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Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO:
Board of County Commissioners
Philip Morley, County Administrator
FROM:
Kate Driehaus, WSU Extension
DATE:
October 24, 2011
SUBJECT:
AGREEMENT NO. IG-CS-ll060900-023, Modification re: Challenge Cost
Share Agreement; No Change in Dollar Amount; Jefferson County WSU
Extension 4H Program; US Forest Service, Olympic National Forest
STATEMENT OF ISSUE:
Challenge Cost Share Agreement Modification; US Forest Service; WSU Extension
ANALYSIS:
Modification to update the Principal Contract and add standard prevision to the Challenge Cost Share
Agreement for the Jefferson 4-H Stewardship Project
RECOMMENDATION:
Approve and sign attached Challenge Cost Share Agreement Modification; US Forest Service; WSU
Extension
REVIEWED BY:
. . strator
Date
I S USDA Forest Servke
OMB 0596-02171
FS-1500-19
PAGE OF PAGES
MODIFICATION OF GRANT OR AGREEMENT 1 I 2
I. u.s. FOREST SERVICE GRANT/AGREEMENTNUMBER: 2. RECIPIENT/COOPERATOR GRANT or 3. MODlFICATIONNUMBER:
1 O-CS-ll 060900-023 AGREEMENT NUMBER, IF ANY: 01
4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING S. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING
GRANT/AGREEMENT (unitlllllIlO, stn:et, city. state. and zip + 4): PROJECT/ACTlV11Y (unit name. stn:et, city. state. and zip + 4):
OLYMPIC NATIONAL FOREST HOOD CANAL RANGER DISTRICT
1835 BLACK LAKE BLVD. SW, STE. A 29512 HWY 101, P.O. BOX 280
OLYMPIA, WA 98512~5623 QUILCENE, WA 98376
6. NAMElADDRESS OF RECIPIENT/COOPERATOR (stn:et, city. state. and zip + 7. REClPlENTfCOOPERATOR'S HHS SUB ACCOUNTNUMBER (For HHS
4.co~): payment use only):
JEFFERSON COUNTY N/A
BY AND THROUGH JEFFERSON COUNTY
WASHINGTON 4-H
201 W. PATISON STREET
PORTHADLOCK,WA 98339
.
8. fURPOSE OF MODIFICATION
CHECK ALL This modification is issued.pursuant to the modification provision in thegrant/agreenrent
mAT APPLY: referenced in item no. 1, above.
D CHANGE IN PERFORMANCE :PERIOD:
D CHANGE IN FUNDINO:
[gI ADMINISTRATIVE CHANGES: Update Principal Contacts and add a provision nnder Sectlon m. (See item 9,
~-~ . .
D OTHER (Specify type of modification):
Except as provided herein, an terms and conditions of the Grant/AgreeIIlent referenced In 1, above, remain nncltanged and In full
force and effect.
9. ADDmONAL SPACE FOR DESCRIPTION OF MODIFICATION (add additional pages as needed):
Revise Section V. as follows:
Update the Principal Contacts as follows:
U.S. Forest Service Program Contact U.S. Forest Service Administrative
Contact .
Name: Rebecca Hammargren Name: Colleen Brower
Address: 29512 Hwy 101, Po Box 280 Address: 1835 Black Lake Blvd. SW
City, State, Zip: Quilcene, WA 98376 City, State, Zip: Olympia, WA 98512
Telephone: 360-765-2219 Telephone: 360-956-2389
FAX: 360-765-2202 FAX: 360-956-2277
Email: rbammargren(q}fs.fed.us Email: cbrower@fs.fed.us
- I
OMB 0596-02171
FS-1500-19
I S USDA Forest Service
Cooperator Program Contact
Name: Kate Driehaus
Address: 201 W. Patison Street
City, State, Zip: Port Hadlock, W A 98339
Telephone: 360-379-5610, Ex!. 206
FJLK:360-379-5617
Email: kdriehaus@.co.iefferson.wa.us
Add the followim! Drovision to Section V.:
TEXT MESSAGING WHILE DRIVING. In accordance with Executive Order (EO) 13513, "Federal Leadership on Reducing
Text Messaging While Driving,>> any and all text nill$saging by Federal employees is banned: a) while driving a Government owned
vehicle (GOY) or driving a privately owned vehicle (POY) while on official Governnient business: or b) using any electronic equipment
supplied by the GoVernnient when driving any vehicle at any time. All recipients and subrecipients are encouraged to adopt and enforce
policies that ban text messaging when driving company owned, leased or rented vehicles or GOVs when driving while on official
Government business or when perfoTniing any work for or on behalf of the Government
10. ATTACHED DOCUMENTATION (Check all that apply):
Revised Scope of Work 0
Revised Financial Plan
D Other: .
11. SIGNATURE~ 0
AU1HORIZED REPRESENTATIVE: By SIGNATURE BELOW, THE SIGNING PARTIES CERTIFYTHATi1IEY ARE THE OFFICIAL REPRESENTATIVES OF
TIIEIR RESPECTIVE PARTIES AND AUI1IORIZED TO ACT IN TIIEIR RESl'ECTIVE ARIlAS FORMATIERS RELATED TO THE ABOVE-REFERENCED
GRANT/AGREEMENT.
11 A JEFFERSON COUNTY SIGNATURE 1I.B. DAlE I1.C. U.S. FOREST SERVICE SIGNATURE 1I.D.DAlE
SIGNED SIGNED
rSilmlllure ofSilmmorv OlIiclall . (Si"'""'~ ofSi Official)
1I.E. NAME (type or print): 0 0 ..n _0' . . 1I.F. NAME (type or print):
.:rahI'Lll-~:B(\_, DALE HOM
I1.G. TITLE (type or print): 1I.H. TITLE (type or priol):
Ci)ainnan, BOll\'Q ofComtnissioners Forest Suoervisor
12. G&A REVIEW
l2.A. The authority and format of this modification have been revIewed and approved for signatlire by: 12.B. DAlE
SIGNED
{'~~"-" 10/17/2011
COLLEEN BROWER
u.s. Fo_ SOIvice Gnmls & Snecialist
Approved as ta form only:
J)evvJ I 0/1'1 }2C> 11
Jefferson Co. Pr08llllUW'
1'1 USDAF~SeMce
OMB. 0596-02]71
. FS-]500-]9
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CCIl1rol1lllJllbar. Tha w1Id OMB CCIl1roI numbar fer 1his _on coI1acIion Is 0596-0217. The IIms ~ to canpIata 1his _011 _Ollis astimaIad to llVllIa!J& 30 mInulas per
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