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GRANT OR AGREEMENT AWARD COVER SHEET <br />dwim <br />FS-1500-0100 <br />OMB No. 0596-0217 <br />EXP: 05/31 /2027 <br />IDENTIFICATION•- • <br />1. Federal Award Identification Number (FAIN): 24-LE-11061700-080 <br />2. Cooperator Agreement/[nstrument #: NA <br />(Agreement Number) <br />3. New Modification ❑� Mod. Number 003 <br />4. Instrument (Project) Title: <br />Law Enforcement Activities in Kittitas County <br />FFA Award ❑ Master ❑ Stand -Alone ❑ SPA <br />5. Authority U.S.0 and Title: <br />6. Assistance Listing Number and Title: <br />ooperative Law Enforcement Act of August 10, 1971, Pub. L. 92-82, <br />16 U.S.C. 551a <br />10.704, Law Enforcement Agreements <br />7. Cooperator/Recipient Information (Must match SAM.gov): <br />8. U.S. Forest Service Unit Address (where the work is being managed): <br />Name: County of, Kittitas <br />Name: Okanogan -Wenatchee National Forest <br />Address: 307 W. Umptanum Rd <br />Address:215 Melody Lane <br />City: Ellensburg State WA Zip: 98926 <br />City: Wenatchee State WA Zip: 98801 <br />9. Cooperator Unique Entity Identifier (UEI): WQ23XPBSAU44 <br />10. Master Agreement Number if SPA: na <br />11. Period of Performance Start Date: <br />12. Master Agreement Expiration Date: <br />Execution Date: Expiration Date:03/19/2029 <br />(SPA expiration date cannot exceed the Master) <br />13. Cooperator Program Manager: <br />14. U.S. Forest Service Program Manager: <br />Name: Clay Myers, Sheriff <br />Name: Hailey Fuller, Captain <br />Phone: (509) 962-7525 Email: clay.myers@co.kittitas.wa.us <br />Phone: (541) 278-3840 Email: hailey.fuller@usda.gov <br />FINANCIAL INFORMATION <br />15. Federal Funding to be Obligated to Cooperator: $72,960.00 <br />16. Cooperator Contribution Funds: $0.00 <br />17. Payment Method: <br />18. Cooperator Match Percentage: 00.00% <br />No Funds ❑ Reimbursable Advance Advance Period <br />20. Cooperator Indirect Cost Rate (approved rate charged to award): <br />De minimis ❑ Supported ❑ NICRA Rate <br />19. Program Income/Revenue: No Yes <br />REPORTINGe <br />21. Performance Report Frequency: <br />22. Financial Report Frequency: <br />Quarterly ❑ Semi -Annual ❑ Annual Z N/A ❑ <br />ATTACHMENTS <br />Quarterly ❑ Semi -Annual Annual / N/A <br />The attachments listed below are hereby incorporated and made a part <br />of this instrument. <br />23. REQUIRED FOR ALL INSTRUMENTS: <br />24. REQUIRED DEPENDENT ON INSTRUMENT TYPE: <br />ZUSDA FFA/MIA General Terms and Conditions <br />Statement of Mutual Benefit and Interest <br />ZFS FFA/MIA/R&D General Terms and Conditions <br />Federal Financial Assistance Forms/Assurances <br />Purpose/Scope of Work Narrative <br />TFPA/638 Project Proposals <br />❑ Budget/Financial Plan <br />Modification Purpose and/or Description <br />Z Other (specify): Annual Operating and Financial Plan <br />I Z Other (specify): Addendum A, Specialized Equipment Rates <br />25. By signing this instrument, the signer certifies that they are vested with <br />the authority to enter into this instrument. <br />Cooperator Signature: <br />Name and Title: CLAY MYERS, Sheriff, Kitittas County <br />Date:i 130l'� <br />(l [[ <br />26. This instrument, subject to the provisions above, is executed by The U.S. Forest Service Authorized Signatory: <br />U.S. Forest Service Signatory Official (SO) Name and Title: <br />Signature: <br />SONNY ST.JOHN, Special Agent in Charge (Acting), <br />Date: <br />Pacific Northwest Law Enforcement and Investigations <br />27. The authority and format of this instrument have been reviewed and approved for signature. <br />MICHAEL Digitally signed by <br />U.S. Forest Service Grants Management Specialist Name: <br />Signature: MICHAEL GADDIS <br />GADDIS Date:0:084 <br />MICHAEL K. GADDIS <br />Date: 06/24/2026 <br />06-0700 <br />File Code:1500 For technical questions and Section 508 accommodation, please contact SM.FS.fseforms(a)usda.gov Page of <br />