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Home My WebLink AboutFully executed contract4122126,4:06 PM Unrque EntitY lD N48GCZ2FJA47 CAGE/NCAGE OWP75 SAM.gov Active Registration Mailing Address PO Box 47615 Olyrnpia, WashinEton 98504-7615, [Jnited States Entity lnformaticn Expiration Date Mar 4,2A27 STATE OF WASHINGTON PhysicalAddress 300 Desmond DR SE Lacey, Washington 98503-1 27 4, United States Purpose of Registration AllAwards Versiot'l Current Record BUSINESS INFORMATION Doing Business As Department of EcoloEy Division Name {blank) Congressional District Washington 10 Owner lmmediate Owner URL https://ecologY.wa"E ov/ Division Number (bflank) State/CountrY of lncorporation (b!ant<), (blank) CAGE Legal Business Name (blan[<)(biank] Registration Dates Activation Date Mar 5, 2026 Submission Date hlar 4, 2026 lnitial Registration Date Jan 3, 2002 FNighest Leve! Owner (blank) (biank)Entity Dates https://sam.gov/entities/view/N 4BGCZ2F JA47/coreData?status=Active&emrKeyValue=20166 22-1768488882701 534&reg Id =16934982 112 4122126,4:06 PM SAM.gov Entity Start Date Ju! t, '1970 Fiscal Year End Close Date Jun 30 Executlve Cornpensation Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 11A-252, amending the Federal Funding Accountability and TransparencyAct (P.L. 1Og-282). This information is not displayed in SAM. lt is sent to USAspending.gov for display rn association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. SAM SEARCH AUTHORIZATION I authorize my entity's non-sensitive information to be displayed in SAM public search results ,' jYes ENTITY TYPES Eusiness Types Soclo-EconCIril;c TYPes Entity Structure U.S. Government Entity Entity Type US State Government Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. ProfitStructure (blank) Organization Factors (b!ank) https://sam.gov/entities/view/N 4BGCZZF JA47lcoreData?status=Active&emrKeyValue=20166 22-1768488882701 534&regld=16934982 212 Docusign Envelope lD: 45542800-F078-88E3-82CC-B1C8A3BDE84C DEPARTMENT OF ECOLOGY State of Washington AMENDMENT NO. 01 TO ContractNO. C2500178 BETWEEN THE STATEoFWASHINGTONDEPARTMENToFECoLOGY AND Kittitas County Public Health District PROJECT TITLE: Pollution Prevention Assistance PURPOSE: To amend the Agreement between the state of washington, Department.o.f Ecology' hereinafter referied to as "ECOLOGY," and Kittitas County Public Health District, hereinafter referred to as or'oContractor " wHEREAS: the negative balance in the Model Toxics control Act (MTCA) Operating Account has resulted in the Hazardous Waste and Toxics Reduction (HWTR) Program, reducing funds originally provided in agreements with our Pollution Prevention Assistance Partnership (ppA) purtn.rr. The amindment will reflect the modified budget. IT IS MUTUALLY AGREED the Agreement is amended as follows: 1) Section 3: GoMPENSATION of the agreement is amended as follows: New text is indicated with underlined (sample)' The source of funds for this IAA is Model Toxics control operating Accouqt (23PJ a-n-d Model Toxics control capitalAccount 1zrl.ry eoth purties agree to comply with all applicable rules and regulations associated with these funds. 2) Section 3: GoMPENSATION of the agreement is amended as follows: Total compensation is decreased by $8,649.33, from $125,608'84 to new total contract value of $116,959.51. Version 4/14/2025 Docusign Envelope lD: A5542800-F07B-88E3-82CC-B1CBA3BDE84C State of Washington Department of Ecology Contract no. C2500178, Amendment 0l Kittitas County Public Health District 3) Appendix B, Budget Detail is amended as follows: Deleted text is indicated with strikethrough (ssmp+e) and new text is underlined (sample)' *8 Applied to Salaries onlY Table A: Goods & Services Table B: AmountCategory $6ep6#8 Salaries $43#21=H 08Benefits $0.00Subcontracts $s00.00Goods & Services (see Table A Below) $ 1,500.00Equipment (see Table B Below) $2,000.00Travel & Training $0.00Small Change Voucher Program (See Section XLU) $+e829+ZsSubtotal Direct Costs 28.4YoRate (2&4%) $+H+49 $15.878.66Indirect AmountIndirect Costs* $+4#08s4 $116.959.51Total Award Estimated CostGoods & Services over $1'000 must be listed here or LOGY PRIOR to reimbursement approved by ECO Estimated Costorherebybemustlistedapprovedover$r,000Equipment reimbursementtoPRIORECOLOGY version 4/14/2025 Pg2 B w Docusign Envelope lD: A5542800-F078-88E3-82CC-B1CBA3BDE84C State of Washington Department of Ecology Contract no. C2500178, Amendment 0l Kittitas County Public Health District All other terms and conditions of the original Agreement including any other amendments remain in full force and effect, except as expressly provided by this Amendment This Amendment is signed by persons who represent that they have the authority to execute this Amendment and bind iheir respective organizations to this Amendment. This Amendment is effective on the Ecology signature date' IN WITNESS WHEREOF, the parties below, having read this Amendment in its entirety' including any attachments, do agree in each und "u.ry particular as indicated by their below signatures' State of Washington Department of EcologY Kittitas CountY Public Health By By: 5t2512026 5t1412026 Date Signature Date Katrina Lassiter Chelsey Loeffers Print Name Print Name Hazardous Waste & Toxic Reduction Program Public Health Director Title Title by:G" b,ffir\ Signature Version 4/14/2025 Pg3 Docusign Envelope lD: 45542800-F078-88E3-82CC-81 C8A3BDE84C CONTRACT FACE SHEET For lnternal Routing Use (lnstructions on lnstructions Tab) -- T;TF ECOLOCY Type: CGP System #: Contract #: Amendment #: Work Assignment #: Contract 21938 c2500r78 1 Contractor Statewide Vendor - SWV #:swv 0010475-07 EIN: Public HealthKittitas Cou pollution prevention Assistance (PPA) - technical assistance and education outreach to small businesses. Contractor Name: Contract Title / Description / Bid #: Program:MOO-HWTR Project Officer:Andrew Maher Phone s09-329-3672 Secondary Project Officer (i.e., Budget Analyst):Ellen Hafer Phone s54-233-8638 Staff DES ControdTroining Yes (check all that apPlY)E Goods/Services ncw rg.ze I Decision to Contract E lnteragency RCW 39.34 E oEs state contract # !tr RCW 39.26 I Competitive Bid # E Public works RCW 39.04 I sole source # n Arch./Eng.RCW 39.80 tr Direct Buy E other: OMWBE: (check allthat aPPlyl OMWBE WA Small Bus WA Veteran Bus Uses Sub Contractor I Time Extension ! lncrease E Decrease Amount of Amendment: Subcontractor: AMENDMENT: (check allthat aPPIY) Other: Deliverable Reduction Total of Contract after Amendments:s116,959.5 TERM:Start Date:7/t/2o2s End Date 6/30/2027 How To Encumber and Disburse: m M Completes Contract Cost:S116,9s9.s1 Sales Tax (PW onlY)s Total Eligible Cost:5 116,959.51 (Required for Single-year Operating Appropriations & uired information:contracts extendi current bienni Prior Bien's Current Bl Current Bl MIC (8 char)Fund/EAl ffi 23N/p10 Project - Sub-Proj FY:2026 FY:2027 Totals M723r7HO 38,921.94 93 77,843.87 9M997D10 7.82 82 3 15.64 Staff;Budget 5 116,959.51 Subsidiary:Budget Total must equal Total Eligible Cost Funded? No Federol Amount ( Remarks:Am total and MlCs nd Contract Freeze form in 3/23/20 's contract file. 23 before ca ital (23 Approval Date ECY 010-53 Rev 2/2024 Docusign Envelope lD: 45542800-F078-88E3-B2CC-B1CBA3BDE84C Face Sheet CONTRACT INSTRUCTIONS General: Do not use this form for Grant or Loan Agreements. See the EAGL Face Sheet. project Officer, Program Budget Analyst, or Program Budget Manager familiar with the content of the contract or amendment fills out the Face Sheet' program Budget Manager provides complete information in the Budget section' program sends final draft documents for review and approval by Contracts/Fiscal staff' Contracts/Fiscal staff reviews and assigns a Contract number (if new), enters sub-object on Face Sheet and signs their approval, then returns to the Program. Obtain contractor signature and then appropriate Ecology signature. When all parties have signed the contract-or amendment, Program sends the Face Sheet with the signed contract or amendment to Fiscalfor filing. Line Specific: Type: Contract - can be an IAA or contract. Moster - generally has an RFQQ, Work Assignment - will be related to a convience contract. Total Eligible Cost: This line always shows the total eligible Ecology amount of the Contract. Sales Tax: This line is lF the sales tax is not included in the contract cost but must be paid (usually for public works contracts). program Budget Manager completes the Fund lnformation (Master lndex Code (MlC), Fund, Expenditure Authority lndex (EAl), and Project & Sub-Project)' Encumbrance/Disbursement Section: See Exomples tab for examples ln the fiscalyear (FY)columns enter amounts, by MlC, fund/EAl, and project coding (if applicable)l Sptit codes must be split on separate lines on the face sheet A. Original Contract - Enter the total amount for each fiscal year in the FY columns. -oR- B. Amendment - Leave oriSlnalAnoQu_n_tg OR sum pior bien amounts and on new rows enter ONLY the inc ase/decre ase amounts for each fiscal Year Sum prior bien omounts poid ond enter in the "Prior Bien's" column' Remarks: lf descriptions for "other" fields above are too long, then enter here' Enter general comments, note which MIC to pay from first, J code info, etc. Federally Funded: Please select Yes or No and enter the federal dollars for the contract. Docusign Envelope lD: A5542800-F078-88E3-82CC-B1CgA3BDE84C Definitions: Contract Manager serves as the primary point of contact for the contractor and is key to ensure the agency receives satisfactory performace. See Purchasing Directives for additional responsibilities' DES Contract Training requirements are available at e P n s X. Program Budget Manager Approves budget coding and signs/approves face sheet' project Officer is responsible for the planning, management, communication, and execution of a particular project. They are responsible for accomplishing the project objectives. Works with Contract Manager. The same person may be both the project officer and contract manager' Secondary project Officer is a secondary contact in the program for fiscal to send reports (closeout reports) (i.e., budget analYst)' Subcontractor: an individual, firm, or organization, hired and paid by the contractor, to perform all or part of the services identified in the statement of work of the contract with Ecology' Subcontractors are not staff employed by the Contractor' SWV #: Statewide Vendor #, unique to the Contractor and issued by Office of Financial Management, used for processing contractor payments. Required before contract can be NOTE: Terms and definitions listed on the face sheet are being used to match those within CGP' Docusign Envelope lD: A5542800-F078-88E3-82CC-81 C8A3BDE84C 1) Complete and preferred: Shows amendment on new line' AMENDMENT: (clreck a ll that aPPIY)E rime Exten5ion lncrease Decrea5e 2l complete and preferred: shows prior paid amounts in Previous Mlc AMENDMENT: (chEck all that aPP E ri*e Extension E Incred9e ! oecrease 3) NOT COMPLETE/INCORRECT - only lists amendment amount. E lnc.ease fl Decrease An'roLrnt 6f Amendmentl Am0unt of Amendr'ent: $ 321,98.0.00 $ 50.825.GO Am6unl of ,lmendmeni: $ .r,1$s,372-ooTrt;l of ContractName change/addE other: End 0ate:Start Date: 1,1&S.872.00Contrart fost: Sales aost:Total El How To Encum ber and Disburse: rCoMa {Reqilrred for 5tnEle-yeJr Operating Approprlatlon5 & c0ntracts extending beyond currenl bierrnium ) Totals Current 8l FY: 2t20 Current BlPrior Bien'9 866,892.00 321,980.i10321,980.00 red information: P ro i ect- 5u b- Proi o009J831 oaay&2L Mlc xJzE-07 xJzS-47 fund/EAl 23N/Ar.3 23N/A13 L,1&8,872.00 Fiscal Staff: Misc:9ubsidia6L;Budget Total must equal Total Eligible Cost Budget $ 248,010.cF!tota I 6f Corrtract iflFr A0rP!rdrllerll!; Add deliverables farE other: 7r.h2/2:024End oate:$/t4l\fiLeStart Date: 248.010.t10Contract Colt: $SaletTax {P!V onlY}: $ z48.o1o.ooTotal Eligible co5t:Prosram Budget Manaeer ComDletes How To EDcutnber and Disburse: (Hequrred for 5f n gle-yeat upercttng Apllrsprlat'ons & contracts extending beyond eurrent bienniuml Tota ls Current El FY:2t Current Bl FY, Prior Bien's 197,re5.O0L97,Lss.Og 38,LrB.V538,11S.75 L2,706.25Lzla6.75 | Required information; Fund/EAl Froiect sub.Prai EOlPLOAO F6NTROAO gWG6_EM 9WD2'MN Mlc (B char) Prior-BN 23P/AAA 23?l_o!! Fieca I staf{: Misc:GL:Subsidiary:Oud6et Total mutt eguql Totol El igiblc cost Budget AMENDMENT: (check all that aPPIY)E Tin e ExtPnsion s s,630.o0 Docusign Envelope lD: 45542800-F078-88E3-82CC-BlC8A3BDE84C fl other: total ot Contrart I zzfi,ns.ffi ilr5.lzazrFnd Date:Start Date: 2Zg,fis.a0Contract cosi: $SalesTax {PWonlY}: Total EliSible Cosi:Program Eudget ai^-^-^- .^-^l^+dc tlow To Encumber and Dis burse: ( Requared for Single-year OperatinE AFpropriation5 & contracts extend lng rJeyond current hlennlursrl fotals crrrent 8l FT: Current 8l FYl. a) Prior Bien's s,630.oos.6:o.dl Fund/EAt Fr'oiect-sub-Proj Required information: 9DG9-0?azP/pao MIC (8 cha4 DSG270AO Fiscal Staff: Misc:3Ll Subsidiery:Eudget Total muet equal Total Eligible Cost Budget Total ,:r -;,ii,riir.lrii Signer Events Katrina Lassiter klas461@ecy.wa.gov HWTR Program Manager Department of EcologY Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign ln Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Gertified Delivery Events Carbon CoPY Events Witness Events Notary Events Envelope Summary Events Envelope Sent Envelope Updated Envelope Updated Envelope Updated Envelope UPdated Envelope Updated Envelope UPdated Certified Delivered Signing Complete Completed Payment Events Signature Adoption: Uploaded Signature lmage Using lP Address: 67.183.127 94 Signed using mobile Signature Status Status Status Status Status Signature Signature Status Hashed/Encrypted Security Checked Security Checked Security Checked Security Checked Security Checked Security Checked Security Checked Security Checked Security Checked Status TimestamP Senl: 512212O26 1 I :1 2:57 AM Viewed: 512212026 2:02:52 PM Signed: 5/2512026 4:09:58 PM TimestamP Timestamp Timestamp Timestamp Tlmestamp Timestamp Timestamp TimestamP Timestamps 312512026 10:40:59 AM 41812026 1:29:58 PM 41812026 1:29:58 PM 41812026 1:29:58 PM 41812026 1:29:58 PM 41812026 1:29:58 PM 41812026 1:29:58 PM 512212026 2:02:52PM 512512026 4:09:58 PM 512512026 4:09:58 PM TimestamPs Signature -"*":ry'V,:',4I*, Docusign Envelope lD: A5542800-F078-88E3-82CC-B1C8A3BDE84C .*ffiffiGontractsUnitFreezeExemptionTrackingFormfor = contracUlAA/Amendments fi*;V tnstructions: This form must be submitted with all contraculAA/Amendment packets s.iro'wa,ing,c, to the Fiscal contracts Unit. lf the Program is seeking an exemption/exception that requires Deputy Direct approval (see section 2 and guidance page), the Freeze Exemption/Exception Request Form for Service contracts must also be filled out, approved, and included in the packet submitted to the Fiscal Contracts Unit' Request lnformation Date: 1/30/26 To Program Budget Manager: Ellen Hafer From Approving Manager: Elaine Snouwaert Program/Office/Division: HWTR / ERO / PPA ContracUlAA/Amendment I nformation Yes Z *o Yes Z *o Yes E *o Yes Z *o Amendment No. (if aPPlicable): 01 Contract No. (if applicable): C2500178 contractor/lAAAgency: Kittitas county Public Health District Exemption lnformation This form affirms that the attached contracuamendment meets afreeze exemption or has been approved by the Deputy Director as outlined in Ecology's Directive 24-19 Freeze Guidance and Forms page. section 1 - Contracts and Amendments that DO NOT required Deputy Director approval and exempt from the OFM Freeze: Service contract orAmendment costing less than $10,000. Note: This also includes lnteragency and lntergovernmentalAgreements (lAAs), rier 2 Work orders under DES Master cOntracts, and work Assignments under Ecorogy's convenience Contracts (Prime). ECYlnternalForm_ContractsUnitFreezeExemptionTrackingForm New Service Contract: New IAA: New WorkAssignment: New DES Work Order: Rev.1l14l25 Docusign Envelope lD: A5542800-F078-88E3-82CC-81 CBA3BDES4C Funded entirelv by private OR federal funding sources Note: Any Service Contracts with state match, or a combination of state, federal/private local funds, are subject to the freeze. Zero-cost amendments. Note: Such as time extensions that don't add funds, administrative amendments (e.9., changing the contract manager, or redistributing existing contract funds between tasks). per additional OFM direction received 121612024 and updates received on 1211212024, the contracts below are also exempt from the freeze. All contracts funded by the enacted capital budqet and paid for entirely by bonds proceeds (e.g., State Building Construction Account). All public works contracts (as defined in RCW 39.04) funded by the enacted budgets, regardless of fund source (i.e. account). Section 2 - Service Contract or Amendments that DO required Deputy Director Approval per Directive 24-19 Freeze Guidance and Forms: This also includes lnteragency and lntergovernmentalAgreements (lAAs), Tier 2Work Orders under DES Master Contracts, and Work Assignments under Ecology's Convenience Contracts (Prime). Allservice Contracts costing $10,000 or more. (10K+; Amendments that increase the contract value by $10,000 or more. (Amd 10K+) Related to protection of life or public safety. (Safety) Tax collection or other revenue-generating activities. (Tax/Rev) Approved information technology projects (see OFM FAQ 6 and 7 for definition). (lT) Emergency Contracts as defined in RCW 39.26.130. (Emergency) ANY contract or amendment deemed essential by the Program/Office that does not meet an exemption listed above. (DD) ln accordance with Ecology's Freeze Guidance please move the referenced contracVamendment forward through the normal process. Budget Manager Approval Budget Manager's Signature: Digitally signed by Hafer Ellen (ECY) Date: 3t23t26€t'fa{d Date: 2026.03.23 13:42:54 -O7'OO' ECY lnternal Form - contracts unit Freeze Exemption Tracking Form Rev. 1114125 Docusign Envelope lD: A5542800-F078-88E3-82CC-B1C8A3BDE84C Form lnstructions and OFM Definitions Form lnstructions Contracts/Amendments - Approving Manager is to complete this form and submit it to the Program erJg"t Manager. erogram Budget ilt"n"get (or designee) shall submit this form along with the contiact pacr6t (FacJsneet and contraclamendment, etc.) as a complete packet via email to the Contracts Unit. Deputy DirectorApproval- For any item in Section 2 above, include the approved Freeze Exemitionlrxcepiiln Request Form for Service contracts Under Directive 24-19 in the email to the Contracts Unit with the contract packet (Contract, Face Sheet, orAmendment, and the Deputy Director Approval, if applicable). ln the email to the contracts Unit the Program Budget Manager shall state: ,,1 electronically approve both the attached Face Sheet and Contracts Unit Freeze Exemption Form for coniract Amendment # _contractor _:' OFM Definitions Exemption: the freezedoes not apply due to the criteria listed in the instructions (e g. protection of life or public safety related). However, agencies must document the rationale for their decisions internally and be prepared.to provide this documentation, if requested' Exception: An expense (hiring, contract, travel, goods or equipment) that is subject to the fre-eze but is deemed critical to statutory luties and therefore approved by the director (and reported to oFM)' Agencies must use the OFt\{ Freeze log to report their exceptions' ECY lnternal Form - Contracts Unit Freeze Exemption Tracking Form Rev.1114125 l'f docusign CerllfiEate Of ComPletion Envelope ld: A5542800-F07B-88E3-82CC-B1C8A3BDE84C subject: )25OO17B Kittitas and Dept. of Ecology PPA Contract Amendment FY2025-27 Docusign Source EnveloPe: Document Pages: 1 1 Signatures: 2 Certificate Pages: 2 lnitials: 3 AutoNav: Enabled Envelopeld StamPing: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) Record Tracking Status: Original 312512026 10:37:32 AM Security Appliance Status: Connected $igner Events Chelsey Loeffers jesse.cox@co. kittitas.wa. us EH Manager Kittitas County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Chelsey Loeffers chelsey.loeffers@co. kittitas.wa.us PH Director Kittitas County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Kristine Ray kray461@ecy.wa.gov Administrative Assistant 3 Department of EcologY Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Cheryl Blackburn cbla461@ecy.wa.gov Program Manager's Assistant Department of EcologY Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Holder: Kristine Ray kray461 @ecY.wa.gov Pool: StateLocal Signature Adoption: Pre-selected Style Using lP Address: 66.243.254.18 Status: Completed Envelope Originator: Kristine Ray P.O. Box 47600 Olympia, WA 98504 kray461@ecy.wa.gov lP Address: 162. 10.9.31 Location: DocuSign Timestamp Sent: 3/2512026 10:40:59 AM Resent: 4/8/2026 1 :30:11 PM Viewed: 51612026 9:19:35 AM Signed: 5/1412026 12:16:05 PM Senl: 51 1412026 I 2:16:07 PM Viewed: 511412026 12:16:54 PM Signed: 5/1412026 12:17:01 PM Senl 51 1 412026 12:17 :O3 PM Viewed: 512212026 8:57:08 AM Signed: 5/2212026 8:57:16 AM Sent: 512212026 8:57: 1 8 AM Viewed: 512212026 11:12:35 AM Signed 512212O26 1 1 : 1 2:55 AM Signature G" [Hi;b,ffrr\ 1aE42l. Signature Adoption: Pre-selected Style Using lP Address: 66.243.254.18 B Signature Adoption: Pre-selected Style Using lP Address: 162.10.9.29 Signature Adoption: Pre-selected Style Using lP Address: 162.10.9.32 W