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This outline is for LPA and other governmental entities to report Title VI activities that occurred over the past year and report Title VI goals for the upcoming year. Reports must be returned on or before due date to meet eligibility requirements for federal funding. Send to TitleVl@WSDOT.wa.gov DUE DATES: Refer to Section 28.3 for scheduled reporting period and due date Contact Information Name and title of administrator (signature on Standard Assurances): Cory Wright, Chairman of the Board, Kittitas County Board of Commissioners Mailing Address: 205 W 5th AVE STE 108, City: Ellensburg WA Zip Code: 98926 County: Kittitas Phone #: 509-962-7508 email address: bocc@co.kittitas.wa.us Name and title of head of transportation -related services: Mark Cook, Public Works Director Mailing Address: 411 North Ruby, Suite 1 City: Ellensburg WA Zip Code: 98926 County: Kittitas Phone #: 509-962-7523 email address: mark.cook@co.kittitas.wa.us Name and title of designated Title VI coordinator*: Joshua Fredrickson, County Engineer Mailing Address: 411 North Ruby, Suite 1 City: Ellensburg WA Zip Code: 98926 County: Kittitas Phone#: (509) 962-7609 email address: josh.fredrickson@co.kittitas.wa.us *When the Title VI coordinator changes, notify TitleVl@WSDOT.wa.gov within 30 days. To comply with Title VI requirements, each annual report submission must include signed Standard Assurances (USDOT1050.2A). Accomplishments 1. Have there been any changes to the approved Title VI Plan that have not been reported to OEO? If Yes, please submit an update to the Title VI Plan with a new signature. No changes 2. Organization, Staffing, Structure — Describe the Title VI Program reporting structure including the Title VI Coordinator, Administrative Head, and transportation -related staff. The list should include name, race, color, and national origin of each individual. Include the same details if your LPA has a volunteer or appointed board related to transportation decision making.