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FFATA FORM Subreclplent Agency : Kittitas County Grant and Year: 2019 Agreement Number: E20-156 Completed Darren Higashiyama Commander (509) 933-8206 by: Name Title T_e/~pflone Dale Completed: 11/08/19 r STEP ,11! --- --. -. -• ----------n STOP, no further NO Is your grant agreement less than $25,000? analysis needed , [l] GO to Step 2 GO toSl~p 6 --:r-=-----· -REP -2 .. - -~. I _. - • -·.a. ._..,,.. ~ ,·_ -----:: =--L. ---= -' _ .. -----In your preceding fiscal year, did your YES NO STOP, no further organization receive 80% or more of its annual D GO to STEP 3 [{] analysis needed, GO to gross revenues from federal funding? Step6 .. -.. ----__:_--=-~ .~.._ ;;..:_. I . . -----,SJ!SP 3 --·-=-' .. ---.!. - --------. -- In your preceding fiscal year, did your YES NO STOP, no further organlzatton receive $25,000,000 or more In D GO.to STEP4 D ~rialy~ls ne~ded, GO IQ federal "funclln_g_? Step6 --------,l-_ .. l I 1"': ,-. ? --·-~-1-c.-.. ---1 -~--:JI' ··-----.rrr: ~-._ -r _ ·1;-_ ~ Does the public have access to Information about YES STOP, no further NO the total compensation* of senior executives in D analysis needed, D GO to STEP 5 your organization? GO to step 6 ' --_ -. - I - -._. •_ ---81EP.5--------·-. . ~ -----.-.--, lia... ---- Executive #1 Name: Total Compensation amount: $ Executive #2 Name: Total Compensa.Uon amount: $ Executive #3 Name: Total Compensation amount: $ Executive 'lt4 Name: Total Compensation amount: $ Executive #5 Name: Total Compensation amount: $ ~ T ·SJEp.ye· ------------- ---.. --. ---·-.• - If your organization does not meet these criteria, specifically Identify below !!!:h criteria that Is not met for your organization: For Exati:u;ile: "Our Qrganlzatlon received less than i25,0QQ ," Kittitas County did not receive 80% or more annual gross revenues from federal funding Signature: _____________________ _ Date: 11 /08/19 "Total compensation refers to: • Salary and bonuses • Awards of stock, stock options, and stock appreciation rights • Other compensation fncludlng, but not limited to, severance and termination payments • Life insurance value paid on behalf of the employee Additional Resources: http;flwww,whltehouse.gov/ombtopen bttp:ltwww.hrsa .gov/qrants/ffata.html http://WWW.gpo.gov/fdsys/pkg/FR-2010-09-14/pdf/2010-22705.pdf http://www,arants.aoy/ Page 1 of3 --.-- I -