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Federal Funding Accountability and Transparency Act Data Col lection FormThiscontracttssupportedbyfederalfundsthatrequirecomplrancewiththeFederalFundingTransparencyAct.The purpose of the Transpa <br />Accountability andrencyActtstomakeinformationavatlableonlinesothepubliccan seehowfederafundsarespent.To comply with the act and be eligible to enter into th is contract,have a Data Universal Numbering <br />you orga nization m ustSystemnumber(DUNS@ ).If you do not al ready have one,you may receive a DUNS@numberfreeofchargebycontactingDunandBradstreetatwww.dnb.com.The Department of Hea Ithencouragesregistrationwiththe DOH )a lsoSystemforAwardManagement(sAM)to reduce data entry by both DOH and yourorganizationYoumayregisterwithSAMfreeofchargeat.sa m.gov Information aboutcontractwillbereportedbyDOHtothefederal <br />your organization and thi s <br />made lable <br />government as required by P .1.109-282 Th ts nformation wil then beavartothepublicbythefederalgovernmentonUSASpending.90vSUBRECIPIENT <br />4. Are you registered in SAM?ZlyES (skip to signature block. Sign, date and return)NO5. In the preceding fiscal year did your organization <br />a Receive 80o/o or more ofannual gross revenue from federal contracts, subcontracts, grants, loans, subgrants, and/o1 cooperative agreements; and <br />$25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and <br />b. <br />c,The public does not have access to this information about the compensation of the senior executives of yourorganization through periodic reports filed under section 13(a) or 15(d) of the securities and Exchange Act of1934 (15 U.S.c' 55 78m(a), 78o(d) or section 6104 ofthe Internal Revenue Code of 19g6. <br />NO (skip to signature block. Sign, date and return) <br />YES (You must report the names and total compensation of the top 5 highly compensated officials of your <br />organization). <br />Note: "Total compensation" for purposes of this requirement generally means the cash and non-cash value earned by theexecutive during the past fiscal year and includes sa.lary and 6onrr; awards of stock, stoii options and stock appreciationrights; and other compensation such as severance and termination pivruntr, and value of life insurance paid on behalf of theemployee, and as otherwise provided by FFATA and appricabre ortre griiu,i.". <br />By signing this document, the Authorized Representative attests to the information. <br />Subrecipient's Authorized Representative Sign & Date <br />(01t20t21 <br />{0ji2ii t9) <br />1. Legal Name <br />Tristen Lamb <br />2. DUNS Number <br />01-020-25473. Principle Place of performance <br />Kittitas County <br />3a. City <br />Ellensburg <br />3b. State <br />WA <br />3c.Zip+4 <br />98926-2886 <br />3d. Country <br />USA <br />me of <br />1 <br />2 <br />3. <br />4. <br />5. <br />Page I of2 <br />DoH will not endorce your subaward until this form is completed and returned.