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Home My WebLink AboutC17-315 USDA Road Project ModificationUSDA Forest Service OMB 0596-0217 FS -1500-19 MODIFICATION OF GRANT OR AGREEMENT PAGE OF PAGES1 1 3 1. U.S. FOREST SERVICE GRANTIAGREEMENT NUMBER: 2. RECIPIENT/COOPERATOR GRANT or3. MODIFICATION NUMBER: 17-RO-11021500-044 AGREEMENT NUMBER, IF ANY: 1 4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING 5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING GRANT/AGREEMENT (unit name, street, city, state, and zip +4): PRO]ECr1ACTIVITY (unit name, street, city, state, and zip + 4): White River National Forest Program Contact: White River National Forest Admin. Contact: Miles Barkhurst, Transportation Engineer Clark M. Woolley, Grants & Agreements Specialist 900 Grand Avenue 900 Grand Avenue Glenwood Springs, CO 81601 Glenwood Springs, CO 81601 Telephone: 970-945-3282 Telephone: 970-945-3227 FAX: 970-945-3266 Email: cmwoolley@fs.fed.us Email: markhurst@fs.fed.us b. NAME/ADDRESS OF RECIPIENTICOOPERATOR (street, city, state, and zip + 7. RECIPIENTICOOPERATOR'S HHS SUB ACCOUNT NUMBER (Far HHS 4, county): payment use only]: Eagle County Contact: Eagle County Admin. Contact: Jahn Harris Nicole Trujillo P.O. Bax 250 P.O. Bax 250 Eagle, CO 81631 Eagle, CO 81631 Telephone: 970-328-3542 Telephone: 970-328-3550 FAX: 970-328-3546 FAX: 970-328-3546 Email: iohn.harrisL ea le�y.us Email: nicole.trujilloL ea le�y.us 8. PURPOSE OF MODIFICATION CHECK ALL This modification is issued pursuant to the modification provision in the grant/agreement THAT APPLY: referenced in item no. 1, above. CHANGE IN PERFORMANCE PERIOD: CHANGE IN FUNDING: ® ADMINISTRATIVE CHANGES: Incorporates mandatory provision and revises provision. El OTHER (Specify type of modification): Except as provided herein, all terms and conditions of the Grant/Agreement referenced in 1, above, remain unchanged and in full force and effect. 9. ADDITIONAL SPACE FOR DESCRIPTION OF MODIFICATION (add additional pages as needed): 10. ATTACHED DOCUMENTATION (Check all that apply): Incorporates Operating Plans Incorporates Financial Plans Other: Exhibits 11. SIGNATURES USDA Forest Service OMB 0595-0217 FS -1500-19 AL1THoRlzED REPRESENTATIVE: By SIGNATURE BELOW, THE SIGNING PARTIES CERTIFY THAT THEY ARE THE OFFICIAL REPRESENTATIVES OF THEIR RESPECTIVE PARTIES AND AUTHORIZED TO ACT IN THEIR RESPECTIVE AREAS FOR MATTERS RELATED TO THE ABOVE -REFERENCED GRANTIAGREEMENT. 11. to Mtt^TT'v S7 I I.B. DATE 11 FYIRFCT CF12Vif I ATLTRE I I.D. DATE c wx<.WGJ<<a�td/.ur�u� SIGNED SIGNED 9/06/2017 K.v.,,..,..e......... —...... /07/2017 (Signature of Signatory Official) (Signature of Signatory Official) I I.E. NAME (type or print): ]Illlan H. Ryan I I.F. NAME (type or print): SCOTT G. FFZZWILLIAMS I I.G. TITLE (type or print): County COrnnliSSiOnCr 11.H. TITLE (type or print): Forest Supervisor, White River National Forest 12. G&A REVIEW M�_, __� a 12.A _ ;, ris modification have been reviewed and approved for signature by: 12.B. DATE SIGNED CLARK M. WOOLLEY 09/07/2017 U.S. Forest Service, White River National Forest, Grants & Agreements Specialist Burden Statement According to the Paperwork Reduction Actof 1995, an agency may not oonduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid DMB control number. The valid OMB control number for this information collection is 0596-0217. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TAR GET Genlerat 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of GiviI Rights, 1400 Independence Avenue, SW, Washington, DD 20250-9410 or call toll free (966) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal re lay at (900) 977-8339 [TDD) or (966) 377-8642 (relay voice). USDA is an equal opportunity providerarid employer. USDA, Forest Service DMB 0596-0217 FS -1500-16 Project Road Agreement Section IV shall be amended by the addition of the following provision: B. PAYMENT/REIMBURSEMENT. The U.S. Forest Service shall reimburse Eagle County for the U.S. Forest Service's share of actual expenses incurred, not to exceed $25.566.00, as shown in the Financial Plan. The U.S. Forest Service shall make payment upon receipt of the Cooperator's quarterly invoice. Each invoice from Eagle County must display the total project costs for the billing period. Each invoice must include, at a minimum: 1) Eagle County's name, address, and telephone number 2) U.S. Forest Service agreement number 3) Invoice date 4) Performance dates of the work completed (start and end) 5) Total invoice amount for the billing period The invoice must be forwarded to: U.S. Forest Service Albuquerque Service Center Payments — Grants & Agreements 101E Sun Ave NE Albuquerque, NM 87109 FAX: 877-687-4894 Send a copy to: Miles Barkhurst at mbarkhurst@usda.gov Revises: Section V, Provision K K. COMMENCEMENT. This Project Road Agreement is executed as the date of last signature and is effective through the life of the signed Cooperative Forest Road Agreement. Page 3 of 3 (Rev. 12-13)