HomeMy WebLinkAboutModification of AgreementUSDA Forest Service OMB 0596-0217
FS -1500-19
MODIFICATION OF GRANT OR AGREEMENT
1 U.S. FOREST SERVICE GRANT/AGREEMENT 2. RECIPIEN
NUMBER: AGREEMEN
16 -CO -11061700-100 (Cie Elum
District Visitor_ Services)
4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING
GRANT/AGREEMENT (unit name, street, city, stale, and zip + 4):
DeEtte Stofleth, Grants Management Specialist
Okanogan -Wenatchee National Forest
215 Melody Lane
Wenatchee, WA 98801
Phone: 509-664-9315
Email: dInstolli thfrt, ls, Ced. tls
6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, stale, and
zip + 4, county):
Kittitas County
205 W 5th Ave, Suite 108
Ellensbura, WA 98926
T/COOPERATOR GRANT or
T NUMBER, IF ANY:
PAGE OF
PAGES
1 2
3. MODIFICATION NUMBER:
1
5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING
PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4):
Barry Collins
Cie Elum Ranger District
803 W. 2nd Street
Cie Elum, WA 98922
Phone: 509-852-1070
Email: bcol1inserr'f's.1' d.us
7. RECIPIENT/COOPERATOR'S HITS SUB ACCOUNT NUMBER (For
HHS payment use only):
N/A
8. PURPOSE OF MODIFICATION
CHECK ALL
THAT APPLY:
This modification is issued pursuant to the modification provision in the grant/agreement
referenced in item no. 1, above.
®
CHANGE 1N PERFORMANCE PERIOD: Extending the expiration date from 07/04/2017 to 10/31/2017
❑
CHANGE 1N FUNDING:
❑
ADMINISTRATIVE CHANGES:
❑
OTHER (Specify type of modification):
Except as provided herein, all terms and conditions of the Grant/Agreement referenced in I, above, remain unchanged and in full force
and effect.
9. ADDITIONAL SPACE FOR DESCRIPTION OF MODIFICATION (add additional pages as needed):
Modification #1 is to extend the expiration date to continue visitor services.
10. ATTACHED DOCUMENTATION (Check all that apply):
Revised Scope of Work
Revised Financial Plan
Other:
11. SIGNATURES
AUTHORIZED REPRESENTATIVE: BY SIGNATURE BELOW, THE SIGNING PARTIES CERTIFY TI4AT THEY ARE THE OFFICIAL
REPRESENTATIVES OF THEIR RESPECTIVE PARTIES AND AUTHORIZED TO ACT IN THEIR RESPECTIVE AREAS FOR MATTERS RELATED
TO
THE ABOVE -REFERENCED GRANT/AGREEMENT.
11. A. KITTITAS COUNTY. SIGNATURE
1 I. B. DATE
I l.C_ i1.S. I REST SERVICE=SIC= A+TURE
I I.D.
SIGNED
AI
DATE
SIGNED
"A// 6
(Signature Signatory Official)
ignatory Official)
of
(Signature
I I.E. NAME (type or print): t
I I.F. NAME (type or print):
OBIE O'BRIEN �`�
MICHAEL R. WILLIAMS
1 I .G. TITLE (type or print):
I I.H. TITLE (type or print):
Chairman of the Board, Kittitas County Commissioners
Okanogan- Wen atch ee National Forest, Forest Supervisor
. -............................................... —
USDA Forest Service OMB 0596-0217
FS -1500-19
12. G&A REVIEW
12.A. The authority and format of this modification #1 (16 -CO -11061700-100) have been reviewed and
12.6 DATE
approved for signature by:
SIGNED
6/5/17
ANNE DOOLIN,
U.S. Forest Service Grants & Agreements Specialist
..................... .......
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