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friY ~ USDA Forest Service OMB 0596-02\ 7 <br />FS-\500-\9 <br />I PAGE OF PAGES <br />MODIFICATION OF GRANT OR AGREEMENT I 1 I 3 <br />l. U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: 2. RECIPIENT/COOPERATOR GRANTor 3. MODIFIC A nON NUMB ER: <br />14-LE-II061720-011 (Kittitas County AGREEMENT NUMBER, IF ANY: 003 <br />Cooperative Law Enforcement) <br />4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING 5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING <br />GRANT/AGREEMENT (unit name , street, city, state, and zip + 4): PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4): <br />Amy VerelIen Michael Kujala, Acting Patrol Captain <br />Okanogan-Wenatchee National Forest Okanogan-Wenatchee National Forest <br />215 Melody Lane 215 Melody Lane <br />Wenatchee, WA 98801 Wenatchee, W A 98801 <br />Telephone: (509) 664-9231 Telephone: (509) 668-5817 <br />FAX: (509) 664-9281 FAX: (509) 664-9283 <br />EMAIL: 3verclien @fs.fcd .lls EMAIL: Il'Ikujala @Js.fe d.u s <br />6. NAME/ADDRESS OF RECIPIENT/COO PERATOR (street, city, state, and zip + 7. RECIPIENT/COOPERATOR'S HHS SUB ACCOUNT NUMBER (For HHS <br />4, county): payment use only): <br />Kittitas County Sheriff's Office <br />N/A 307 W. Umptanum Road <br />Ellensburg, W A 98926 <br />8. PURPOSE OF MODIFICATION <br />CHECK ALL This modification is issued pursuant to the modification provision in the grant/agreement <br />THAT APPLY ; referenced in item no. 1, above. <br />0 CHANGE IN PERFORMANCE PERIOD: <br />~ CHANGE IN FUNDING: Add CY funding in the amount of $47,960.00 <br />~ ADMIN1STRATIVE CHANGES: Update contacts from Moelder to Kujala (block 5) and Stofleth to Verellen (block 4) <br />~ OTHER (Specify type of modification): See item no . 9, below. <br />Except as provided herein, aD terms and conditions of the Grant/Agreement referenced in 1, above, remain unchanged and in full <br />force and effect. <br />9. ADDITIONAL SPACE FOR DESCRIPTION OF MODIFICATION (add additional pages as needed): <br />This modification is to add the 2017 Annual Operating and Financial Plan and update contacts. <br />The following provisions are updated to reflect this modification: <br />A. PA YMENTIREIMBURSEMENT. The US. Forest Service shall reimburse the Cooperator for the US. Forest Service's share of <br />actual expenses incurred, not to exceed $47,960.00, as shown in the Financial Plan for this modification. The US. Forest Service <br />shall make payment upon receipt of the Cooperator's monthly invoice. Each invoice from the Cooperator shall display the total <br />project costs for the billing period, separated by V.S. Forest Service and the Cooperator's share. In-kind contributions must be <br />displayed as a separate line item and must not be included in the total project costs available for reimbursement. The final invoice <br />must display the Cooperator's full match towards the project, as shown in the financial plan, and be submitted no later than 90 days <br />from the expiration date . <br />Each invoice must include, at a minimum: <br />1. Cooperator's name, address, and telephone number. <br />2. US. Forest Service agreement number. <br />3. Invoice date. <br />4. Performance dates of the work completed (start & end). <br />5. Total invoice amount for the billing period, separated by the U.S. Forest Service and Cooperator share with in-kind <br />contributions displayed as a separate line item. <br />6. Display all costs, both cumulative and for the billing period, by separate cost element as shown on the financial plan. <br />7. Cumulative amount of the US. Forest Service payments to date. <br />8. Statement that the invoice is a request for payment by 'reimbursement'.