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FFATA FORM <br />Subrecipient Agency: Kittitas Countv <br />Grant and Year: 18 SHSP Homeland Security Gra Agreement Number: E19-111 <br />Completed Darren Higashiyama Commander 509-933-8206 by: <br />Name Ti lle Tel eJ:JhOM <br />Date Completed: 10/30/18 <br />---, ---• =--~ . --__ ... _ -~ :::! -•----- <br />YES STOP, no further NO <br />Is your grant agreement less than $25,000? • analysis needed, [Z] GO to Step 2 <br />GO to .Step 6 <br />~..::_-----:n i -------------~ -• ---a <br />In your preceding fiscal year, did your YES NO STOP, no further <br />organization receive 80% or more of its annual • GO to STEP 3 [Z] analysis needed, GO to <br />gross revenues from federal funding? Step 6 <br />r~ -----l:Jit ,c:t' 3 , -::.. -----=-z-=-.-• ~ .•'1 ---.. --------- <br />In your preceding fiscal year, did your YES NO STOP, no further <br />organization receive $25,000,000 or more in • GO to STEP4 • analysis needed, GO to <br />federal funding? Step 6 <br />G ---------I :t!f •ltf'!.ll!.. ---.... , • ··• ... • • -I ~ - <br />Does the public have access to infomiation about YES STOP, no further NO <br />the total compensation* of senior executives in • analysis needed, • GO to STEPS <br />your organization? GO to step 6 <br />,.----... ---..----, --iJ'.I Cll":'5 ;. ------=--- <br />Executive #1 Name: <br />Total Compensation amount: $ <br />Executive #2 Name: <br />Total Campensati on amount: $ <br />Executive #3 Name: <br />Total Compensation amount: $ <br />Executive #4 Name: <br />Total Compensatio n amount: $ <br />Executive #5 Name: <br />Total 0-o mpensatio n amount: $ <br />Eii -------• ff~ -r--£: • • •• ~ ---·-------~ --If your organization does not meet these criteria, specifically identify below !!£h criteria that is not met for your <br />organization: For Example : "0ur orqaniza•tion received less than $25,0.00 , • <br />-/I <br />Signature: /J ) ~-11--, -10/30/18 -Date: -/-Y ~ • 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 temiination payments <br />• Life insurance value paid on behalf of the employee <br />Additional Resources: <br />hl1p://www.wh itehouse.gov/omb/open <br />http-Jiwww.hrsa .gov/grantslffatahtml' <br />http://www.gpo.gov/fdsys/okq/FR-2010-09-14/pdf/2010-22705 .pdf <br />http:l/www.qrarits ,qov/ <br />Page 1 of 3 <br />' I