to the primary function of the institution. NONPROFIT TAX-EXEMPT ACTIVITY: An institution or organization, no part of the net earnings of which inures or may lawfully insure to the benefit of any private shareholder or individual, and which has been held to be tax-exempt under the provisions of Section 501 of the Internal Revenue Code of 1954. PROGRAM FOR OLDER INDIVIDUALS: Any state or local government agency or any nonprofit, tax- exempt activity which receives funds appropriated for programs for older individuals under the Older Americans Act of 1965, as amended, under Titles IV or XX of the Social Security Act, or under Titles VIII and X of the Economic Opportunity Act of 1964 and the Community Services Block Grant Act. PROVIDER OF ASSISTANCE TO THE HOMELESS: A public agency or a nonprofit, tax-exempt institution or organization that operates a program which provides assistance such as food, shelter or other services directly to homeless individuals. The term "homeless individual" means an individual who lacks a fixed, regular and adequate nighttime residence, or who has a primary nighttime residence that is (1) a supervised public or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelter and traditional housing for the mentally ill); (2) an institution that provides a temporary residence for individuals intended to be institutionalized; or (3) a public or private place not designed for, or ordinarily not used as a regular sleeping accommodation for human beings. For purposes of this regulation, the term does not include any individual imprisoned or otherwise detained pursuant to an Act of the Congress or state law. Property acquired through the donation program by such institutions or organizations must be used primarily in their program for providing assistance to homeless individuals. PROVIDER OF ASSISTANCE TO IMPOVERISHED FAMILIES AND INDIVIDUALS: A public or private nonprofit, tax-exempt organization whose primary function is to provide money, goods or services to families or individuals whose annual incomes are below the poverty line as defined in section 673 of the Community Services Block Grant Act (42 U.S.C. 9902). Providers include food banks, self-help housing groups and organizations providing services such as the following: health care; medical transportation; scholarships and tuition assistance; tutoring and literacy instruction; job training and placement; employment counseling; child care assistance; meals or other nutritional support; clothing distribution; home construction or repairs; utility or rental assistance and legal counsel. PUBLIC AGENCY: Any state, political subdivision thereof (including any unit of local government or economic development district) or any department, agency, instrumentality thereof (including instrumentalities created by compact or other agreement between states or political subdivisions), or any Indian Tribe, band, group, pueblo or community located on a state reservation. PUBLIC HEALTH INSTITUTION: An approved, accredited or licensed public or nonprofit institution, facility, or organization conducting a public health program such as a hospital, clinic, health center or medical institution, including research for any such program, the services of which are available to the public at large. PUBLIC PURPOSE: A program or programs carried out by a public agency which are legally authorized in accordance with the laws of the state or political subdivision thereof and for which public funds may be expended. Public purposes include but are not limited to programs such as conservation, economic development, education, parks and recreation, public health and public safety. PUBLIC SAFETY: A program or programs carried out or promoted by a public agency for public purposes involving directly or indirectly the protection, safety, law enforcement activities and criminal justice system of a given political area. Public safety programs may include but are not limited to those carried out by public police department, sheriff's offices, the courts, penal and correctional institutions including juvenile facilities, state and civil defense organizations, fire departments and rescue squads, including volunteer fire departments and rescue squads supported in whole or in part with public funds. SCHOOL: A public or nonprofit approved or accredited organizational entity devoted primarily to approved academic, vocational or professional study and instruction which operates primarily for educational purposes on a full-time basis for a minimum school year and employs a full-time staff of qualified instructors. SERVICE EDUCATIONAL ACTIVITY (SEA): Any educational activity designated by the Secretary of Defense as being of special interest to the armed services. The term include maritime academies; or military, naval, Air Force or Coast Guard preparatory schools; junior colleges & institutes; senior high school -hosted Junior Reserve Officer Training Corps; and nationally organized youth groups such as Boy Scouts, Girl Scouts & Little League, whose primary purpose is to offer courses of instruction devoted to the military arts and sciences. UNIVERSITY: A public or nonprofit approved and accredited institution for instruction and study in the higher branches of learning and empowered to confer degrees in special departments or colleges. Want List Name and Address of requesting agency: Date: Contact Person: Phone Number: Brandy Rinearson From: McLane, Angie (DES) <angie.mclane@des.wa.gov> Sent: Tuesday, October 08, 2019 12:34 PM To: Brandy Rinearson Subject: Eligibility application Attachments: Application Forms 20170616.pdf; Fed Instructions 20170111.doc Here is the application. Please complete and return to me. This will allow you to update your list. Here is who is currently on file as authorized shoppers. Matthes, Timothy C. - Mayor (Certifying Official) Cookson, Jay - Public Works Supervisor Fournier, Marc - Public Works Employee Marti, Geoffrey - gmarti@cityofportorchard.us Phipps, Donna - Public Works Office Manager Rinearson, Brandy- City Clerk Thompson, George - Public Works Angela McLane Program Specialist 2 Surplus Operations I Department of Enterprise Services 360.407-1922 1 angela.mclane@des.wa.gov Available by email: Monday — Friday 7:30-4:00 Federal Surplus Property Program Application for Eligibility Instructions (Please type or print in blue or black ink only) SECTION I: Provide the Federal Identification Tax number for your organization and the full legal name of your organization on the first line of this section. Provide the name of the chief executive officer of the organization and a telephone number at which s/he may be reached, along with your fax number, if you have one. Complete the mailing address of your organization as recognized by the US Postal Service, including the zip code. Provide the street address if different from the mailing address. List the county, business telephone number and e-mail address, if available. SECTION II: Check the appropriate box that describes your organization. If you are unable to determine which status to check, please contact this office for assistance or refer to the definitions attached. SECTION III: Check the appropriate box(es), as many as apply, which indicate the type or purpose of your organization. Definitions have been provided to assist in making this determination. SECTION IV: PLEASE SUBMIT THE FOLLOWING ON YOUR LETTERHEAD: A comprehensive written description of all programs or services provided is required. A description of the operational facilities should also be included. Be sure to include information on staff and staff qualifications, hours of operation, services and programs offered, population or enrollment, fees charged, etc. Include samples of pamphlets, catalogs, brochures or posters. If incorporated, include a complete copy of Articles of Incorporation with all filing certificates and amendments, and a copy of your current by-laws. If your organization is an authority, please include a reference to the Act of Law under which you were created. If you are a volunteer fire or rescue company, please include a written resolution or agreement with your municipality stating that they provide your organization with funding and recognize you as an integral part of their public safety or health program. If your organization is a provider of assistance to the homeless or impoverished: Please submit a detailed narrative description of your program, services or activities, including your hours of operation. If you are operating primarily as a food bank or soup kitchen, include a statement certifying that the majority of the individuals you serve are homeless. If you are operating primarily as a shelter, indicate how many individuals you serve on an annual basis. Also, submit evidence from a local elected official that your organization is a publicly recognized provider of assistance to the homeless or impoverished. Evidence can take the form of a letter or statement from the mayor of your city, or a letter or statement from a local public organization such as the Welfare Office or Social Security. SECTION V: Check the appropriate box that indicates the organization's sources of funding. Supporting documentation indicating the types and amounts of funding must be submitted with the completed application. SECTION VI: All applicants making application as "nonprofit, tax-exempt organizations" must provide a copy of the IRS determination letter indicating tax exemption under Section 501 of the IRS Tax Code of 1954. The name and address of the organization on the IRS letter must match the name provided in Section I of this application. If not, include sufficient evidence such as amendments to Articles of Incorporation or Assumed Name filing certificates to establish an "audit trail" of names showing the legal corrections. SECTION VII: All applicants making application, as "nonprofit, tax-exempt organizations" are required to submit evidence that the applicant is currently approved, accredited or licensed. Programs for older individuals must include evidence of funding under the Older Americans Act of 1965; Titles IV or XX of the Social Security Act; Titles VIII and X of the Economic Development Act of 1964; or the Community Services Block Grant Act. AUTHORIZED REPRESENTATIVE: The CEO designated individuals to be responsible to acquire Federal Surplus Property, obligate necessary funds for this purpose and execute Distribution Documents. Names and titles must be completed with each individual's signature. SIGNATURE/DATE: Annotate the date and provide an original signature of applicant's CEO.