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6 | Page <br /> <br /> <br />Participating Department <br /> <br />Organization: Coon Rapids Fire Department________________________________________ <br />City, State, Zip:_______________________________________________________________ <br />Federal Identification Number (FEIN):______________________________________________ <br />Authorized Official Name (Typed):_________________________________________________ <br />Signature:__________________________________________________Date:______________ <br />Authorized Official Title:_________________________________________________________ <br />Point of Contact Name:_________________________________________________________ <br />Signature:__________________________________________________Date:______________ <br />Point of Contact Title:___________________________________________________________ <br /> <br />The Local Match committed by this participating department is: $$6,303 <br /> <br /> <br /> <br /> <br />