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Exhibit "W: §200.331 requirements for pass-throueh entities <br />- <br />Is this a subaward? <br />Yes Yes <br />Yes <br />i <br />Federal Award Identification #'s <br />B01OT009058 B01OT009058 <br />U58DP006004 <br />ii <br />Subrecipient Name <br />Kittitas County Public Health <br />iii <br />Subrecipient DUNS # <br />01-0202547 <br />iv <br />Federal Award Identification # <br />B01OT009058 <br />B01OT009058 <br />U58DP006004 <br />v <br />Federal Award Date <br />7/2/2014 <br />3/23/2015 <br />3/23/15 <br />Subaward Period of <br />January 1, 2015 — September <br />October 1, 2015 — December <br />March 29, 2015 — March 28, <br />vi <br />Performance Start and End Date <br />30, 2015 <br />30, 2015 <br />2016 <br />Amount of Federal Funds <br />$11,250 <br />$25,000 <br />V11 <br />Obligated by this action <br />$45,000 <br />Total Amount of Federal Funds <br />$1,000 <br />$2,000 <br />viii <br />Obligated to the subrecipient <br />$7,272 <br />Federal award project <br />FFY15 PH BG CBP Tobacco- <br />FFY15 CDC Tobacco Prevention <br />ix <br />description <br />FFY14 PHBG CBP Tobacco-PPHF <br />PPHF <br />x (a) <br />Name of Federal awarding <br />Department of Health and <br />Department of Health and <br />Department of Health and <br />agency <br />Human Services, CDC <br />Human Services, CDC <br />Human Services, CDC <br />x (b) <br />Pass-through entity <br />Department of Health <br />Department of Health <br />Department of Health <br />Contact information for <br />Grant County Health District <br />Grant County Health District <br />x (c) <br />awarding official <br />Grant County Health District <br />CFDA # (note dollar amount <br />93.758 <br />93.305 <br />awarded for this CFDA# in "vii" <br />A <br />above <br />93.758 <br />Is the award for R&D (research <br />No <br />No <br />xii <br />and development)? <br />No <br />Indirect Cost Rate for <br />40.25% of salaries <br />All <br />Subrecipient Award <br />Youth Tobacco Interagency Agreement - Kittitas Amendment41 <br />11/5/15 Page 9 <br />