E16-157 Kittitas County - 15EMPG

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FFATA FORM Subrecipient Agency: Kittitas County Sheriff's Office Grant and Year: 2015 Agreement Number- E16-157 Completed Darren Higashiyama by - Operations Commander (509) 933-8206 Date Completed 1/08/16 - _ STEP 1 YES STOP, no further NO Is your grant agreement less than $25,000? IZI analysis needed,' ❑ I GO to Step 2 GO to Step 6 STEP 2 In your preceding fiscal year, did your YES NO STOP, no further organization receive 80% or more of its annual ❑ GO to STEP 3 ❑ analysis needed, GO to gross revenues from federal funding? Step 6 STEP 3 In your preceding fiscal year, did your YES NO STOP, no further organization receive $25,000,000 or more inF-1GO to STEP 4 ❑ analysis needed, GO to federal funding? Step 6 STEP 4 Does the public have access to information about YES STOP, no further NO the total compensation" of senior executives in1:1analysis needed, to STEP 5 your organization? GO to step 6 LlGO STEP 5 Name: Executive #1 Total Compensation amount: $ Name: Executive #2 Total Compensation amount: $ Name: Executive #3 Total Compensation amount: $ Name: Executive #4 Total Compensation amount: $ Name: Executive #5 Total Compensation amount: $ STEP 6 If your organization does not meet these criteria, specifically identify below each criteria that is not met for your organization: For Example: "Our organization received less than $25,000." Signature: Date: 1/08/16 Total compensation refers to: • Salary and bonuses • Awards of stock, stock options, and stock appreciation rights • Other compensation including, but not limited to, severance and termination payments • Life insurance value paid on behalf of the employee Additional Resources: http://www.whitehouse.gov/omb/open hftp://www.hrsa.gov/qrants/ffata.html htto://www.aDO.aov/fdsys/Dka/FR-2010-09-14/r)df/2010-22705-odf http://www.grants.gov Page 1 of 3