EXHIBIT 2 - SAFETY SHOE AUTHORIZATION FORM - SECURITY BRANCH.pdf

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Safety and Uniform Boots
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SAFETY /UNIFORM/DRESS FOOTWEAR AUTHORIZATION

DEPARTMENT OF HOMELAND SECURITY/

FEDERAL EMERGENCY MANAGEMENT AGENCY

DATE:

19844 BLUE RIDGE MOUNTAIN ROAD

BLUEMONT, VA 20135

EMPLOYEE NAME:

The above-named employee is entitled to (please circle - one or two) pair of (please circle - safety, uniform or dress) footwear. DHS/FEMA will cover the not-to-exceed amount of $200.00 per pair. Any amount over $200.00 will be the responsibility of the employee named above.

If there are any questions, please call Garrett Adams, 540-542-2220.

SIGNATURE:

AUTHORIZED BY (DIVISION POC): Darby Burdette Security Branch Chief

STORE AND LOCATION: _________________________

SHOE REQUIREMENTS/RESTRICTIONS: Only the styles listed below are allowed for Security Specialist personnel.

MERRELL: Men: Jl5841 (coyote)

Revised 5/2019

EXHIBIT 2

File details come from the government source that posted it. Updated .