HomeMy WebLinkAboutCONSENT PH Amend 1 On Site Sewage 615 Sheridan Street
Port Townsend, WA 98368
dell Orsonwww.JeffersonCountyPublicHealth.org
Public He5a1 Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, County Administrator
FROM: Pinky Feria Mingo, Environmental Health and Water Quality Director
Emma Erickson, Environmental Health Specialist
DATE:
SUBJECT: Agenda item — Amendment 1 to On-Site Sewage Action Plan with Puget Sound
Partnership; date of execution until June 30, 2027; $90,645
STATEMENT OF ISSUE:
Jefferson County Public Health, Environmental Health Division (JCPH), requests Board approval of the
Amendment (aka Administrative Memo #1) to the On-Site Sewage (OSS) Action Plan with Puget Sound
Partnership (PSP); date of execution until June 30, 2027; $90,645.
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
The purpose of this agreement is to complete goals identified in JCPH's OSS Action Plan with PSP: enhance
Jefferson County's permitting and records database to increase clarity in septic inspection data; develop OSS
education and outreach tools for septic system homeowners and property developers; and, digitize septic
permit records by scanning al4 paper septic records, ensuring records are complete, legible and available
online.
Contractor desires to amend the agreement to clarify that, under the terms of the agreement, "all"septic
records will not be digitized, nor was it ever intended that they would be.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Compensation for the work provided in accordance with this agreement has been established not to exceed
$90,645. This Contract includes federal funding. The amendment does not affect fiscal impact.
RECOMMENDATION:
JCPH management requests approval of the First Amendment to the OSS Action Plan with PSP; date of
execution until June 30, 2027; $90,645.
REVIEWED BY:
.Y/_30/2,.5"
Mark McCauley, C�e�in ty Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
EH-25-007-A 1
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Puget Sound Partnership Contract No: EH-25-007-A1
Contract For: On-Site Sewage Action Plan,Amendment 1 Term: Upon execution - 6/30/2027
COUNTY DEPARTMENT: Environmental Health
Contact Person: Emma Erickson
Contact Phone: #407
Contact email: eerickson@co.jefferson.wa.us
AMOUNT: $90,645 PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: $90,645 Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds _ Vendor List Bid
Fund #
127 RFP or RFQ
Munis Org/Obj 12756210 Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WIT JC"i 080 AND CHAPTER 42.23 RCW.
CERTIFIED: ■ N/A: Feb. 27, 2025
Signature `' Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
:e.
CERTIFIED: F. N/A: K, / Feb. 27, 2025
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 2/27/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 2/28/2025.
Amendment to paragraph 3 of the purpose statement.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
Administrative Memo #1
/ PUGETSOUND
PARTNERSHIP
Agreement Number: 2025-19
Title: Jefferson County On-Site Septic(OSS) Program Improvements
CONTRACTOR INFORMATION Project Manager
Jefferson County Public Health Emma Erickson
615 Sheridan Street EEricksonAco.iefferson.wa.us
Port Townsend,WA 98360 (360) 385-9407
Fiscal: Veronica Shaw
veronicaAco.iefferson.wa.us
(360)385-9405
PSP INFORMATION Project Manager
PUGET SOUND PARTNERSHIP Monea Kerr
PO Box 40900 Monea.kerr(a�psp.wa.gov
Olympia, WA 98504 (360) 742-7147
PURPOSE
This administrative memo#1 strikes the word "all of" from point 3 in the purpose statement, as indicated below.
The project team did not intend to have this grant cover the digitization of ALL the records. For clarity, the
funding dedicated to this task will be less than 10%of the total septic records.
The purpose of this agreement is to complete the following actions related to On-Site Sewage Systems(OSS)
in Jefferson County.
1. Enhance Jefferson County's permitting and records database Tyler Enterprise Permitting and Licensing
(EPL) by further developing the Application Programming Interface (API) that imports professional
septic inspection reports from OnlineRME (Responsible Management Entity) to EPL. API
enhancements will create clarity and consistency in septic inspection data imported into EPL. In
addition, Jefferson County will purchase the Tyler module Decision Engine which will integrate into EPL
and create an online tool for authorized homeowners to submit their septic inspection reports directly
into EPL.
2. Develop education and outreach tools for septic system homeowners and property developers
regarding best practices for owning and maintaining a septic system and nitrogen impacts to
groundwater and marine ecosystems. In addition, create demonstration models for use at septic
operation and monitoring outreach events.
3. Digitize septic permit records and files by scanning all--ef Jefferson County's paper septic records, which
will ensure the digital septic records are complete, legible, and available to the public online.
All other Terms & Conditions of the original agreement remain in full force and effect.
Jefferson County
Puget Sound Partnership Board of County Commissioners
Monea Kerr 2/10/2025
Name: Monea Kerr Date Heidi Eisenhour, Chair Date
Title: Project Manager
Approved as F Only:
/224 for 02/28/2025
Philip C. Hunsucker, Date
EH-25-007-A1 Chief Civil Deputy Prosecuting Attorney
PARTNERSHIP
Interagency Agreement
Agreement Number: 2025-19
Title: Jefferson County On-Site Septic OSS Pro•ram Im•rovements
This agreement is made and entered into pursuant to the Interlocal Cooperation Act, RCW 39.34, by and
between the state of Washington, Puget Sound Partnership (PSP), and the below named agency,
hereinafter referred to as "CONTRACTOR."
CONTRACTOR INFORMATION Project Manager
Jefferson County Public Health Emma Erickson UBI: 161001169
615 Sheridan Street EEricksonAco.iefferson.wa.us EIN: 916001322
Port Townsend,WA 98360 (360) 385-9407 UEI: FNXKANAVBP15
Type: Municipality
Fiscal: Veronica Shaw
v ronica ct=°z�,co.jeffers0n.wa.us
(360) 385-9405
PSP INFORMATION Project Manager
PUGET SOUND PARTNERSHIP Monea Kerr
PO Box 40900 Monea.kerrApsp.wa.aiov
Olympia,WA 98504 (360) 742-7147
PURPOSE
The purpose of this agreement is to complete the following actions related to On-Site Sewage Systems
(OSS) in Jefferson County.
1. Enhance Jefferson County's permitting and records database Tyler Enterprise Permitting and
Licensing (EPL) by further developing the Application Programming Interface (API)that imports
professional septic inspection reports from OnlineRME (Responsible Management Entity)to EPL.
API enhancements will create clarity and consistency in septic inspection data imported into EPL. In
addition, Jefferson County will purchase the Tyler module Decision Engine which will integrate into
EPL and create an online tool for authorized homeowners to submit their septic inspection reports
directly into EPL.
2. Develop education and outreach tools for septic system homeowners and property developers
regarding best practices for owning and maintaining a septic system and nitrogen impacts to
groundwater and marine ecosystems. In addition, create demonstration models for use at septic
operation and monitoring outreach events.
3. Digitize septic permit records and files by scanning all of Jefferson County's paper septic records,
and available to the public online.
which will ensure the digital septic records are complete, legible,
By implementing these actions, Jefferson County will be creating accessibility, clarity and consistency in the
County's septic operations and monitoring program.
STATEMENT OF WORK
The CONTRACTOR shall furnish the necessary personnel, equipment, material and/or service(s) and
otherwise do all things necessary for or incidental to the performance of the work set forth in Exhibit B
attached and incorporated herein.
In the event that the CONTRACTOR is a Sub-Recipient (grantee), Exhibit B shall describe the activities of
the Sub-Recipient that are eligible for reimbursement under the award or sub-award.
PERIOD OF PERFORMANCE February 2025
The period of performance under this agreement will be from the date of execution ( 3, )
through June 30, 2027. No work shall commence under this agreement until it has been fully
executed by both parties.
COMPENSATION AND PAYMENT
Compensation for the work provided in accordance with this agreement has been established under the terms
of RCW 39.34.130. The parties have estimated that the cost of accomplishing the work herein will not exceed
Ninety thousand six hundred forty five dollars($90,645). Payment for satisfactory performance of the work shall
AGREEMENT NO. 2025-19 Page 1 of 26
not exceed this amount unless the parties mutually agree to a higher amount prior to the commencement of
any work which will cause the maximum payment to be exceeded. CONTRACTOR'S compensation for
services rendered shall be in accordance with the Budget& Billing Procedures attached as Exhibit C.
In the event that the CONTRACTOR is a Sub-Recipient, the total amount of the award or sub-award for
reimbursable activities shall not exceed the above amount, also in accordance with the Budget & Billing
Procedures attached as Exhibit C.
FEDERAL FUNDING INFORMATION
This Contract includes federal funding ® Yes ❑No
Use this language if its State matched funds but has federal requirements within SOW:
The Statement of Work in Exhibit B is included in a Federal work plan and therefore, this contract is subject
to Federal Requirements in Exhibit A? ®Yes ❑No
CONTRACTOR is a Sub-Recipient for purposes of this agreement ® Yes ❑ No
Federal Grant Federal Grant Federal Agency
CFDA# CFDA Title Award Number Award Name Name
66.456 National Estuary CE-01J97401-0 Puget Sound Environmental
Program Base and Partnership National Protection Agency
IS/SCI Estuary Program
TERMS AND CONDITIONS
All rights and obligations of the parties to this contract shall be subject to and governed by the Terms and
Conditions contained in the following exhibits, herein incorporated by reference. The contents of this
Agreement include:
1. This contract cover sheet
2. Exhibit A—General Terms and Conditions
3. Exhibit B—Statement of Work
4. Exhibit C— Budget& Billing Procedures
5. Exhibit D - Lobbying Certification
6. Exhibit E—Sub-Recipient Federal Requirements (only if this is a Sub-Recipient contract)
• Attachment 1- Federal Assurances Form 424E (Rev 4-2012)
• Attachment 2- Federal Funding Accountability and Transparency Act Data Collection (FFATA
form
ORDER OF PRECEDENCE
In the event of an inconsistency in this agreement, the inconsistency shall be resolved by giving precedence
in the following order:
1. Applicable Federal and State of Washington Statutes and regulations
2. This Agreement/Contract, including Exhibit A, General Terms and Conditions
3. Exhibit B, Statement of Work and Exhibit C, Budget& Billing Procedures
4. Any other Exhibit or provision, term or material incorporated herein by reference or otherwise
incorporated
ENTIRE AGREEMENT
This agreement, including referenced exhibits and any other provision, term or material expressly
incorporated by reference, represents all the terms and conditions agreed upon by the parties. No other
statements or representations, written or oral, shall be deemed a part hereof.
APPROVAL
This agreement shall be subject to the written approval of the AGENCY'S authorized representative and
shall not be binding until so approved. The agreement may be altered, amended, or waived only by a
written amendment executed by both parties.
AGREEMENT NO. 2025-19 Page 2 of 26
This agreement is executed by the persons signing below, who warrant they have the authority to execute
the agreement.
Jefferson County Puget Sound Partnership
Board of County Commissioners
02/03/2025
A AAA
Heidi Eisenhour Date Brent Barnes Date
Chair Chief Operating Officer
Approved as to Form Only:
6,fp.. for 01/23/2025
Philip C. Hunsucker Date
Chief Civil Deputy Prosecuting Attorney
APPROVED AS TO FORM:
/s Jonathan Thompson
Assistant Attorney General
December 5, 2013
Date
AGREEMENT NO. 2025-19 Page 3 of 26
EXHIBIT A -
GENERAL TERMS AND CONDITIONS
Title: Jefferson County On-Site Septic(OSS) Program Improvements
1. DEFINITIONS
As used throughout this contract, the following terms shall have the meaning set forth below:
A. "AGENCY" means the Puget Sound Partnership(PSP)of the State of Washington, any division,
section, office, unit or other entity of the AGENCY, or any of the officers or other officials lawfully
representing that AGENCY.
B. "AGENT" means the Director, and/or the delegate authorized in writing to act on the Director's behalf.
C. "CONTRACTOR" means that firm, provider, organization, individual or other entity performing
service(s) under this contract, and shall include all employees of the CONTRACTOR.
D. "DEBARMENT" means an action taken by a Federal agency or official to exclude a person or
business entity from participating in transactions involving certain federal funds.
E. "EPA" means U.S. Environmental Protection Agency.
F. "SUBCONTRACTOR" means one not in the employment of the CONTRACTOR, who is performing
all or part of those services under this contract under a separate contract with the CONTRACTOR.
The terms"SUBCONTRACTOR"and"SUBCONTRACTORS" means SUBCONTRACTOR(s) in any
tier.
G. "SUB-RECIPIENT" means a non-Federal entity that receives a subaward from a pass-through entity
to carry out part of a Federal program; but does not include an individual that is a beneficiary of such
program. A subrecipient may also be a recipient of other Federal awards directly from a Federal
awarding agency. Guidance on distinguishing between a subrecipient and a contractor is provided in
2 CFR§200.330. Subrecipient and contractor determinations.
2. AMERICANS WITH DISABILITIES ACT (ADA)
If the contract includes federal funding, the CONTRACTOR must comply with Section 504 of the
Rehabilitation Act of 1973, which prohibits discrimination against persons with disabilities by entities
receiving Federal financial assistance. The CONTRACTOR may also be required to comply with the
ADA, which provides comprehensive civil rights protection to individuals with disabilities in the areas of
employment, public accommodations, state and local government services, and telecommunications.
3. ADVANCE PAYMENTS PROHIBITED
No payments in advance of or in anticipation of goods or services to be provided under this contract shall
be made by the AGENCY.
4. AMENDMENT
This Agreement may be amended by mutual agreement of the parties. Such amendments shall not be
binding unless they are in writing and signed by personnel authorized to bind each of the parties.
5. ASSIGNMENT
The work to be provided under this Agreement, and any claim arising under this Agreement, is not
assignable or delegable by either party in whole or in part, without the express prior written consent of the
other party, which consent shall not be unreasonably withheld.
6. ASSURANCES
The parties agree that all activity pursuant to this Agreement shall be in accordance with all applicable
federal, state and local laws, rules, and regulations as they currently exist or as amended.
AGREEMENT NO. 2025-19 Page 4 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
7. CONFIDENTIALITY
Confidential information: The CONTRACTOR shall not use or disclose any information that is identified as
such, for any purpose not directly connected with the administration of this contract, except with prior
written consent of the AGENCY, or as may be required by law. Each party will utilize reasonable security
procedures and protections to assure that records and documents provided by the other party are not
erroneously disclosed to third parties. However, the parties acknowledge that state and local agencies
are subject to chapter 42.56 ROW, the Public Records Act.
Personal Information (one form of confidential information): Personal information including, but not limited
to, "Protected Health Information," collected, used, or acquired in connection with this contract shall be
protected against unauthorized use, disclosure, modification or loss. CONTRACTOR shall ensure its
directors, officers, employees, subcontractors or agents use personal information solely for the purposes
of accomplishing the services set forth herein. CONTRACTOR and its subcontractors agree not to
release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal
information without the express written consent of the agency or as otherwise required by law. Any
breach of this provision may result in termination of the contract and the demand for return of all personal
information. The CONTRACTOR agrees to indemnify and hold harmless the AGENCY for any damages
related to the CONTRACTOR'S unauthorized use of personal information.
8. CREDIT AND ACKNOWLEDGEMENT
Reports, documents, signage, videos, or other media, developed as part of projects funded by EPA
funded Agreements shall display both the EPA and Puget Sound Partnership logos and the following
credit line: "This project has been funded wholly or in part by the United States Environmental Protection
Agency under Assistance Agreement[CE-01J97401-0 to Jefferson County Public Health].The contents
of this document do not necessarily reflect the views and policies of the Environmental Protection
Agency, nor does mention of trade names or commercial products constitute endorsement or
recommendation for use."
9. DEBARMENT AND SUSPENSION
CONTRACTOR, by signature to this Contract, certifies that CONTRACTOR is not presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal
department or agency from participating in transactions (Debarred). CONTRACTOR shall comply with
applicable federal agency debarment and suspension rules adopted pursuant to Office of Management
and Budget guidance at 2 CFR Part 180, such as 2 CFR Part 1532 for the Environmental Protection
Agency, which implement Executive Order 12549. CONTRACTOR acknowledges that failing to disclose
the information required at 2 CFR 180.335 may result in the delay or negation of this contract, or
pursuance of legal remedies, including suspension and debarment.
CONTRACTOR shall not award subcontracts or subawards to persons (individuals or organizations)
listed on the Excluded Parties List located at www.sam.gov/. CONTRACTOR agrees to include the above
requirements in all subcontracts into which it enters. The CONTRACTOR shall immediately notify
AGENCY if, during the term of this Contract, CONTRACTOR becomes Debarred. AGENCY may
immediately terminate this Contract by providing CONTRACTOR written notice if CONTRACTOR
becomes Debarred during the term hereof.
10. DISALLOWED COSTS
CONTRACTOR is responsible for any audit exceptions or disallowed costs incurred by its own
organization or that of its Subcontractors.
11. DISPUTES
In the event that CONTRACTOR is a state agency and a dispute arises under this Agreement, either of
the parties may request intervention by the Governor, as provided by chapter 43.17.330 ROW, in which
event the Governor's process will control.
In the event that a dispute arises under this Agreement, and the CONTRACTOR is not a state agency, it
shall be determined by a Dispute Board in the following manner: Each party to this Agreement shall
appoint one member to the Dispute Board. The members so appointed shall jointly appoint an additional
AGREEMENT NO. 2025-19 Page 5 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
member to the Dispute Board. The Dispute Board shall evaluate the facts,Agreement terms, applicable
statutes and rules, and make a determination of the dispute. The determination of the Dispute Board shall
be final and binding on both parties.
The cost of resolution will be borne as allocated by the Dispute Board or the Governor.
12. DUPLICATION OF BILLED COSTS
The CONTRACTOR shall not bill the Agency for services performed under this contract, and the Agency
shall not pay the CONTRACTOR if the CONTRACTOR is entitled to payment or has been or will be paid
by any other source, including grants, for that service.
13. GEOSPATIAL DATA STANDARDS
All geospatial data created must be consistent with Federal Geographic Data Committee(FGDC)
endorsed standards. Information on these standards may be found at https://www.fgdc.00vt
14. GOVERNING LAW
AND VENUE
This Agreement shall be construed and interpreted in accordance with the laws of the State of
Washington and the venue of any action brought under this Agreement shall be in Superior Court for
Thurston County.
15. HOTEL MOTEL FIRE SAFETY ACT
The Hotel and Motel Fire Safety Act of 1990 (Public Law 101-391, as amended by PL 105-85 in 1997),
establishes a number of fire safety standards which must be met for hotels and motels. Pursuant to the
Act, if applicable, and 15 USC 2225a if any portion of this contract will be paid with federal funds,
CONTRACTOR agrees to ensure that all space for conferences, meetings, conventions, or training
seminars funded in whole or in part with federal funds complies with the protection and control guidelines
of the Hotel and Motel Fire Safety Act(PL 105-85, as amended). CONTRACTOR may search the Hotel-
Motel National Master List at: https:llapps.usfa.fema.gov?hotel to see if a property is in compliance (FEMA
ID is currently not required), or to find other information about the Act.
If necessary, the head of the Federal agency may waive this prohibition in the public interest.
16. INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the performance of this Agreement shall
continue to be employees or agents of that party and shall not be considered for any purpose to be
employees or agents of the other party.
17. INTELLECTUAL PROPERTY RIGHTS
Unless otherwise provided, all materials produced under this contract shall be considered"works for hire"
as defined by the U.S. Copyright Act 17 U.S.C. § 101, et seq., and shall be owned by the AGENCY.
Where federal funding is involved, the awarding federal agency may have a proprietary interest in patent
rights to any inventions that are developed by the CONTRACTOR as provided in 35 U.S.C. §§200-212
and 37 CFR part 401 and retains a royalty-free, nonexclusive, and irrevocable right to reproduce, publish,
or otherwise use the work for Federal purposes, and to authorize others to do so.
CONTRACTOR acknowledges that in accordance with 40 CFR 30.36 and 31.34, EPA has the rights to
reproduce, publish, use, and authorize others to use copyrighted works or other data developed under
this assistance agreement for Federal purposes.
Examples of a Federal purpose include but are not limited to: (1) Use by EPA and other Federal
employees for official Government purposes; (2) Use by Federal contractors performing specific tasks for
the Government; (3) Publication in EPA documents provided the document does not disclose trade
secrets (e.g. software codes) and the work is properly attributed to the recipient through citation or
otherwise; (4) Reproduction of documents for inclusion in Federal depositories; (5) Use by State, tribal
and local governments that carry out delegated Federal environmental programs as"co-regulators" or act
AGREEMENT NO. 2025-19 Page 6 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
as official partners with EPA to carry out a national environmental program within their jurisdiction and; (6)
Limited use by other grantees to carry out Federal grants provided the use is consistent with the terms of
EPA's authorization to the other grantee to use the copyrighted works or other data.
Under Item 6, the grantee acknowledges that EPA may authorize other grantee(s)to use the copyrighted
works or other data developed under this grant as a result of:
• the selection of another grantee by EPA to perform a project that will involve the use of the
copyrighted works or other data or:
• termination or expiration of this agreement.
In addition, EPA may authorize another grantee to use copyrighted works or other data developed with
Agency funds provided under this grant to perform another grant when such use promotes efficient and
effective use of Federal grant funds.
Materials means all items in any format and includes, but is not limited to, data, reports, documents,
pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or
sound reproductions. Ownership includes the right to copyright, patent, register and the ability to transfer
these rights.
In the event the materials are not considered"works for hire" under the U.S. Copyright laws
CONTRACTOR shall grant AGENCY, and any federal entity which provided federal funds used in this
contract, retain a royalty-free, nonexclusive and irrevocable license to reproduce, publish, recover or
otherwise use the material(s) or property and to authorize others to use the same for federal, state or
local government purposes.
Material which CONTRACTOR uses to perform the contract but is not created for or paid for by AGENCY
is not"work made for hire"; however, CONTRACTOR grant the AGENCY a nonexclusive, royalty-free,
irrevocable license to translate, reproduce, distribute, prepare derivative works, publicly perform, and
publicly display, provided that such license shall be limited to the extent which CONTRACTOR has a right
to grant such a license to use this material for AGENCY internal purposes at no charge to AGENCY.
18. INTERNATIONAL TRAVEL (including Canada) —FOR FEDERAL FUNDED
AGREEMENTS ONLY
All International Travel must be approved by the Office of International and Tribal Affairs (OITA) BEFORE
travel occurs. Even a brief trip to a foreign country, for example attending a conference, requires OITA
approval. Please contact your EPA Project Officer as soon as possible if travel is planned out of the
country, including Canada and/or Mexico, so that they can obtain appropriate approvals from EPA
Headquarters. If you have questions, please contact your EPA Project Officer listed on the front page of
the Award Document
19. LIGHT REFRESHMENTS and/or MEALS
Unless the event(s) and all of its components are described in the approved workplan, the recipient
agrees to obtain prior approval from EPA for the use of grant funds for light refreshments and/or meals
served at meetings, conferences, training workshops, and outreach activities(events). The recipient must
send requests for approval to the EPA Project Officer and include:
1) An estimated budget and description for the light refreshments, meals, and/or beverages to be
served at the event(s);
2) A description of the purpose, agenda, location, length and timing for the event; and,
3) An estimated number of participants in the event and a description of their roles.
Cost for light refreshments and meals for recipient staff meetings and similar day-to-day activities are not
allowable under EPA assistance agreements.
20. LOBBYING PROHIBITED
a. By signing this contract, CONTRACTOR agrees to comply with Title 40 CFR Part 34, New
Restrictions on Lobbying, 31 U.S.C. § 1352, and 40 CFR Part 30 if applicable. CONTRACTOR
shall include the language of this provision in subcontracts that exceed $100,000 of federal funds
and require all subcontractors to certify and disclose accordingly.
AGREEMENT NO. 2025-19 Page 7 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
b. This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code.Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
c, No Federal appropriated funds shall be paid by or on behalf of the CONTRACTOR to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant,the
making of any Federal loan,the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or
cooperative agreement.
d. If this contract includes federal funds exceeding $100,000, CONTRACTOR shall sign and
submit to AGENCY Exhibit D,Attachment 2, PSP Certification Regarding Lobbying (based on
EPA Form 6600-06(Rev. 06/2008). If CONTRACTOR signed and submitted the PSP
Certification Regarding Lobbying form during the procurement process for this contract it is
not necessary to resubmit the certification.
e. If CONTRACTOR expends non-federal funds in any amount to lobby as detailed in a., above,
CONTRACTOR shall complete and submit to Standard Form LLL(Rev. 4/2012), Disclosure of
Lobbying Activity. The form can be found at:
http:/lwww.epa.gov/ogd/AppKitlformisflllin_sec.pdf.
21. LOBBYING AND LITIGATION
a. All recipients
i. The chief executive officer of this recipient agency shall ensure that no grant funds awarded under this
assistance agreement are used to engage in lobbying of the Federal Government or in litigation against
the U.S. unless authorized under existing law. The recipient shall abide by the Cost Principles available at
2 CFR 200 which generally prohibits the use of federal grant funds for litigation against the U.S. or for
lobbying or other political activities.
ii. The recipient agrees to comply with Title 40 CFR Part 34, New Restrictions on Lobbying. The recipient
shall include the language of this provision in award documents for all subawards exceeding $100,000
and require that subrecipients submit certification and disclosure forms accordingly.
iii. In accordance with the Byrd Anti-Lobbying Amendment, any recipient who makes a prohibited
expenditure under Title 40 CFR Part 34 or fails to file the required certification or lobbying forms shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such expenditure.
iv. Contracts awarded by a recipient shall contain,when applicable, the anti-lobbying provision as
stipulated in the Appendix II to Part 200—Contract Provisions for Non-Federal Entity Contracts Under
Federal Awards.
v. Pursuant to Section 18 of the Lobbying Disclosure Act,the recipient affirms that it is not a nonprofit
organization described in Section 501(c)(4) of the Internal Revenue Code of 1986; or that it is a nonprofit
organization described in Section 501(c)(4) of the Code but does not and will not engage in lobbying
activities as defined in Section 3 of the Lobbying Disclosure Act. Nonprofit organizations exempt from
taxation under section 501(c)(4)of the Internal Revenue Code that engage in lobbying activities are
ineligible for EPA subawards.
22. NONDISCRIMINATION
a. Nondiscrimination Requirement. During the term of this Contract, Contractor, including any
subcontractor, shall not discriminate on the bases enumerated at RCW 49.60.530(3). In addition,
Contractor, including any subcontractor, shall give written notice of this nondiscrimination
requirement to any labor organizations with which Contractor, or subcontractor, has a collective
bargaining or other agreement.
AGREEMENT NO. 2025-19 Page 8 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
b. Obligation to Cooperate. Contractor, including any subcontractor, shall cooperate and comply
with any Washington state agency investigation regarding any allegation that Contractor,
including any subcontractor, has engaged in discrimination prohibited by this Contract pursuant
to RCW 49.60.530(3).
c. Default. Notwithstanding any provision to the contrary,Agency may suspend Contractor,
including any subcontractor, upon notice of a failure to participate and cooperate with any state
agency investigation into alleged discrimination prohibited by this Contract, pursuant to RCW
49.60.530(3). Any such suspension will remain in place until Agency receives notification that
Contractor, including any subcontractor, is cooperating with the investigating state agency. In the
event Contractor, or subcontractor, is determined to have engaged in discrimination identified at
RCW 49.60.530(3), Agency may terminate this Contract in whole or in part, and Contractor,
subcontractor, or both, may be referred for debarment as provided in RCW 39.26.200.
Contractor or subcontractor may be given a reasonable time in which to cure this
noncompliance, including implementing conditions consistent with any court-ordered injunctive
relief or settlement agreement.
d. Remedies for Breach. Notwithstanding any provision to the contrary, in the event of Contract
termination or suspension for engaging in discrimination, Contractor, subcontractor, or both,
shall be liable for contract damages as authorized by law including, but not limited to, any cost
difference between the original contract and the replacement or cover contract and all
administrative costs directly related to the replacement contract, which damages are distinct
from any penalties imposed under Chapter 49.60, ROW.Agency shall have the right to deduct
from any monies due to Contractor or subcontractor, or that thereafter become due, an amount
for damages Contractor or subcontractor will owe Agency for default under this provision.
23. NONDISCRIMINATION and DISADVANTAGED BUSINESS ENTERPRISES
In accordance with 40 CFR 33.106 and its Appendix A, the CONTRACTOR shall not discriminate on the
basis of race, color, national origin or sex in the performance of this contract. The contractor shall carry
out applicable requirements of 40 CFR part 33 in the award and administration of contracts awarded
under EPA financial assistance agreements. Failure by the contractor to carry out these requirements is a
material breach of this contract which may result in the termination of this contract or other legally
available remedies.
24. PAYMENT TO CONSULTANTS
EPA will limit its participation in salary rate (excluding overhead) paid to individual consultants retained by
recipients or by a recipients' contractors or subcontractors shall be limited to the maximum daily rate for
Level IV of the Executive Schedule(formerly GS-18), to be adjusted annually, unless a greater amount is
authorized by law. This limitation applies to consultation services of designated individuals with
specialized skills who are paid at a daily or hourly rate. This rate does not include transportation and
subsistence costs for travel performed (the recipient will pay these in accordance with their normal travel
reimbursement practices).
All contracts between recipients and subrecipients and individual consultants are subject to the
procurement standards in subpart D of 2 CFR part 200. Contracts or subcontracts with multi-employee
firms for consulting services are not affected by the limitation described above, provided the contractor or
subcontractor, rather than the recipient or subrecipient, selects, directs and controls individual employees
providing consulting services.
As of January 1, 2024, the limit is $91.95 per hour or$735.60 per day.
(Calculations: 2024 Level IV Executive Schedule annual pay=$191,900/2087= $91.95 per hour or
$735.60 per day).
25. PROJECT APPROVAL
The quality, extent and character of any and all work, deliverables and/or services to be performed under
this agreement by the CONTRACTOR shall be subject to the review and approval of the AGENCY
through the Project Manager or other designated official. In the event that the AGENCY determines, that
any work, deliverable, and/or service performed by the CONTRACTOR is unsatisfactory, the AGENCY
AGREEMENT NO. 2025-19 Page 9 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
may withhold reimbursement for the unsatisfactory work performed by the CONTRACTOR or require that
the CONTRACTOR remediate their work product to get it to the satisfaction of the AGENCY. Such
approval and satisfaction is not unreasonably withheld. The Parties may agree in the Statement of Work
to specific approval, acceptance, and/or remediation terms. If the Statement of Work is silent on this topic,
the Disputes provision, above, will govern the resolution process.
26. RECORDS MAINTENANCE
The parties to this Agreement shall each maintain books, records, documents and other evidence that
sufficiently and properly reflect all direct and indirect costs expended by either party in the performance of
the service(s) described herein. CONTRACTOR shall retain such records for a period of six years
following the date of final payment.
At no additional cost, these records, including materials generated under the contract, shall be subject at
all reasonable times to inspection, review or audit by the AGENCY, personnel duly authorized by the
AGENCY, the Office of the State Auditor, and federal and state officials so authorized by law, regulation
or agreement. If this contract exceeds$100,000 and any portion of the funding source is federal, the
federal funding agency, the Comptroller General of the United States, or any duly authorized
representatives shall have access to books documents, papers, and records of CONTRACTOR directly
pertinent to this contract for purpose of making audits, examination, excerpts and transcriptions (40 CFR
30.48(d)).
If any litigation, claim or audit is started before the expiration of the six(6) year period, the records shall
be retained until all litigation, claims, or audit findings involving the records have been resolved.
27. RECYCLED PAPER
In accordance with Section 6002 of the Resource Conservation and Recovery Act (RCRA) (42 U.S.C.
6962) any State agency or agency of a political subdivision of a State which is using appropriated Federal
funds shall comply with the requirements set forth. Regulations issued under RCRA Section 6002 apply
to any acquisition of an item where the purchase price exceeds$10,000 or where the quantity of such
items acquired in the course of the preceding fiscal year was $10,000 or more. RCRA Section 6002
requires that preference be given in procurement programs to the purchases of specific products
containing recycled materials identified in guidelines developed by EPA. These guidelines are listed in 40
CFR 247.
In accordance with the policies set forth in EPA Order 1000.25 and Executive Order 13423,
Strengthening Federal Environmental, Energy and Transportation Management(January 24, 2007), Sub-
Recipient agrees to use recycled paper and double-sided printing for all reports which are prepared as
part of this Agreement and delivered to EPA. This requirement does not apply to reports prepared on
forms supplied by EPA, or to Standard Forms, which are printed on recycled paper and are available
through the General Services Administration.
28. RESPONSIBILITIES OF THE PARTIES
Each party to this Agreement hereby assumes responsibility for claims and/or damages to persons and/or
property resulting from any negligent act or omissions on the part of itself, its employees, its officers, and
its agents. Neither party assumes any responsibility to the other party for the consequences of any claim,
act, or omission of any person, agency, firm, or corporation not a part to this Agreement.
29. SEVERABILITY
If any term or condition of this Agreement is held invalid, such invalidity shall not affect the validity of the
other terms or conditions of this Agreement.
30. STATE GRANT CYBERSECURITY
(a) The recipient agrees that when collecting and managing environmental data under this assistance
agreement, it will protect the data by following all applicable State law cybersecurity requirements.
(b) (1) EPA must ensure that any connections between the recipient's network or information system and
EPA networks used by the recipient to transfer data under this agreement, are secure.
AGREEMENT NO. 2025-19 Page 10 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
(2)The recipient agrees that any subawards it makes under this agreement will require the
subrecipient to comply with the requirements in (b)(1) if the subrecipient's network or information system
is connected to EPA networks to transfer data to the Agency using systems other than the Environmental
Information Exchange Network or EPA's Central Data Exchange.
31. SUBCONTRACTING
Neither the CONTRACTOR nor any SUBCONTRACTOR shall enter into subcontracts for any of the work
contemplated under this contract without obtaining prior written approval of the AGENCY. In no event
shall the existence of the subcontract operate to release or reduce the liability of the contractor to the
agency for any breach in the performance of the contractor's duties. This clause does not include
contracts of employment between the contractor and personnel assigned to work under this contract.
Additionally, the CONTRACTOR is responsible for ensuring that all terms, conditions, assurances and
certifications set forth in this agreement are carried forward to any subcontracts
32.TERMINATION DUE TO FUNDING
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after
the effective date of this contract and prior to normal completion,the AGENCY may terminate the contract
under the"Termination for Convenience"clause, without the ten-day notice requirement, subject to
renegotiation at the AGENCY'S discretion under those new funding limitations and conditions. Agency will
reimburse CONTRACTOR for all expenses incurred, including non-cancelable expenses, up until the date
of termination.
33.TERMINATION FOR CAUSE
If for any cause either party does not fulfill in a timely and proper manner its obligations under this
Agreement, or if either party violates any of these terms and conditions, the aggrieved party will give the
other party written notice of such failure or violation. The responsible party will be given the opportunity to
correct the violation or failure within 15 working days. If the failure or violation is not corrected, this
Agreement may be terminated immediately by written notice of the aggrieved party to the other.
34. TERMINATION FOR CONVENIENCE
Either party may terminate this Agreement upon 30 calendar days' prior written notification to the other
party. If this Agreement is so terminated, the parties shall be liable only for the performance rendered or
costs incurred, including NON-CANCELABLE expenses, in accordance with the terms of this Agreement
prior to the effective date of termination.
35. TREATMENT OF ASSETS
a. Title to all property furnished by the AGENCY shall remain in the AGENCY. Title to all property
furnished by the CONTRACTOR, for the cost of which the CONTRACTOR is entitled to be
reimbursed as a direct item of cost under this contract, shall pass to and vest in the AGENCY
upon delivery of such property by the CONTRACTOR. Title to other property, the cost of which is
reimbursable to the CONTRACTOR under this contract, shall pass to and vest in the AGENCY
upon (i) issuance for use of such property in the performance of this contract, or(ii)
commencement of use of such property in the performance of this contract, or(iii) reimbursement
of the cost thereof by the AGENCY in whole or in part, whichever first occurs.
b. Any property of the AGENCY furnished to the CONTRACTOR shall, unless otherwise provided
herein or approved by the AGENCY, be used only for the performance of this contract.
c. The CONTRACTOR shall be responsible for any loss or damage to property of the AGENCY that
results from the negligence of the CONTRACTOR or which results from the failure on the part of
the CONTRACTOR to maintain and administer that property in accordance with sound
management practices.
d. If any AGENCY property is lost, destroyed or damaged, the CONTRACTOR shall immediately
notify the AGENCY and shall take all reasonable steps to protect the property from further
damage.
AGREEMENT NO. 2025-19 Page 11 of 26
Exhibit A
General Terms and Conditions
Title: Jefferson County On-Site Septic(OSS) Program Improvements
e. The CONTRACTOR shall surrender to the AGENCY all property of the AGENCY prior to
settlement upon completion, termination or cancellation of this contract.
f. All reference to the CONTRACTOR under this clause shall also include CONTRACTOR'S
employees, agents or SUBCONTRACTORS.
36. UTILIZATION OF DIVERSE BUSINESSES
The State of Washington works towards providing the maximum practicable opportunity for small and
diverse businesses in the performance of all State contracts. Contractor shall use genuine efforts to utilize
race-or gender-neutral means to allow opportunities for small and diverse businesses to participate in
subcontracts, where participation opportunities are present. Contractor shall make genuine efforts to
ensure all available business enterprises, including small and diverse businesses, have equal opportunity
for participation which might be presented under this Agreement.
37.WAIVER
Waiver of any default or breach shall not be deemed to be a waiver of any subsequent default or breach.
Any waiver shall not be construed to be a modification of the terms of this Agreement unless stated to be
such in writing and signed by personnel authorized to bind each of the parties.
AGREEMENT NO. 2025-19 Page 12 of 26
EXHIBIT B-
STATEMENT OF WORK
Title: Jefferson County On-Site Septic(OSS) Program Improvements
Purpose Statement:
The purpose of this agreement is to complete the following actions related to On-Site Sewage Systems
(OSS) in Jefferson County.
1. Enhance Jefferson County's permitting and records database Tyler Enterprise Permitting and
Licensing (EPL) by further developing the Application Programming Interface (API)that imports
professional septic inspection reports from OnlineRME (Responsible Management Entity)to EPL.
API enhancements will create clarity and consistency in septic inspection data imported into EPL.
In addition, Jefferson County will purchase the Tyler module Decision Engine which will integrate
into EPL and create an online tool for authorized homeowners to submit their septic inspection
reports directly into EPL.
2. Develop education and outreach tools for septic system homeowners and property developers
regarding best practices for owning and maintaining a septic system and nitrogen impacts to
groundwater and marine ecosystems. In addition, create demonstration models for use at septic
operation and monitoring outreach events.
3. Digitize septic permit records and files by scanning all of Jefferson County's paper septic records,
which will ensure the digital septic records are complete, legible, and available to the public
online.
By implementing these actions, Jefferson County will be creating accessibility, clarity and consistency in
the County's septic operations and monitoring program.
The CONTRACTOR shall report in writing any problems, delays or adverse conditions that will materially
affect their ability to meet project objectives or time schedules. This disclosure shall be accompanied by a
statement of the action taken or proposed and any assistance needed by PSP to resolve the situation.
Payment 1
Deliverable/ Due Date/ Information
Task Task/Activities/ Outcome Timeframe and/or
Description Amount
1 Complete OSS Focused Actions in Jefferson County $90,645
a Project management Submit quarterly invoices and Ongoing through
and administration progress reports 6/30/2027
b - Data Management 1. Import OnlineRME 6/30/2027
and Improvement (Responsible Management
Entity) data into EPL
(Enterprise Permitting and
Licensing) database and
consult with Tyler
Technologies.
2. Purchase the Decision Engine
for Online Homeowner Septic
inspections.
c Develop Educational 1. Develop Educational Videos 6/30/2027
Tools(e.g. videos, for homeowners and property
classes, models) developers. Video topics on
'Best Practices of Owning and
Maintaining an on-site septic
system' and 'Development
considerations of septic
systems on small lots;
AGREEMENT NO. 2025-19 Page 13 of 26
Exhibit B
Statement of Work
Title: Jefferson County On-Site Septic(OSS)Program Improvements
Payment I
Deliverable/ Due Date/ Information
Task Task/Activities/ Outcome Timeframe and/or
Description Amount
Nitrogen impacts to
groundwater and marine
ecosystem'.
2. Develop a tabletop model of a
Septic System for use at septic
classes, home shows, and
other events.
3. Develop a model of sewer line
impacted by roots for use at
septic classes, home shows,
and other events.
d Digitize Septic Digital files prepared for 6/30/2027
Records conversion by Central Services
Staff.
Total Maximum Amount $90,645
PROGRAM SPECIFIC REQUIREMENTS/NARRATIVE
Staffing Requirements: The PSP Executive Director or designee must approve project personnel
changes.
AGREEMENT NO. 2025-19 Page 14 of 26
EXHIBIT C -
Budget& Billing Procedures
Title: Jefferson County On-Site Septic(OSS) Program Improvements
CONTRACT: 2025-19
PROJECT TITLE: Jefferson County On-Site Septic (OSS) Program improvements
TASK 1 TOTAL
Complete OSS
Focused Actions
in Jefferson
{ County
Job Classificatior` UNIT RATE UNITS COST UNITS COST
SALARY COST EHSII HR $36.66 110 $4,033 110 $4,033
TOTAL SALARY 110 F. $4,033 i 110 r $4,033
BENEFITS EHSII HR 33% ' $1,317' $1,317
TOTAL BENEFITS - $1,317 0' $1,317
INDIRECT 27.94%
$19,795 $19,795
OTHER DIRECT COSTS (ODC)
Digital Files Prep
(Jefferson County
Central Services Staff) $ - $24,000 $24,000
Total ODCs $24,000 r $24,000
SUPPLIES $ -
Educational Tools (e.g videos, classes, models) $9,500 $9,500
TOTAL SUPPLIES $9,500 $9,500
SUBCONTRACTS $ -
Tyler Technologies $17,000 $17,000
Video Contractor TBD $ - $15,000 $15,000
TOTAL SUBCONTRACTORS $32,000 $32,000
TOTAL COSTS $90,645 $90,645
AGREEMENT NO.2025-19 Page 15 of 26
Exhibit C
Budget & Billing Procedures
Title: Jefferson County On-Site Septic(OSS) Program Improvements
BILLING PROCEDURES
The AGENCY shall reimburse the CONTRACTOR upon review and approval of work performed under the scope
of this agreement and receipt of properly completed reimbursement requests.
THE AGENCY will pay for work and expenses that occurred within the period of performance. The AGENCY
reserves the right to withhold 10% of the payment under each reimbursement request until satisfactory completion
of the project. Such satisfaction is not unreasonably withheld.
Payment may be withheld if required work, services, progress reports and/or deliverables are not submitted to the
satisfaction of the AGENCY. Such satisfaction is not unreasonably withheld.
The AGENCY may terminate the agreement if the CONTRACTOR fails to comply with any term or condition of
this contract.
The AGENCY will pay indirect costs as approved in the budget. The CONTRACTOR may be required to submit a
copy of their current federally approved indirect cost rate.
The CONTRACTOR shall receive reimbursement for travel and other expenses as identified below or as
authorized in advance by the AGENCY as reimbursable. Such expenses may include airfare(economy or coach
class only), other transportation expenses, lodging and subsistence necessary during periods of required travel at
the current state reimbursement rates (http:l/www.ofm.wa.gov/resources/travel.asp ).
If the CONTRACTOR expends more than the amount of the AGENCY funding in this agreement in anticipation of
receiving additional funds from the AGENCY, it does so at its own risk. The AGENCY is not legally obligated to
reimburse the CONTRACTOR for costs incurred in excess of the AGENCY's approved budget.
The CONTRACTOR must submit a monthly invoice voucher or equivalent document to the AGENCY by the 20th
of each month for the previous month's billing (e.g. March invoice to be submitted by April 20th) UNLESS the
agreement has been identified as a"deliverable-based"contract with specific due date or special conditions that
has been approved by the PSP Project Manager. Contractors must submit invoices within 30 days after the month
of completion of deliverables to the PSP Project Manager for"deliverable-based" contracts. Payment for approved
goods and/or services will be made by check, warrant or electronic fund transfer(EFT)within 30 days of receipt of
the invoice. The CONTRACTOR must submit invoices for all work done within a fiscal year 30 days after the end
of the fiscal year. Invoices shall be paid within 30 days after the final invoice has been submitted.
BILLING CONDITIONS:
All Subrecipients/Contractors must submit any budget changes to PSP for sufficient processing time of any
amendment execution between PSP and the Contractor/LIO. If information provided does not allow for sufficient
processing time, PSP will not adjust or pay for any invoices or billing over the 10% of the total amount listed for
each task or subtask even if the added total amounts for those tasks/subtasks does not exceed the total budget.
BILLING DETAIL
Each invoice voucher or equivalent document submitted to the AGENCY by the CONTRACTOR must include all
necessary information for the AGENCY to verify all expenditures. At a minimum, the CONTRACTOR shall
specify the following:
1. The PSP contract/agreement number.
2. The time period during which the services were performed.
3. A description of purchases, work and services performed.
4. Total invoice amount.
5. Expenditure detail based on the approved budget. Supporting documentation must include the same
level of detail as the approved budget, such as:
a. Task Number
AGREEMENT NO. 2025-19 Page 16 of 26
Exhibit C
Budget & Billing Procedures
Title: Jefferson County On-Site Septic(OSS) Program Improvements
b. Budget category(personnel, goods/services, subcontractors)
c. Number of hours billed, if applicable and
d. Hourly rate, if applicable.
6. A receipt must accompany any single expense in the amount of$50.00 or more.
7. If match is required:
a. match requirement met during the billing period, and
b. cumulative match requirement met
8. A progress report describing the deliverables completed during the reimbursement request period.
The AGENCY shall not process payments if the CONTRACTOR fails to submit the required documentation.
Submit reimbursement requests to:
Puget Sound Partnership
Fiscal Unit
PO Box 40900
Olympia, WA. 98504
Submit all invoices electronically to psptiscal(Opsp.wa.govv
Payment shall be considered timely if made by the AGENCY within thirty (30)calendar days after receipt of
properly completed reimbursement request.
AGREEMENT NO. 2025-19 Page 17 of 26
PUGETSOUND
PARTNERSHIP
Exhibit D
PSP Agreement#2025-19
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form
to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including sub-contracts, sub-grants, and contracts
under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and
disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, title 31 U.S. Code. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
Heidi Eisenhour, Chair
1e erson County Board of Commissioners
T i;-d Nam1 & Title of Authorized Representative
Sig ature and Date of Authorised Repro entative
PSP form (rev 8/2013) based on EPA form 5500-06(Rev.06/2008) Previous editions are obsolete
AGREEMENT NO. 2025-19 Page 18 of 26
EXHIBIT E
Puget Sound Partnership
SUB-RECIPIENT FEDERAL REQUIREMENTS
Title: Jefferson County On-Site Septic(OSS) Program Improvements
1. INTRODUCTION
This Exhibit E contains provisions that are not listed on OMB Standard Form 424B (Rev 4-
2012). These provisions apply only to Sub-recipients.
2. AUDIT REQUIREMENTS
Sub-recipient CONTRACTOR shall meet the provisions in Office of Management and Budget
(OMB) Guidance, Subpart F, §200.501 (Audit Requirements), if the CONTRACTOR expends
$750,000 or more in total Federal funds in a fiscal year. The $750,000 threshold for each year
is a cumulative total of all federal funding from all sources. The CONTRACTOR shall forward a
copy of the audit along with the RECIPIENT'S response and the final corrective action plan to
AGENCY within ninety (90) days of the date of the audit report. For complete information on
how to accomplish the single audit submissions, visit the Federal Audit Clearinghouse Web site.
htt :/lharvester.censu .govtfacwebi
3. COST PRINCIPLES/INDIRECT COSTS FOR STATE AGENCIES
GRANT RECIPIENT agrees to comply with the cost principles of 2 CFR 200 Subpart E as
appropriate to the award.
In addition to the US Environmental Protection Agency's General Terms and Conditions
"Indirect Cost Rate Agreements", if the recipient does not have a previously established indirect
cost rate, it agrees to prepare and submit its indirect cost rate proposal in accordance with 2
CFR 200 Appendix VII.
4. CIVIL RIGHTS OBLIGATIONS
This term and condition incorporates by reference the signed assurance provided by the
recipient's authorized representative on Standard Form 424B. These assurances and this term
and condition obligate the recipient to comply fully with applicable civil rights statutes and
implementing EPA regulations.
5. CYBERSECURITY CONDITION
The subrecipient(s) must comply with the recipient's requirements (section (b) (1) — EPA must
ensure that any connections between the recipient' network or information system and EPA
networks used by the recipient to transfer data under this agreement, are secure) if the
subrecipients network or information system is connected to EPA networks to transfer data to
the Agency using systems other than the Environmental Information Exchange Network or
EPA's Central Data Exchange.
6. NON-DISCRIMINATION AND DISADVANTAGED, MBE, WBE BUSINESS ENTERPRISES
ADDITIONAL REQUIREMENTS
CONTRACTOR agrees to comply with the requirements of EPA's Program for Utilization of
Small, Minority, and Women's Business Enterprises in procurement, contained in 40 CFR, Part
AGREEMENT NO. 2025-19 Page 19 of 26
33. CONTRACTOR shall include the following provision in all subcontracts involving use of
federal funds:
In accordance with 40 CFR 33.106 and its Appendix A, the CONTRACTOR shall not
discriminate on the basis of race, color, national origin or sex in the performance of this contract.
The contractor administration shall carry out applicable requirements of 40 CFR part 33 in the
award of contracts awarded under EPA financial assistance agreements. Failure by the
contractor to carry out these requirements is a material breach of this contract which may result
in the termination of this contract or other legally available remedies.
7. DRUG FREE WORKPLACE
CONTRACTOR (Sub-Recipient) shall make an ongoing, good faith effort to maintain a drug-free
workplace pursuant to the specific requirements set forth in Title 2 CFR Part 1536 Subpart B.
Additionally, in accordance with these regulations, the recipient organization shall identify all
known workplaces under its federal award and keep this information on file during the
performance of the award.
CONTRACTORS who are individuals must comply with the drug-free provisions set forth in Title
2 CFR Part 1536 Subpart C.
The consequences for violating this condition are detailed under Title 2 CFR Part 1536 Subpart
E. Recipient can access the Code of Federal Regulations (CFR) Title 2 Part 1536 at:
http://scfr.qpoaccess.gov.
8. FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)
REPORTING REQUIREMENTS
a. In order to comply with the FFATA, the Sub-Recipient shall complete the FFATA Data
Collection Form (FFATA Data Collection Form, Exhibit E, Attachment 2) and return it to the
AGENCY. The AGENCY will report basic agreement information, including the required UEI
number, for all federally funded agreements at www.fsrs.gov. The new 12-digit
alphanumeric identifier is provided by SAM.gov registration to all entities who register to do
business with the federal government (including the existing entities). This is the identifier
which is replacing the use of the DUNS number.
b. To comply with the act and be eligible to enter into this contract, your organization must
have a Unique Entity Identifier(UEI) number. A UEI number provides a method to verify
data about your organization. If you do not already have one, you may receive a UEI
number by logging into www.SAM.gov and if required, complete an entity registration.
c. Any sub-recipient that meets each of the criteria below must also report compensation for
its five top executives, using AGENCY's Federal Funding Accountability and Transparency
Act (FFATA) Data Collection Form if the sub-recipient meets the following criteria:
• Receives more than $25,000 in federal funds under this award.
• Receives more than 80 percent of its annual gross revenues from federal funds.
• Receives more than $25,000,000 in annual federal funds.
• The public does not have access to this information about the compensation of the
senior executives of your organization through periodic reports filed under section 13(A)
or 15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. 78m(a), 78(d) or section
6104 of the Internal Revenue Code of 1986.
See www.fsrs.gov for details of this requirement. If your organization falls into this above
category, you must report the required information to AGENCY.
AGREEMENT NO. 2025-19 Page 20 of 26
9. GEOSPATIAL DATA STANDARDS
All geospatial data created must be consistent with Federal Geographic Data Committee
(FGDC) endorsed standards. Information on these standards may be found at
https:llwwvv.fgdc,goy/
10. INTERNATIONAL TRAVEL (Including Canada
All International Travel must be approved by the US Environmental Protection Agency's Office
of International and Tribal Affairs (OITA) BEFORE travel occurs. Even a brief trip to a foreign
country, for example attending a conference, requires OITA approval. Please contact your
Partnership Project manager as soon as possible if travel is planned out of the country,
including Canada and/or Mexico, so that they can submit a request to the EPA Project Officer if
they approve of such travel.
11. LEP (Limited English Proficiency)Title VI
As a recipient of EPA financial assistance, you are required by Title VI of the Civil Rights Act to
provide meaningful access to LEP individuals. In implementing that requirement, the Sub-
recipient agrees to use as a guide the Office of Civil Rights (OCR) document entitled "Guidance
to Environmental Protection Agency Financial Assistance Recipients Regarding Title VI
Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons."
The guidance can be found at
http:tifrwebgate.access.gpo.dovlcq..binfgetdoc.cgi?dbname=2004 mister&docid-fr25in0 -79.pd.
In accepting this contract, the recipient acknowledges it has an affirmative obligation to
implement effective Title VI compliance programs and ensure that its actions do not involve
discriminatory treatment and do not have discriminatory effects even when facially neutral. The
recipient must be prepared to demonstrate to EPA/PSP that such compliance programs exist
and are being implemented or to otherwise demonstrate how it meets its Title VI obligations. For
example, if CONTRACTOR's responsibilities under this contract include gathering public input
on an environmental issue, CONTRACTOR's communication with the public should attempt to
minimize barriers that interfere with the ability of LEP persons to meaningfully participate.
12. MANAGEMENT FEES
Management fees or similar charges in excess of the direct costs and approved indirect rates
are not allowable. The term "management fees or similar charges" refers to expenses added to
the direct costs in order to accumulate and reserve funds for ongoing business expenses,
unforeseen liabilities, or for other similar costs which are not allowable under this CONTRACT.
Management fees or similar charges may not be used to improve or expand the project funded
under this Agreement, except to the extent authorized as a direct cost of carrying out the scope
of work.
13. PEER REVIEW
The results of this project may affect management decisions relating to Puget Sound. Prior to
finalizing any significant technical products the Principal Investigator(PI) of this project must
solicit advice, review, and feedback from a technical review or advisory group consisting of
relevant subject matter specialists. A record of comments and a brief description of how
respective comments are addressed by the PI will be provided to the Project Monitor prior to
releasing any final reports or products resulting from the funded study.
AGREEMENT NO. 2025-19 Page 21 of 26
14. REIMBURSEMENT LIMITATION
If CONTRACTOR expends more than the amount of the Environmental Protection Agency
(EPA) funding in this agreement in anticipation of receiving additional funds from EPA, it does
so at its own risk. EPA is not legally obligated to reimburse PSP, nor its sub-recipients, for costs
incurred in excess of the EPA approved budget.
15. SEMI-ANNUAL AND ANNUAL PERFORMANCE REPORTS
The Sub-recipient shall submit performance reports during the life of the project, as specified in
the statement of work or work plan developed under this contract.
In addition to the periodic performance reports, the recipient shall submit a final performance
report, which is due 90 calendar days after the expiration or termination of the award, or as
specified in the work plan or statement of work. The report shall be submitted to the PSP Project
Officer and may be provided electronically. The report shall generally contain the same
information as in the periodic reports, but should cover the entire project period. After
completion of the project, the PSP Project Officer may waive the requirement for a final
performance report if the PSP Project Officer deems such a report is inappropriate or
unnecessary.
16. SIX GOOD FAITH EFFORTS, 40 CFR, PART 33, SUBPART C
Pursuant to 40 CFR, Section 33.301, the recipient agrees to make the following good faith
efforts whenever procuring construction, equipment, service and supplies under an EPA
financial assistance agreement, and to require that subrecipients, loan recipients, and prime
contractors also comply. Records documenting compliance with the six good faith efforts shall
be retained:
a) Ensure DBEs are made aware of contracting opportunities to the fullest extent
practicable through outreach and recruitment activities. For Indian Tribal, State and
Local Government recipients, this will include placing DBEs on solicitation lists and
soliciting whenever they are potential sources.
b) Make information on forthcoming opportunities available to DBEs and arrange time
frames for contracts and establish delivery schedules, where the requirements permit, in
a way that encourages and facilitates participation by DBEs in the competitive process.
This includes, whenever possible, posting solicitations for bids or proposals for a
minimum of 30 calendar days before the bid or proposal closing date.
c) Consider in the contracting process whether firms competing for large contracts could
subcontract with DBEs. For Indian Tribal, State and local Government recipients, this will
include dividing total requirements when economically feasible into smaller tasks or
quantities to permit maximum participation by DBEs in the competitive process.
d) Encourage contracting with a consortium of DBEs when a contract is too large for one of
these firms to handle individually.
e) Use the services and assistance of the SBA and the Minority Business Development
Agency of the Department of Commerce.
f) If the prime contractor awards subcontracts, require the prime contractor to take the
steps in paragraph (a)through (e) of this section.
17. SUB-AWARDS
If CONTRACTOR (Sub-Recipient) makes sub-awards under this contract, CONTRACTOR is
responsible for selecting its sub-awardees and, if applicable, for conducting sub-award
competitions. CONTRACTOR agrees to:
AGREEMENT NO. 2025-19 Page 22 of 26
a. Establish all sub-award agreements in writing;
b. Maintain primary responsibility for ensuring successful completion of the approved project
(Sub-Recipient cannot delegate or transfer this responsibility to a sub-awardee);
c. Ensure that any sub-awards comply with the standards in Section 210(a)-(d) of OMB
Circular A-133, and are not used to acquire commercial goods or services for the sub-
awardee;
d. Ensure that any sub-awards to 501(c)(4) organizations do not involve lobbying activities;
e. Monitor the performance of sub-awardees, and ensure sub-awardees comply with all
applicable regulations, statutes, and terms and conditions which flow down in the sub-
award;
f. Obtain AGENCY's consent before making a sub-award to a foreign or international
organization, or a sub-award to be performed in a foreign country; and
g. Obtain approval from AGENCY for any new sub-award work that is not outlined in the
approved work plan in accordance with 40 CFR Parts 30.25 and 31.30, as applicable.
18.TRAFFICKING IN PERSONS AND TRAFFICKING VICTIM PROTECTION ACT OF 2000
(TVPA) AS AMENDED IN 22 U.S.C. 7104(g)
This provision applies only to a Sub-Recipient, and all sub-awardees of Sub-Recipient, if any.
See page one (1) of this contract for determination of whether CONTRACTOR is a sub-
recipient. Sub-Recipient shall include the following statement in all sub-awards made to any
private entity under this Agreement.
"You as the Sub-Recipient, your employees, sub-awardees under this award, and sub-
awardees' employees may not engage in severe forms of trafficking in persons during the
period of time that the award is in effect; procure a commercial sex act during the period of time
that the award is in effect; or use forced labor in the performance of the award or sub-awards
under this Award."
Sub-Recipient, and all sub-awardees of Sub-Recipient must inform AGENCY immediately of
any information you receive from any source alleging a violation of this prohibition during the
award term.
Federal agency funding this agreement may unilaterally terminate, without penalty, the funding
award if this prohibition is violated, Section 106 of the Trafficking Victims Protection Act of 2000,
as amended.
19. UNLIQUIDATED OBLIGATIONS (ULO)
Sub-recipients, and all sub-awardees of Sub-Recipients, if any, should manage their agreement
and subaward funding in ways that reduce the length of time that federal funds obligated and
committed to subaward projects are unspent (not yet drawn down through disbursements to
sub-recipients and sub-awardees).
AGREEMENT NO. 2025-19 Page 23 of 26
ViewOMB Number:4040 0007
Burden Statement
Expiration Date:01/31/2019
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for
reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and
reviewing the collection of information.Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden,to the Office of Management and Budget, Paperwork Reduction
Project(0348-0040),Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY,
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case,you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance and Act of 1973,as amended(29 U.S.C. §794),which prohibits
the institutional,managerial and financial capability discrimination on the basis of handicaps;(d)the Age
(including funds sufficient to pay the non-Federal share of Discrimination Act of 1975, as amended(42 U.
project cost)to ensure proper planning,management and S.C. §§6101-6107),which prohibits discrimination on the
completion of the project described in this application. basis of age; (e)the Drug Abuse Office and Treatment Act
of 1972(P.L.92-255),as amended, relating to
2. Will give the awarding agency,the Comptroller General of nondiscrimination on the basis of drug abuse;(f)the
the United States and, if appropriate,the State,through Comprehensive Alcohol Abuse and Alcoholism
any authorized representative,access to and the right to Prevention,Treatment and Rehabilitation Act of 1970
examine all records,books,papers,or documents related (P.L.91-616),as amended, relating to nondiscrimination
to the award;and will establish a proper accounting on the basis of alcohol abuse or alcoholism;(g)§§523
system in accordance with generally accepted accounting and 527 of the Public Health Service Act of 1912(42
standards or agency directives. U.S.C. §§290 dd-3 and 290
ee-3),as amended, relating to confidentiality of alcohol
3. Will establish safeguards to prohibit employees from and drug abuse patient records;(h)Title VIII of the Civil
using their positions for a purpose that constitutes or Rights Act of 1968(42 U.S.C. §§3601 et seq.),as
presents the appearance of personal or organizational amended, relating to nondiscrimination in the sale, rental
conflict of interest,or personal gain. or financing of housing;(i)any other nondiscrimination
provisions in the specific statute(s)under which application
4. Will initiate and complete the work within the applicable for Federal assistance is being made;and,(j)the
time frame after receipt of approval of the awarding requirements of any other nondiscrimination statute(s)
agency. which may apply to the application.
5. Will comply with the Intergovernmental Personnel Act of 7 Will comply,or has already complied,with the
1970(42 U.S.C.§§4728-4763)relating to prescribed requirements of Titles II and III of the Uniform Relocation
standards for merit systems for programs funded under Assistance and Real Property Acquisition Policies Act of
one of the 19 statutes or regulations specified in Appendix 1970(P.L.91-646)which provide for fair and equitable
A of OPM's Standards for a Merit System of Personnel treatment of persons displaced or whose property is
Administration(5 C.F.R.900,Subpart F). acquired as a result of Federal or federally-assisted
programs.These requirements apply to all interests in
6. Will comply with all Federal statutes relating to real property acquired for project purposes regardless of
nondiscrimination.These include but are not limited to: Federal participation in purchases.
(a)Title VI of the Civil Rights Act of 1964(P.L. 88-352)
which prohibits discrimination on the basis of race,color or 8. Will comply,as applicable,with provisions of the Hatch
national origin;(b)Title IX of the Education Amendments of Act(5 U.S.C.§§1501-1508 and 7324-7328)which limit
1972,as amended(20 U.S.C.§§1681-1683, and 1685- the political activities of employees whose principal
1686),which prohibits discrimination on the basis of sex;(c) employment activities are funded in whole or in part
Section 504 of the Rehabilitation with Federal funds.
Previous Edition Usable Standard Form 424B(Rev.7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
AGREEMENT NO. 2025-19 Page 24 of 26
9. Will comply, as applicable,with the provisions of the Davis- 13. Will assist the awarding agency in assuring compliance
Bacon Act(40 U.S.C. §§276a to 276a-7),the Copeland Act with Section 106 of the National Historic Preservation
(40 U.S.C. §276c and 18 U.S.C. §874),and the Contract Act of 1966, as amended(16 U.S.C. §470), EO 11593
Work Hours and Safety Standards Act(40 U.S.C. §§327- (identification and protection of historic properties),and
333), regarding labor standards for federally-assisted the Archaeological and Historic Preservation Act of
construction subagreements. 1974(16 U.S.C. §§469a-1 et seq.).
10. Will comply, if applicable,with flood insurance purchase 14. Will comply with P.L. 93-348 regarding the protection of
requirements of Section 102(a)of the Flood Disaster human subjects involved in research, development, and
Protection Act of 1973(P.L. 93-234)which requires related activities supported by this award of assistance.
recipients in a special flood hazard area to participate in the 15. Will comply with the Laboratory Animal Welfare Act of
program and to purchase flood insurance if the total cost of 1966(P.L. 89 544, as amended, 7 U.S.C. §§2131 et
insurable construction and acquisition is$10,000 or more. seq.)pertaining to the care, handling, and treatment of
11. Will comply with environmental standards which may be warm-blooded animals held for research, teaching, or
prescribed pursuant to the following: (a)institution of other activities supported by this award of assistance.
environmental quality control measures under the National 16. Will comply with the Lead-Based Paint Poisoning
Environmental Policy Act of 1969(P.L.91-190)and Prevention Act(42 U.S.C. §§4801 et seq.)which
Executive Order(EO) 11514; (b)notification of violating prohibits the use of lead-based paint in construction or
facilities pursuant to EO 11738; (c)protection of wetlands rehabilitation of residence structures.
pursuant to EO 11990; (d)evaluation of flood hazards in
floodplains in accordance with EO 11988; (e)assurance of 17. Will cause to be performed the required financial and
project consistency with the approved State management compliance audits in accordance with the Single Audit
program developed under the Coastal Zone Management Act Amendments of 1996 and OMB Circular No.A-133,
Act of 1972(16 U.S.C. §§1451 et seq.); (f) conformity of "Audits of States, Local Governments, and Non-Profit
Federal actions to State(Clean Air)Implementation Plans Organizations."
under Section 176(c)of the Clean Air Act of 1955, as
amended(42 U.S.C. §§7401 et seq.); (g)protection of 18. Will comply with all applicable requirements of all other
underground sources of drinking water under the Safe Federal laws, executive orders, regulations, and policies
Drinking Water Act of 1974, as amended(P.L. 93-523); governing this program.
and, (h)protection of endangered species under the
Endangered Species Act of 1973, as amended(P.L. 93- 19. Will comply with the requirements of Section 106(g)of
205). the Trafficking Victims Protection Act(TVPA)of 2000, as
amended(22 U.S.C. 7104)which prohibits grant award
12. Will comply with the Wild and Scenic Rivers Act of recipients or a sub-recipient from (1) Engaging in severe
1968(16 U.S.C. §§1271 et seq.)related to protecting forms of trafficking in persons during the period of time
components or potential components of the national that the award is in effect(2)Procuring a commercial
wild and scenic rivers system, sex act during the period of time that the award is in
effect or(3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
M Heidi Eisenhour, Chair
APPLICANT ORGANIZATION DATE SUBMITTED
Jefferson County Washington, Board of Commissioners d
Standard Form 424B(Rev.7-97)Back
AGREEMENT NO. 2025-19 Page 25 of 26
PUGETSOUND
PARTNERSHIP
424B (Rev 4-2012) Federal Funding Accountability and Transparency Act Data Collection Form
This award is supported by Federal Funds that require compliance with the Federal Funding Accountability and
Transparency Act. The purpose of the Transparency Act is to make information available online so the public can see how
Federal Funds are spent. To comply with the act and be eligible to receive this award, your organization must have a Unique
Entity Identifier(UEI) number. If you do not already have one, you may receive a UEI number free of at
www.SAM.gov and if required, complete an entity registration.
The Puget Sound Partnership (PSP)also encourages registration with the System for Award Management(SAM)to reduce
data entry by both PSP and your organization. You may register with SAM Free of Charge at www.sam.qov. Information
about your organization and this grant will be reported by PSP to the Federal government as required by P.L 109-282. This
information will then be made available to the public by the Federal Government on www USASpeadinQ.cagv.
Subrecipient
1. Legal Name 2. UEI Number FNXKANAVBPI5
Jefferson County Public Health
3. Principle Place of Performance
615 Sheridan Street
3a. City Port Townsend, WA 3b. State WA
3c.Zip 98368 3d. Country
USA
4. Are you registered in SAM? /1 Yes ID No If yes,skip to signature block.Sign, Date&Return
5. In the preceding fiscal year,did your organization:
a. Receive 80% or more of annual gross revenue from Federal contracts,subcontracts, grants, loans,
subgrants, loans and/or cooperative agreements,AND
b. $25,000 or more in annual gross revenues from Federal contracts,subcontracts, grants, loans,
subgrants, loans and/or cooperative agreements,AND
c. Receives more than $25,000,000 in annual federal funds.
d. The public does not have access to this information about the compensation of the senior executives
of your organization through periodic reports filed under section 13(A)or 15(d) of the Securities and
Exchange Act of 1934(15 U.S.C. 78m(a), 78(d) or section 6104 of the Internal Revenue Code of 1986.
E No—skip to signature block. Sign, Date, & Return
E Yes—you must report the names and total compensation of the top 5 highly compensated officials of your
organization
r
Name of Official Total Compensation
1, $ Annually
2. $ Annually
3. $ Annually
4. $ Annually
5. $ Annually
NOTE: Total compensation for the purposes of this requirement generally means the cash and non-cash value
earned by the executive during the past fiscal year and includes salary and bonus; awards of stock; stock
options and stock appreciation rights; and other compensation such as severance and termination payments,
and value of life insurance paid on behalf of the employee, and as otherwise provided by FFATA and applicable
OMB guidance.
B signing this document,the Authorized Representative attests to this information
S nature f Authorized Representative Date Printed Name of Authorized Representative
- ,,/ Heidi Eisenhour, Chair
'/C------
GJ -1,� Jefferson County Washington Board of Commissioners
AGREEMENT NO. 2025-19 Page 26 of 26