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HomeMy WebLinkAboutC20-462 USDA Forest Service USDA Forest Service OMB 0596-0217 FS-1500-19 11. SIGNATURES AUTHORIZED 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 GRANT/AGREEMENT. 11.A. EAGLE COUNTY SIGNATURE 11.B. DATE SIGNED 11.C. U.S. FOREST SERVICE SIGNATURE 11.D. DATE SIGNED (Signature of Signatory Official) (Signature of Signatory Official) 11.E. NAME (type or print): KATHY CHANDLER-HENRY 11.F. NAME (type or print): LISA M. STOEFFLER 11.G. TITLE (type or print): Board of County Commissioners, Chair Eagle County, Colorado 11.H. TITLE (type or print): Acting Forest Supervisor, White River National Forest MODIFICATION OF GRANT OR AGREEMENT PAGE OF PAGES 1 2 1.U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: 19-CO-11021500-013 2. RECIPIENT/COOPERATOR GRANT or AGREEMENT NUMBER, IF ANY: 3. MODIFICATION NUMBER: 2 4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING GRANT/AGREEMENT (unit name, street, city, state, and zip + 4): Rocky Mount Region – Center of Excellence Grants and Agreements 1617 Cole Blvd., Lakewood, CO 80401 5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4): White River National Forest Paula K Peterson, Recreation Staff Officer PO Box 190, Minturn, CO 81645 6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip + 4, county): Eagle County Program Contact: Rhea Silverkorn, Executive Coordinator PO Box 850, Eagle, CO 81631 E-Mail: rhea.silverkorn@eaglecounty.us 7. RECIPIENT/COOPERATOR’S HHS SUB ACCOUNT NUMBER (For HHS payment use only): 8.PURPOSE OF MODIFICATION CHECK ALL THAT APPLY: This modification is issued pursuant to the modification provision in the grant/agreement referenced in item no. 1, above. CHANGE IN PERFORMANCE PERIOD: Extends the expiration date of the Collection Agreement to December 31, 2021. CHANGE IN FUNDING: Parties agree that any “carry-over” funding from the previous calendar year (e.g., 2020) may be utilized by the U.S. Forest Service for activities and projects in the next Calendar year (e.g., 2021). ADMINISTRATIVE CHANGES: Modify to change FS Administrative Contact to: Dave Graham, 605-716-2119, dave.graham@usda.gov 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): The purpose of this Modification is to extend this agreement through December 31, 2021 and to update Forest Service Administrative Contact as shown above. 10. ATTACHED DOCUMENTATION (Check all that apply): Revised Scope of Work Revised Financial Plan Other: Kathy Chandler-Henry Digitally signed by Kathy Chandler-Henry Date: 2020.12.22 12:10:32 -07'00' LISA STOEFFLER Digitally signed by LISA STOEFFLER Date: 2020.12.22 18:49:59 -07'00' C20-462 USDA Forest Service OMB 0596-0217 FS-1500-19 12. G&A REVIEW 12.A. The authority and format of this modification have been reviewed and approved for signature by: ______________________________________ DAVE GRAHAM U.S. Forest Service, Grants & Agreements Specialist 12.B. DATE SIGNED Burden Statement According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB 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 TARGET Center at 202 -720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer. DAVID GRAHAM Digitally signed by DAVID GRAHAM Date: 2020.12.16 15:37:16 -07'00'