HomeMy WebLinkAboutSH17-032 FFY16 EMPG Amend A-Signed ExtensionWashington State Military Department
AMENDMENT
1. SUBRECIPIENT NAME/ADDRESS:
2. GRANT AGREEMENT NUMBER.
1 AMENDMENT NUMBER:
K
Kittitas, County of
E17-156
A
Kittitas County Sheriff's Office
307 W. Umptanum Rd
Ellensburg, WA 98926-6720
4. SUBRECIPIENT CONTACT, PHONE/EMAIL:
5. DEPARTMENT CONTACT, PHONE/EMAIL:
Darren Higashiyama, (509) 933-8206
Michael Alston, (253) 512-7083
darren.higashiyama@co.kiftitas.wa.us
michael.alston@mil.wa.gov
6. TIN or SSN:
7. CATALOG OF FEDERAL DOMESTIC
8. FUNDING SOURCE NAME/AGREEMENT#:
NA
ASST. (CFDA) #: 97.042 (16EMPG)
EMS-2016-EP-00002-S0I
9. FUNDING AUTHORITY:
Washington State Military Department (Department) and the U.S. Department of Homeland Security (DHS)
10. DESCRIPTION/JUSTIFICATION OF AMENDMENT:
The end date is extended until September 30, 2017, to ensure full expenditure of funds within the
performance period.
11. AMENDMENT TERMS AND CONDITIONS:
1. The overall Grant Agreement amount $24,465 remains unchanged,
2. Replace original Timeline Exhibit D with revised Timeline Exhibit D, attached to this amendment.
3. Extend original agreement end date from August 31, 2017 to September 30, 2017.
This Amendment is incorporated in and made a part of the Grant Agreement. Except as amended herein, all other terms
and conditions of the Grant Agreement remain in full force and effect. Any reference in the original Grant Agreement or an
Amendment to the "Grant Agreement" shall mean "Grant Agreement as amended", The Department and Subreciplent
acknowledge and accept the terms of this Amendment as identified above, effective on the final date of execution below.
By signing this Amendment, the signatories warrant they have the authority to execute this Amendment.
IN WITNESS WHEREOF, the parties have executed this Amendment:
FOR THE DEPARTMENT:
FORTHE $_WRECIff NT -:_-1-
,
-/ e7
Signature Date
Signature Date
Dan Swisher, Chief Financial Officer
Gene Dana, Sheriff
Washington State Military Department
Kittitas County Sheriff's Office
-APPROVED,AS TOapplicable):
-
BOILERPLATE APPROVED AS TO FORM:
-
I eP1'w,-V-
Brian E. Buchholz (signature on file) 6/13/2012
Assistant Attorney General
Applicant's Legal Review Date
Form Date: 10/27/00
DHS-FEMA-EMPG-FFY 16 Page 1 of 2 Kittitas, County of, E17-156 Amendment A
Exhibit D
Revised TIMELINE
IFFY 2016 Emergency Management Performance Grant Program
DATE
TASK
June 1, 2016
Grant Agreement Start Date
April 30, 2017
Submit reimbursement request
July 30, 2017
Submit reimbursement request
August 31 September 30,
2017
Grant Agreement End Date
October 45-30, 2017
Submit final reimbursement request, additional reports, and/or
deliverables.
DHS-FEMA-EMPG-FFY 16 Page 2 of 2 Kittitas, County of, E17-156 Amendment A
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION
DATE SUBMITTED
Kittitas County Sheriffs Office
8/23/17
PROJECT DESCRIPTION
CONTRACT NUMBER
EMPG F'FY-16
E17 -156A
1. AUTHORIZING AUTHORITY
SIGNATURE
PRINT OR TYPE NAME
TITLE/TERM OF OFFICE
Gene Dana
Sheriff/ 12/31/18
Heather Seibert
Chief Financial Manager
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE
PRINT OR TYPE NAME
TITLE
Gene Dana
Sheriff
Heather Seibert
Chief Financial Manager
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
54qNATURE
PRINT OR TYPE NAME
TITLE
Darren Higashiyama
Commander
Heather Seibert
Chief Financial Manager
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