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~ ~ USDA Forest Service OMB 0596 -02 17 <br />FS-1500-19 <br />I PAGE OF PA GES <br />MODIFICATION OF GRANT OR AGREEMENT I 1 I 9 <br />l. [/.S. FOREST SERV ICE GRANT/AGREEf'.lENT NU~IBER : 2. RECIP I ENT/COOPERATO R GRA NT or 3. MOD IFIC ATION NUt\IBER: <br />I ~-LE -I I 06l720-0 11 (Kittitas L aw Enforcement) AG REEME T NUMBER. Jr-ANY: 002 <br />4. NAME/ADDR ESS O F U .S. fO REST SE RVICE UN IT ADM IN ISTERING 5. NAME/ADDRESS OF U .S. FOREST SERVICE UNIT ADMINISTERING <br />GRA NT /AG REEMENT (linilnllmc . street . city. stale . and 7ip f-4): PR OJE CT /ACTIVITY (unit na me. street. city. state . and zip + 4): <br />De Ette Stot1eth Robert Moe lder, Patrol Captain <br />Okanogan-Wenatchee National Forest Okanogan -Wenatchee National Forest <br />215 Melody Lane 215 Melody Lane <br />Wenatc hee , W A 98801 Wenatchee , W A 98801 <br />6. NAME/ADDR ESS OF REC II'I ENT/COO PER ATOR (stree t. ci ty. state . ami 71p + 7. RECI PIENT/COOPERATOR'S HHS SUB ACCOUNT NU MBER (Fo r HHS <br />4. county): pa yment usc on ly): <br />Kittitas County Sheriffs Office <br />307 W. Umptanum Road N/A <br />Ell ensburg. W A 98926 <br />8. PURPOSE OF MODIFICATION <br />CHECK ALL This modification is issued pursuant to the modification pro v ision in the grant/agreement <br />THAT APPLY: referenced in item no. I , above . <br />D CHANGE IN PERFORMANCE PER.lOD: <br />~ CHANGE IN FUNDING: Add CY funding in the lllllount of $47,960.00 <br />D ADMINISTR.A TIVE CHANGES: <br />~ OTHER. (Specify typ e of moditication ): See item no . 9, below. <br />Except as provided herein, all terms and conditions of the Grant/Agreement referenced in I , above, remai n unchanged a nd in full <br />force and effect. <br />9. ADDITIONAL SPAC E FOR DESCRlPTlON OF MODIFICATION (add add itional page s as needed): <br />The following pro visio ns are updated to reflect thi s modification : <br />I ) PA YMENTfREIMBURS EMENT . The U .. Fo re st Service sha ll reimburse Kittita s Counly Sheriffs Office for the U.S. Forest <br />Service's share of actua l expenses incurred . not to exc eed S47,960.00 , as sho wn in the Financial Plan. The U.S. Forest Service shall <br />make payment upon receipt of Kittita s Co unty Sh eriffs Office's monthl y in voi ce . Ea ch invoice trom Kittitas County SherifFs Office <br />snaH display the total project costs for the billin g per iod , se parat ed by U.S. Forest Service and Kittitas County Sheriffs Office share . <br />In-kind contribution s must be displayed as a separate line item and mu t not be included in the total project costs available for <br />reimbursement. The final invoice must displ ay Kittitas County Sheriff s Office's full match towards the project, as shown in the <br />financial plan, and be submitted no later than 90 day s from the ex piration date. <br />Each invoice must include , at a minimum : <br />I. Kittitas Coun ty Sheriffs Offices's name , addre ss, and telephone number <br />2. U.S. Forest Servic e agree ment number <br />3. Invoice date <br />4. Performance dates of the work co mpleted (start & end) <br />5. Total invoice amount for the bi ll ing period <br />6. Statement that the invoice is a request for payment by 'reimbursement' <br />7. If using SF-270 , a signature is required. <br />8. Invoice Number, if applicable <br />The invoice must be sent by one of three methods (email is preferred ): <br />EMAIL: asc _ga @ fs. fed. us <br />FAX : 877 -687-4894 <br />POSTAL: USDA Forest Service <br />Albuquerque Service Center