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HomeMy WebLinkAboutC21-006 USDA Forest Service USDA Forest Service OMB 0596-0217 FS-1500-19 MODIFICATION OF GRANT OR AGREEMENT PAGE OF PAGES 1 2 1.U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: 18-PA-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 Mountain Region – Center of Excellence 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 900 Grand Ave, Glenwood Springs, CO 81601 6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip + 4, county): Eagle, County of Program Contact: Scott Griffin, Vegetation Manager Eagle County Vegetation Management 3289 Cooley Mesa, Gypsum, CO 81637 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 agreement to December 31, 2021. CHANGE IN FUNDING: ADMINISTRATIVE CHANGES: Update FS Administrative Contact from Clark Wooley to Dave Graham, 605-716-2119, dave.graham@usda.gov Update ASC payment center address to: sm.fs.asc_ga@usda.gov . OTHER: None 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 Mod 2 is to execute a no-cost extension of the agreement to complete agreed to activities on and off of National Forest System lands within the scope of the agreement. Update FS Administrative contact as shown above. Update ASC’s email address for submitting invoices, see address above. 10.ATTACHED DOCUMENTATION (Check all that apply): Scope of Work: Remains the Same Financial Plan: Remains the Same Other: DocuSign Envelope ID: EFBE72F4-9BD8-4E7D-B42A-0854CCC0307D C21-006 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 OF 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): KELLEY COLLIER 11.F. NAME (type or print): LISA M. STOEFFLER 11.G. TITLE (type or print): Deputy County Manager, Eagle County 11.H. TITLE (type or print): Acting Forest Supervisor, White River National Forest 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, c olor, 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. (FOR) DocuSign Envelope ID: EFBE72F4-9BD8-4E7D-B42A-0854CCC0307D 1/7/2021 1/7/2021