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State of Washington Department of Ecology Agreement No: SWMLSWFA-2019-KiCPHD-00034 Project Title: 2019-21 LSWFA Kittitas SWE Recipient Name: KITTITAS COUNTY PUBLIC HEALTH Funding Distribution Summar Recipient / Ecology Share Page 11 of 21 Funding Distribution Name Recipient Match % Recipient Share Ecology Share Total Kittitas IMP 25.00 % $ 19,222.83 $ 57,668.50 $ 76,891.33 Total $ 19,222.83 $ 57,668.50 $ 76,891.33 AGREEMENT SPECIFIC TERMS AND CONDITIONS N/A SPECIAL TERMS AND CONDITIONS RECIPIENT shall update the Spending Plan and Outcomes Data Collection form at least quarterly. The Spending Plan and Outcomes Data Collection form must be submitted along with a Payment Request/Progress Report. By checking the box provided in the Outcomes Data Collection section of the form, the RECIPIENT certifies that the outcomes reported for that quarter represent ONLY what was achieved with LSWFA (Ecology share plus local contribution). RECIPIENT shall not report outcomes achieved with funds that exceed the LSWFA Agreement's total budget. RECIPIENT must submit within thirty (30) days after the expiration date of this Agreement, all financial (including payment requests), performance, and other reports required by this Agreement. ECOLOGY shall have the right to deny reimbursement of payment requests received after this date. GENERAL FEDERAL CONDITIONS If a portion or all of the funds for this agreement are provided through federal funding sources or this agreement is used to match a federal grant award, the following terms and conditions apply to you. A. CERTCFICATION REGARDING SUSPENSION, DEBARMENT, INELIGIBILITY OR VoI.U1N JARY EXCLUSION: I . The RECIPIENT/CONTRACTOR, by signing this agreement, certifies that it is not suspended, debarred, proposed for debarment, declared ineligible or otherwise excluded from contracting with the federal government, or from receiving contracts paid for with federal funds. If the RECIPIENT/CONTRACTOR is unable to certify to the statements contained in the certification, they must provide an explanation as to why they cannot. 2. The RECIPIENT/CONTRACTOR shall provide immediate written notice to ECOLOGY if at any time the RECIPIENT/CONTRACTOR learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances. 3. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact ECOLOGY for assistance in obtaining a copy of those regulations. 4. The RECIPIENT/CONTRACTOR agrees it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under the applicable Code of Federal Regulations, debarred, suspended, Template Version 10/30/2015