Authorized signatures



Authorized SignatureThe form shall identify the name, title, and signature of those individuals designated by the appointing authority to sign and approve requisitions, purchase orders, sole source certifications, change order requests, and surplus property transactions for each state agency and effective date of change. Identify the removal of a designation of signature authority by the appointing authority by listing the name and title of the individual and effective date of the change. The form shall be submitted to the State Purchasing Director within 30 days of any additions or deletions in the signature authority. Reference OAC 260:115-5-13.Submission of this form shall be sent to: CP.Feedback@omes. FORMCHECKBOX Addition FORMCHECKBOX Deletion Agency Name: FORMTEXT ?????Agency # FORMTEXT ?????Date: FORMTEXT ?????Primary Contact: FORMTEXT ????? Phone: FORMTEXT ?????REQUISITIONS:PURCHASE ORDERS:133351955800SignatureSignature FORMTEXT ?????95251530350 FORMTEXT ?????Printed Name and TitlePrinted Name and Title95251885950SignatureSignature FORMTEXT ?????01479550 FORMTEXT ?????Printed Name and TitlePrinted Name and Title01835150SignatureSignature FORMTEXT ?????01428750 FORMTEXT ?????Printed Name and TitlePrinted Name and TitleCHANGE ORDER REQUESTS:SURPLUS PROPERTY TRANSACTIONS:-571501797050SignatureSignature FORMTEXT ?????-285751581150 FORMTEXT ?????Printed Name and TitlePrinted Name and Title-285751841500SignatureSignature FORMTEXT ?????-285751727200 FORMTEXT ?????Printed Name and TitlePrinted Name and Title01739900SignatureSignature FORMTEXT ?????01524000 FORMTEXT ?????Printed Name and TitlePrinted Name and TitleSOLE SOURCE / SOLE BRAND CERTIFICATIONS:-3683118923000 FORMTEXT ?????SignaturePrinted Name, Chief Administrative Officer of the Agency-36831196215 FORMTEXT ?????SignaturePrinted Name, Chief Administrative Officer of the AgencyChief Administrative Officer of the AgencyChief Administrative Officer of the Requisitioning Unit ................
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