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Grantee Summary Information Sheet (GSIS) <br />Small Cities Development Program — State of Minnesota <br />Please complete all sections that apply to the proposed activities. If the same person is responsible for multiple <br />duties, please list their name for each duty they are assigned to for this proposal. Contact information only <br />needs to be listed once. If a category is not applicable to your grant, please indicate as not applicable. <br />Authorized Official and Environmental Certifying Officer Information (mayor or board chair) <br />All information in this section is required, unless otherwise directed <br />Name: Tyler Gardner <br />Title: Mayor <br />Address: 4638 Main Street <br />City, State, ZIP: Pequot Lakes, MN 56472-4405 <br />Phone: 218-568-2355 <br />Primary Email: mayor@peg uotlakes-mn.eov <br />Secondary Email (if applicable): NA <br />Federal I D#: 41-6005452 <br />State ID#: 8024540 <br />State Vendor #: 0000201754 <br />Applicant Unique Entity Identifier (UEI)#: VC98VQKN11M9 <br />Applicant (proposal) Author <br />Name: Gail M. Leverson <br />Title: Sr. Funding Specialist <br />Address: 315 5th Street NW <br />City, State, ZIP: Bemidji, MN 56601 <br />Phone: 218-308-2604 <br />Email: gail.leverson@widseth.com <br />Primary Implementation Agency <br />Name of Organization: Widseth <br />Primary Contact: Gail Leverson <br />Title: Sr. Funding Specialist <br />Address: 315 5th Street NW <br />City, State, ZIP: Bemidji, MN 56601 <br />Phone: 218-308-2604 <br />Email: gail.leverson@widseth.com <br />2023 Small Cities Development Program Application Coversheet 4 <br />