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Subrecipient Agency:Kittitas County <br />Grant and Year: EMPG Grant 2016 Agreement Number: E17-156 <br />Completed Darren Hi ashi ama Commander <br />by: 0 Y (509) 933-8206 <br />Date Completed: 12/13/2016 <br />Is your grant agreement less than $25,000? <br />In your preceding fiscal year, did your <br />organization receive 80% or more of its annual <br />gross revenues from federal funding? <br />In your preceding fiscal year, did your <br />organization receive $25,000,000 or more in <br />federal fundina? <br />Does the public have access to Information about <br />the total compensation* of senior executives in <br />Your organization? <br />STOP, no further I NO <br />analysis needed, I I GO to Step 2 <br />GO to Step 6 I I <br />YES NO STOP, no further <br />GO to STEP 3 analysis needed, GO to <br />Step 6 <br />YES NO I STOP, no further <br />1:1 <br />GO to STEP 4 analysis needed, GO to <br />Step 6 <br />YES STOP, no further NO <br />analysis needed, GO to STEP 5 <br />F1 GO to step 6 <br />If your organization does not meet these criteria, specifically identify below each criteria that is not met for your <br />organization; For Example: "Our organization received less than $25.000." <br />Signatu <br />Date: !a f 4j <br />* Total compensation refers to: <br />• Salary and bonuses <br />• Awards of stock, stock options, and stock appreciation rights <br />• Other compensation Including, but not limited to, severance and termination payments <br />• Life Insurance value paid on behalf of the employee <br />Additional Resources: <br />http://www.whitehouse,gov/omb/open <br />http://www.hrsa.gov/grants/ffata.html <br />h"i)://www aoo.aov/fdsys/r)ka/FR-2010-09-14/i)df/2010-22705.odf <br />http://www.cirants-gov/ <br />Page 1 of 3 <br />Name; <br />Executive #1 <br />Total'Compensation <br />amount <br />,$ <br />Name: <br />Executive #2 <br />Total Compensation <br />amount: <br />$ <br />Executive #3 <br />.Name: <br />TotalCompensation <br />amount: <br />'$ <br />Name: <br />Executive #4 <br />Total Compensation <br />amount: <br />$ <br />Name: <br />Executive #5 <br />Total'Compensation;amount: <br />$ , <br />If your organization does not meet these criteria, specifically identify below each criteria that is not met for your <br />organization; For Example: "Our organization received less than $25.000." <br />Signatu <br />Date: !a f 4j <br />* Total compensation refers to: <br />• Salary and bonuses <br />• Awards of stock, stock options, and stock appreciation rights <br />• Other compensation Including, but not limited to, severance and termination payments <br />• Life Insurance value paid on behalf of the employee <br />Additional Resources: <br />http://www.whitehouse,gov/omb/open <br />http://www.hrsa.gov/grants/ffata.html <br />h"i)://www aoo.aov/fdsys/r)ka/FR-2010-09-14/i)df/2010-22705.odf <br />http://www.cirants-gov/ <br />Page 1 of 3 <br />