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Asset Transfer Forrn FY20t7fi Sfafe Womeiand Securify Granf Program JA~fi2955 <br />Transfers from County to Community or Agency *to be signed by community or agency receiving equipment <br />SHSGP ~Y06 <br />Item ' Quantity Fric_ per Unit Total Price County requisifion ~ Counb~ FO # <br />0009375-Wacker LTC4L-Li 17t Tower 1 $7,995.00 $7,995 11458 850802 <br />w/Lombardini Diesel ~n ine <br />w/(4 9000 Watt Lamps <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />1 acknowledge and concur that The Gity of North Olmsted has <br />received the above assets in the correct amounts and in satisfactory <br />condftion. I (we) furthermore agree to abide by alt requirements of <br />the Homeland Security grants relative to the purchases of this <br />equipment. I {we) authorize payment of the attached irivoice{s) For <br />the assets listed above. <br />~~~ <br />Signed ommunitylAgency Represe alive <br />~i`Zc~S ~ ~ ~~'Oy <br />Print NameA / r~ <br />~l9~ly/i~/ <br />Date <br />Payment of the attached invoice(s) is approved for the assets listed above. <br />_'.~~ <br />Signed Cuyahoga County <br />Print Name <br /> <br />"~ <br />e <br />~, <br />4 <br />