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<br /> <br />Grantee <br />: __ City of Eugene_______________________________________________________________ <br /> Organization Name <br /> <br />Authorized by: <br /> <br />___________________________________________ Title: _____________________________________ <br /> Print Name <br />Signature: <br /> <br />____________________________________________________ Date: ____________________________ <br /> <br />Grantee Federal Tax ID Number: ____________________ <br /> <br />Grantee’s Fiscal Agent: <br />_________________________________________________________________ <br /> Organization Name <br /> <br />Authorized by: <br /> <br />__________________________________________ Title: ______________________________________ <br /> Print Name <br />Signature: <br /> <br />____________________________________________________ Date: ____________________________ <br /> <br />Grantee Federal Tax ID Number: ____________________ <br /> <br />Agency <br />: Oregon Department of Community Colleges and Workforce Development___________________ <br />Authorized by: <br /> <br />___________________________________________ Title: _____________________________________ <br /> <br /> Print Name <br />Signature: <br /> <br />________________________________________________________ Date: ________________________ <br /> <br />Address: 255 Capitol St NE, Salem, OR 97310 <br />Telephone number: 503-378-8648 Facsimile number: 503-378-8434 <br /> <br />Amendment #001 to Agency Grant Number GRNT0323 <br /> <br /> <br /> <br /> <br />S:\Amendment #001 to GRNT0323 Final 10 6 09 NS.doc 2 <br />