HomeMy WebLinkAbout18874 - SH17-001 USDOJ EQUITABLE SHARING CERT-Cert form-DRAFTEquitable Sharing Agreement and Certification
NCIC/ORI/Tracking Number: WA0190000
Agency Name: Kittitas County Sheriffs Office Type: Sheriff's Office
Mailing Address: 307 W. Umptanum Road
Ellensburg WA 98926
Finance Contact
Name: Seibert, Heather
Phone: 5099627099 Email: Heather. Seibert. sh@CO.KITTITAS.WA.US
ESAC Preparer
Name: DAWSON, KIM
Phone: 509-962-7089 Email: KIM. DAWSON@CO. KITTITAS.WA. US
OMB Number 1123-0011
Expires November 30,2018
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Last FY End Date: 12/31/2016 Agency Current FY Budget: $10,007,472.00
Annual Certification Report
Summary of Eauitable Sharina Activitv Justice Funds Treasury Funds 2
1 Begin ing Equitable Sharing Fund Balance
(Must match Ending Balance from prior FY)
$0.00
$0.00
2 Equitable Sharing Funds Received
$0.00
$0.00
3 Equitable Sharing Funds Received from Other Law
Enforcement Agencies and Task Force (Complete Table B)
$0.00
$0.00
4 10ther Income
$0.00
$0.00
5 Interest Income
$0.00
$0.00
6 Total Equitable Sharing Funds Received (total of lines 1-6)
$0.00
$0.00
7 Equitable Sharing Funds Spent (total of lines a - n below)
$0.00
$0.00
8 Ending Equitable Sharing Funds Balance
(difference between line 7 and line 6)
\ $0.00
l
$0.00
�vapdnniern ui JuZ5uce raaCr rune«ure rrograrn participants are: rrsi, UCH, AI r, VJrIJ, uJUA, U1:51J, UJJ ana I-U/i
2Department of the Treasury Asset Forfeiture Program participants are: IRS, ICE, CBP and USSS.
Summary of Shared Funds Spent
Justice Funds
Treasury Funds
a Law enforcement operations and investigations
$0.00
$0.00
b Training and education
$0.00
$0.00
C Law enforcement, public safety and detention facilities
$0.00
$0.00
d Law enforcement equipment
$0.00
$0.00
e lJoint law enforcement/public safety operations
$0.00
$0.00
f Contracting for services
$0.00
$0.00
g Law enforcement travel and per diem
$0.00
$0.00
h Law enforcement awards and memorials
$0.00
$0.00
i Drug, gang and other education or awareness programs
$0.00
$0.00
J Matching grants (Complete Table C)
$0.00
$0.00
k Transfers to other participating law enforcement
agencies (Complete Table D)
$0.00
$0.00
I Support of community-based programs (Complete Table E)
$0.00
m Non -categorized expenditures (Complete Table F)
$0.00
$0.00
n Salaries (Complete Table G)
$0,00
$0,00
Total
$0.00
$0.00
Date Printed: 1/4/2017 Page 1 of 3 February 2015
Version 3.2
Table B: Equitable Sharing Funds Received From Other Agencies
Transferring Agency Name Justice Funds Treasury Funds
Matching Grants
Matching Grant Name Justice Funds Treasury Funds
Table D: Transfers to Other Participating Law Enforcement Agencies
Receiving Agency Name Justice Funds Treasury Funds
Table E: Support of Community-based Programs
Table F: Non -categorized expenditures in (a) - (n) Above
Description Justice Funds Treasury Funds
Table G: Salaries
Salary Type
Justice Funds
Treasury Funds
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid
OMB control number. We try to create accurate and easily understood forms that impose the least possible burden on you to
complete. The estimated average time to complete this form is 30 minutes. If you have comments regarding the accuracy of this
estimate, or suggestions for making this form simpler, please write to the Asset Forfeiture and Money Laundering Section:
1400 New York Avenue, N.W., Washington, DC 20005.
Did your agency purchase any controlled equipment? ❑ YES ® NO
Date Printed: 1/4/2017 Page 2 of 3 February 2016
Version 3,2
Affidavit
Under penalty of perjury, the undersigned officials certify that they have read and understand their obligations under the
Equitable Sharing Agreement and that the information submitted in conjunction with this Document is an accurate accounting
of funds received and spent by the Agency under the Guide during the reporting period and that the recipient Agency is
compliant with the National Code of Professional Conduct for Asset Forfeiture.
The undersigned certify that the recipient Agency is compliant with the applicable nondiscrimination requirements of the followinc
laws and their implementing regulations: Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.), Title IX of the
Education Amendments of 1972 (20 U.S.C. § 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), and
the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.), which prohibit discrimination on the basis of race, color, national
origin, disability, or age in any federally assisted program or activity, or on the basis of sex in any federally assisted education
program or activity. The Agency agrees that it will comply with all federal statutes and regulations permitting federal investigators
access to records and any other sources of information as may be necessary to determine compliance with civil rights and other
applicable statutes and regulations.
During the past fiscal year: (1) has any court or administrative agency issued any finding,
judgment, or determination that the Agency discriminated against any person or group in violation
of any of the federal civil rights statutes listed above; or (2) has the Agency entered into any
settlement agreement with respect to any complaint filed with a court or administrative agency
alleging that the Agency discriminated against any person or group in violation of any of the
federal civil rights statutes listed above?
❑ Yes ® No
Agency Head
Name: Dana, Gene
Title: Sheriff
Email: gene.dana@co.kittitas.wa.us
Governing Body Head
Name: Jewell, Paul
Title: Chairman
Email: paul.jewell@co.kittitas.wa.us
To the best of my knowledge and belief, the information provided on this form is true and accurate and has been duly reviewed and authorized by the Law
Enforcement Agency Head and the Governing Body Head whose names appear above. Their typed names indicate their acceptance of and their agreement to
abide by the policies and procedures set forth in the Guide to Equitable Sharing for State and Local Law Enforcement Agencies, this Equitable Sharing
Agreement, and any policies or procedures issued by the Department of Justice or the Department of the Treasury related to the Asset Forfeiture or Equitable
Sharing Programs.
❑ I certify that I am authorized to submit this form on behalf of the Agency Head and the Governing Body Head.
Date Printed: 1/4/2017 Page 3 of 3 February 2016
Version 3.2