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<br />FY 06 Homeland Security Grant Program <br />Application Cover Sheet for Vrban Area Security Initiative (VASI) Allocations (Page 1 of 2) <br />Applicant (VASI) <br /> <br />Authorized Agent Information: <br /> <br />Contact Information: <br /> <br />Mailing Address <br /> <br />Name/Title <br /> <br />City, State, Zip Code <br /> <br />Area Code/Office Telephone Number <br /> <br />E-Mail Address <br /> <br />Maximum Amount Authorized <br /> <br />$ <br /> <br />VAS! Amount Requested <br /> <br />$ <br /> <br />, Total Amount Requested <br /> <br />$ <br /> <br />Statement of Certification - City Authorized Agent - VASI <br /> <br />By signing below, I hereby certify that I am the duly appointed Authorized Agent and have the authority to apply <br />for the FY 2006 Homeland Security Grant Program, and the City's application represents the needs for the <br />Urban Areas Security Initiative. <br /> <br />Signature of Authorized Agent <br /> <br />Printed Name <br /> <br />Title <br /> <br />Date <br /> <br />FY06 Homeland Security Grant Program <br /> <br />Page 33 <br />