HomeMy WebLinkAbout- - Cal EMA 130 Form - 6/5/2012STATE OF CALIFORNIA Disaster No:
CALIFORNIA EMERGENCY MANAGEMENT AGENCY Cal EMA ID No:
Cal EMA 130
DESIGNATION OF APPLICANT'S AGENT RESOLUTION
FOR NON -STATE AGENCIES
BE IT RESOLVED BY THE
OF THE
(Governing Body) (Name of Applicant)
THAT ,OR
(Title of Authorized Agent)
OR
(Title of Authorized Agent)
(Title of Authorized Agent)
is hereby authorized to execute for and on behalf of the , a public entity
(Name of Applicant)
established under the laws of the State of California, this application and to file it with the California Emergency Management Agency for
the purpose of obtaining certain federal financial assistance under Public Law 93-288 as amended by the Robert T. Stafford Disaster Relief
and Emergency Assistance Act of 1988, and/or state financial assistance under the California Disaster Assistance Act.
THAT the a public entity established under the laws of the State of California,
(Name of Applicant)
hereby authorizes its agent(s) to provide to the California Emergency Management Agency for all matters pertaining to such state disaster
assistance the assurances and agreements required.
Please check the appropriate box below:
This is a universal resolution and is effective for all open and futures disasters up to three (3) years following the date of approval below.
This is a disaster specific resolution and is effective for only disaster number(s)
Passed and approved this day of
I,
(Name)
20
(Name and Title of Governing Body Representative)
(Name and Title of Governing Body Representative)
(Name and Title of Governing Body Representative)
CERTIFICATION
duly appointed and
(Title)
of
, do hereby certify that the above is a true and correct copy of a
(Name of Applicant)
Resolution passed and approved by the
(Governing Body)
on the day of , 20.
(Signature)
Cal EMA 130 (Rev.4/11) Page 1
of the
(Name of Applicant)
(Title)
STATE OF CALIFORNIA
CALIFORNIA EMERGENCY MANAGEMENT AGENCY
Cal EMA 130 - Instructions
Cal EMA Form 130
Instructions
A new Designation of Applicant's Agent Resolution for Non -State Agencies is required if the previously submitted
document is older than three (3) years from the last date of approval.
When completing the Cal EMA Form 130, Applicants should fill in the blanks on page 1. The blanks are to be filled in as
follows:
Resolution Section:
Governing Body: This is the individual or group responsible for appointing and approving the Authorized
Agents. Examples include: Board of Directors, City Council, Board of Supervisors, etc.
Name of Applicant: This is the official name of the non-profit, agency, city, or county that has applied for the grant.
Examples include: Sacramento Public Water Works; City of Sacramento; or Sacramento County.
Authorized Agent: These are the individuals that are authorized by the Governing Body to engage with the Federal
Emergency Management Agency and the California Emergency Management Agency regarding grants applied for by the
Applicant. There are two ways of completing this section:
1. Titles Only: If the Governing Body so chooses, the titles of the Authorized Agents should be entered here, not
their names. This allows the document to remain valid if an Authorized Agent leaves the position and is
replaced by another individual. If "Titles Only" is the chosen method, this document must be accompanied by
a cover letter naming the Authorized Agents by name and title. This cover letter can be completed by any
authorized person within the agency (e.g.; City Clerk, the Authorized Agent, Secretary to the Director) and
does not require the Governing Body's signature.
2. Names and Titles: If the Governing Body so chooses, the names and titles of the Authorized Agents should be
listed. A new Cal EMA Form 130 will be required if any of the Authorized Agents are replaced, leave the position
listed on the document or their title changes.
Governing Body Representative: These are the names and titles of the approving board members. Examples
include: Chairman of the Board, Director, Superintendent, etc. The names and titles cannot be one of the designated
Authorized Agents.
Name and Title: This is the individual that was in attendance and recorded the Resolution creation and approval.
Examples include: City Clerk, Secretary to the Board of Directors, County Clerk, etc. This person cannot
be one of the designated Authorized Agents to eliminate "Self Certification."
Cal EMA 130 (Rev.4/11) Page 2