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HomeMy WebLinkAboutC23-047 USDA_mod of grant 037USDA 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. 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):JOHN HARRIS 11.F. NAME (type or print): SCOTT G. FITZWILLIAMS 11.G. TITLE (type or print): Road And Bridge Director Eagle County, State of Colorado 11.H. TITLE (type or print): 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 MODIFICATION OF GRANT OR AGREEMENT PAGE OF PAGES 1 2 1. U.S. FOREST SERVICE GRANT/AGREEMENT NUMBER: 21-RO-11021500-037 2. RECIPIENT/COOPERATOR GRANT or AGREEMENT NUMBER, IF ANY: 3. MODIFICATION NUMBER: 1 4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING GRANT/AGREEMENT (unit name, street, city, state, and zip + 4): White River National Forest 900 Grand Ave, Glenwood Springs, CO 81601 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 500 Broadway, Eagle, Colorado 81631-5178 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 Road Project Agreement’s Expiration Date to November 30, 2023. CHANGE IN FUNDING: ADMINISTRATIVE CHANGES: OTHER (Specify type of modification): Incorporates mandatory provisions, operating and financial plans to the Agreement. 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 Modification No. 1 is to extend the expiration date to 11/30/2023 to allow for additional time to complete agreement projects. This extension is authorized by approved deviation FY23-0081. 10. ATTACHED DOCUMENTATION (Check all that apply): Exhibit A –Operating Plan Exhibit A –Financial Plan Other:  DAVID GRAHAM Digitally signed by DAVID GRAHAM Date: 2023.02.01 09:58:57 -07'00' DocuSign Envelope ID: 460F3845-B26B-44BA-8351-ED161EB8C19D 2/13/20232/13/2023 USDA Forest Service OMB 0596-0217 FS-1500-19 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. DocuSign Envelope ID: 460F3845-B26B-44BA-8351-ED161EB8C19D