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USDA Forest Service OMB 0596-0217 <br />FS -1500-19 <br />MODIFICATION OF GRANT OR AGREEMENT <br />PAGE OF PAGES <br />1 3 <br />1. U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: <br />2. RECIPIENT/COOPERATOR GRANT or <br />3. MODIFICATION NUMBER: <br />14 -LE -11061720-011 (Kittitas County <br />AGREEMENT NUMBER, IF ANY: <br />003 <br />Cooperative Law Enforcement) <br />4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING <br />5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING <br />GRANT/AGREEMENT (unit name, street, city, state, and zip + 4): <br />PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4): <br />Amy Verellen <br />Michael Kujala, Acting Patrol Captain <br />Okanogan -Wenatchee National Forest <br />Okanogan -Wenatchee National Forest <br />215 Melody Lane <br />215 Melody Lane <br />Wenatchee, WA 98801 - <br />Wenatchee, WA 98801 <br />Telephone: (509) 664-9231 <br />Telephone: (509) 668-5817 <br />FAX: (509) 664-9281 <br />FAX: (509) 664-9283 <br />EMAIL: averellenfs.fed.us <br />EMAIL: mkujala(a,fs.fed.us <br />6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip + <br />7. RECIPIENT/COOPERATOR'S HHS SUB ACCOUNT NUMBER (For HHS <br />4, county): <br />payment use only): <br />Kittitas County Sheriff's Office <br />307 W. Umptanum Road <br />N/A <br />Ellensburg, WA 98926 <br />8. PURPOSE OF MODIFICATION <br />CHECK ALL <br />This modification is issued pursuant to the modification provision in the grant/agreement <br />THAT APPLY: <br />referenced in item no. 1, above. <br />El <br />CHANGE IN PERFORMANCE PERIOD: <br />® <br />CHANGE IN FUNDING: Add CY funding in the amount of $47,960.00 <br />® <br />ADMINISTRATIVE CHANGES: Update contacts from Moelder to Kujala (block 5) and Stofleth to Verellen (block 4) <br />® <br />OTHER (Specify type of modification): See item no. 9, below. <br />Except as provided herein, all 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. PAYMENT/REIMBURSEMENT. The U.S. Forest Service shall reimburse the Cooperator for the U.S. 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 U.S. 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 U.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. U.S. 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 U.S. Forest Service payments to date. <br />8. Statement that the invoice is a request for payment by 'reimbursement'. <br />