DESIGNATION OF APPLICANT'S AUTHORIZATION REP. FORM.PDF

ARIZONA DEPARTMENT OF EMERGENCY AND MILITARY AFFAIRS
DESIGNATION OF APPLICANT’S AUTHORIZED REPRESENTATIVE FORM
The intent of this DESIGNATION is to appoint an APPLICANT’S AUTHORIZED REPRESENTATIVE for the following:

Select program(s) [] Public Assistance [| HMA Mitigation Program SEC Mitigation

Select duration [X] until further notice L] Only Event [| From to
Applicant: Maricopa County Department of Emergency Management
CERTIFICATION
I Jack Sellers duly appointed and Chairman of
(Authorizing Official’s Name) (Title)

Maricopa County Department of Emergency M f . . . .
anicopa County Deparment of Emergency Management "4 1 ereby certify that the information below is true and correct,

(Applicant)

Board of Supervisors
based on a resolution passed and approved (attached) by the p

(Governing Body)

Maricopa County Department of Emergency Management .
of P ty Dep: gency Management | ine «6th day of November 2024

(Applicant) (day) (month) (year)

Rich Peel : : . .
has been designated as the Applicant's Authorized Representative
(Name of Designated Applicant's Authorized Representative)

to act on behalf of Maricopa County Department of Emergency Management

(Applicant)

(Authorizing Official’s Signature) (Title) (Date)

This document MUST be accompanied by a copy of the Resolution or Meeting Minutes by
your governing board which designated the Applicant's Authorized Representative.

Designated Applicant’s Authorized Representative

Name Rich Peel

Title/Official Position Deputy Director
5630 E McDowell Rd Phoenix, AZ 85008

ult Matting Address
Email Address Richard.Peel@Maricopa.Gov
602-725-68
Daytime Telephone Number 602-273-1411 Cell 7 id

(Please include area code and extension if not a direct number)

For DEMA Use Only
January 2023 Form #AZ PA 204-4

Received By:
(Initials & Date)