HomeMy WebLinkAboutResolution No. 370EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT A
EXHIBIT B- (DRAFT) LOCAL GOVERNMENT INVESTMENT POOL
TRANSACTION AUTHORIZATION FORM
Please fill out this form completely, including any existing information, as this form will replace the previous form.
Name of Entity: City of Medina Mailing Address:
501 Evergreen Point Road
Medina, WA 98039 Fax Number: (425) 451-8197
E-mail Contact: nadams@medina-wa.gov
Do you wish to have your monthly LGIP statements faxed to the number listed above?
Please note – if you choose to receive statements via fax, you will not receive another copy via U.S. mail.
Bank account where funds will be wired when a withdrawal is requested.
(Note: Funds will not be transferred to any account other than that listed).
Bank Name: US Bank
Branch Location: Bellevue, WA
Bank Routing Number: 125000105
Account Number: 153501084583
Account Name: City of Medina
Persons authorized to make deposits and withdrawals for the entity listed above.
Name Title Signature Telephone Number
Michael Sauerwein City Manager 425-233-6412
Nancy Adams Director of Finance 425-233-6415
Aimee Kellerman City Clerk 425-233-6411
By signature below, I certify I am authorized to represent the institution/agency for the purpose of this transaction.
(Authorized Signature) (Title) (Date)
(Print Authorized Signature) (E-mail Address) (Telephone number)
Any changes to these instructions must be submitted in writing to the Office of the State Treasurer. Please mail
this form to the address listed below:
OFFICE OF THE STATE TREASURER
LOCAL GOVERNMENT INVESTMENT POOL
PO BOX 40200
OLYMPIA, WA 98504-0200
FAX: (360) 902-9044
Date Received: ____ / ____ / _____
Fund Number: ____________
(for LGIP use only)
YES, please fax statements No, please send statements via U.S. mail
State of Washington )
County of ) SS.
Signed or attested before me by .
Dated this ___ day of ___________, 20__.
Signature of Notary
SEAL OR STAMP
Typed or printed name of Notary
Notary Public in and for the State of Wash.
My appointment expires: