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State of Washington Department of Ecology Page 8 of 18 <br />Agreement No: W2RLSWFA-1719-KiCPHD-00022 <br />Project Title: 2017-19 LSWFA Kittitas Co SWE <br />Recipient Name: KITTITAS COUNTY PUBLIC HEAL TH <br />.Funding Distribution ummary <br />Recipient/ Ecology Share <br />Funding Distribution Name Recipient Match % Recipient Share Ecology Share Total <br />Kittitas Co. S WE 25.00 % $ 20,733.67 $ 62,201.00 <br />Total $ 20,733.67 $ 62,201.00 <br />AGREEMENT SPECIFIC TERMS AND CONDITIONS <br />NIA <br />SPECIAL TERMS AND CONDITIONS <br />GENERAL FEDERAL CONDITIONS <br />If a portion or all of the funds for this agreement are provided through federal funding sources or this <br />agreement is used to match a federal grant award, the following terms and conditions apply to you. <br />A. CER T IFICATION REGARDrNG SUSPENS ION, DEBARM EN T . JN-ELIG!BILl'flY OR VOLUNTARY <br />EXCLUSION: <br />$ 82,934.67 <br />$ 82,934.67 <br />1. The RECIPIENT/CONTRACTOR, by signing this agreement, certifies that it is not suspended, debarred, <br />proposed for debarment, declared ineligible or otherwise excluded from contracting with the federal <br />government, or from receiving contracts paid for with federal funds. If the RECIPIENT/CONTRACTOR is <br />unable to certify to the statements contained in the certification, they must provide an explanation as to why they <br />cannot. <br />2. The RECIPIENT/CONTRACTOR shall provide immediate written notice to ECOLOGY if at any time the <br />RECIPIENT/CONTRACTOR learns that its certification was erroneous when submitted or had become <br />erroneous by reason of changed circumstances. <br />3. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, <br />person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have <br />the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. <br />You may contact ECOLOGY for assistance in obtaining a copy of those regulations. <br />4. The RECIPIENT/CONTRACTOR agrees it shall not knowingly enter into any lower tier covered transaction <br />with a person who is proposed for debarment under the applicable Code of Federal Regulations, debarred, <br />suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. <br />5. The RECIPIENT/CONTRACTOR further agrees by signing this agreement, that it will include this clause titled <br />"CERTIFICATION REGARDING SUSPENSION, DEBARMENT, INELIGIBILITY OR VOLUNTARY <br />EXCLUSION" without modification in all lower tier covered transactions and in all solicitations for lower tier <br />covered transactions. <br />6. Pursuant to 2CFR180.330, the RECIPIENT/CONTRACTOR is responsible for ensuring that any lower tier <br />covered transaction complies with certification of suspension and debarment requirements. <br />7. RECIPIENT/CONTRACTOR acknowledges that failing to disclose the information required in the Code of <br />Federal Regulations may result in the delay or negation of this funding agreement, or pursuance oflegal <br />Version I 0/30/2015