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APPENDIX V
Certification of Local Government Approval
For Nonprofit Organizations
: Charles K. Windes, Jr. duly authorized to act on behalf of the
(Name and Title)
Okaloosa County hereby approve the submission of the following
(Name of City or County Government)
ESG Application proposed by Opportunity, Inc.
Name of Agency
which will serve persons living in Okaloosa County
(Name of City or County)
This certification solely warrants that the jurisdiction has agreed to allow the nonprofit organization to seek
the grant to be able to serve citizens in need who reside in this jurisdiction. This certification places no
responsibility or liability upon the local government jurisdiction related to the nonprofit’s performance of
grant-funded activities in our jurisdiction.
By: Charles K. Windes, Jr. Chairman
(Name) (Title)
mS,
eye
(Signature)
thelhy
77
(Date)
This form MUST BE signed, dated and returned with the grant application in order for
the application to be considered for funding.
* 2014 Emergency Solutions Grant 46