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DEPARTMENT <br />OF HEALTH <br />APPROVED: <br />1. State Encumbrance Verification <br />individual certifies that funds have been encumbered as required <br />by Minn. Stat. §§ 16A.15 and 16C.05. <br />Digitally signed by Sarah Martin <br />ra � a rt � na 12.6 07:42:49-06'00' <br />By: Date: zo2 . 9 <br />Print name: Sarah artin <br />Date: 12/09/2020 <br />SWIFT Contract/PO Na(s). 186689/3000081148 <br />2. Grantee <br />Grantee certifies that the appropriate persons(s) have executed the grant <br />agreement on behalf of Grantee as required by applicable articles, bylaws, <br />resolutions, or ordinances. <br />By: <br />Print name: <br />Title: <br />Date: <br />By: <br />Print name: <br />Title: <br />Date: <br />3. Minnesota Department of Health <br />Grant Agreement approval and certification that State funds have been <br />encumbered as required by Minn. Stat. §§16A.15 and 16C.05. <br />SWIFT Contract Number [186689] <br />Between the Minnesota Department of Health and [City of Ramsey] <br />By: (with delegated authority) <br />Print name: <br />Title: <br />Date: <br />Distribution: <br />Agency — Original (fully executed) Grant Agreement <br />Grantee <br />State Authorized Representative <br />Page 10 of 10 <br />Standard Grant Template - Version 2.4 --June 2020 <br />