HomeMy WebLinkAboutWashington State Department of Commerce Amendment # B - Amendment DocuSign Envelope ID: ECF32006-D40D-4C8A-83BC-270433EDD22A
1"dd�Iiiny.on Slale
Dep-1- (en of Amendment Face Sheet
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Contract Number: 22-62210-010
Amendment Number: B
Washington State Department of Commerce
Local Government Division
CDBG Public Services Grant
1. Grantee 2. Grantee Doing Business As (optional)
Mason County N/A
411 North 51h Street
Shelton, WA 98584
3. Grantee Representative 4. COMMERCE Representative
Toni Monnier, Financial Analyst Roberta Golden, Project Manager
(360)427-9670 Ext 644 PO Box 42525/1011 Plum St SE, Olympia, WA 98504-2525
tmonnier@masoncountywa.gov (360) 725-5020 1 Roberta.golden@commerce.wa.gov
5. Original Grant Amount 6.Amendment Amount 7. New Grant Amount
(and any previous amendments)
$205,000 $103,000 $308,000
8.Amendment Funding Source 9.Amendment Start Date 10.Amendment End Date
Federal: ✓ State: Other: July 1, 2024 June 30, 2025
11. Federal Funds (as applicable): Federal Agency: ALN (CFDA#):
$308,000 U.S. Department of Housing 14.228
and Urban Development
12. Amendment Purpose:
Public Services through Community Action Council of Lewis, Mason and Thurston counties to low-and moderate-
income persons in Lewis and Mason County for program year 2024.
COMMERCE, defined as the Department of Commerce, and the Grantee, as defined above, acknowledge and
accept the terms of this Grant As Amended and attachments and have executed this Grant Amendment on the date
below to start as of the date and year referenced above. The rights and obligations of both parties to this Grant As
Amended are governed by this Grant Amendment. A copy of this Grant Amendment shall be attached to and made
a part of the original Grant between COMMERCE and the Grantee. Any reference in the original Grant to the
"Grant" shall mean the"Grant as Amended". The Amendment Amount is contingent on obligation of funds from the
U.S. Department of Housing and Urban Development for program year 2024.
FOR GRANTEE FOR COMMERCE
DOCUSig ned by:
X,7L EAtR bA(t,
The norab andy Neatherlin, Chair Mark K. Barkley, Assistant Director
Board of Mason County Commissioners Local Government Division
6/6/2024 1 1:28 PM PDT
�wne 4. ��} Date
Date
APPROVED AS TO FORM ONLY
Sandra Adix
Assistant Attorney General
3/20/2014
Date
DocuSign Envelope ID: ECF32006-D40D-4C8A-83BC-270433EDD22A
Washington State Local Government Division
��►� Commerce Contract/Amendment Routing
Review by: Name: Initials: Date:
CDBG Jon Galow DS
6/5/2024 i 3:35 PM PDT
Section Manager 1-4
DS
Budget Analyst Geoffrey Bracken 6/5/2024 i 3:37 PM PDT
DS
Managing Director Chris McCord (. 6/6/2024 i 9:36 AM PDT
Deputy Asst. Director Tony Hanson DS 6/6/2024 i 1:01 PM PDT
DocuSign
Certificate Of Completion
Envelope Id:ECF32006D4OD4C8A83BC270433EDD22A Status:Completed
Subject:CDBG Public Services contract for Mason County Amendment B
Division:
Local Government
Program:CDBG Public Services
ContractN u m be r:22-62210-010
DocumentType:
Contract Amendment
Source Envelope:
Document Pages:2 Signatures: 1 Envelope Originator:
Certificate Pages:2 Initials:4 Roberta Golden
AutoNav: Enabled 1011 Plum Street SE
Envelopeld Stamping: Enabled MS 42525
Time Zone:(UTC-08:00)Pacific Time(US&Canada) Olympia,WA 98504-2525
roberta.golden@commerce.wa.gov
IP Address: 147.55.134.21
Record Tracking
Status:Original Holder: Roberta Golden Location:DocuSign
6/5/2024 3:25:27 PM roberta.golden@commerce.wa.gov
Security Appliance Status:Connected Pool:StateLocal
Storage Appliance Status:Connected Pool:Washington State Department of Commerce Location:DocuSign
Signer Events Signature Timestamp
Jon Galow I
Sent:6/5/2024 3:31:51 PM
jon.galow@commerce.wa.gov Viewed:6/5/2024 3:35:35 PM
Security Level: Email,Account Authentication Signed:6/5/2024 3:35:46 PM
(None), Login with SSO
Signature Adoption:Pre-selected Style
Using IP Address:50.24.100.158
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Geoffrey Bracken EDS,
Sent:6/5/2024 3:35:48 PM
geoffrey.bracken@commerce.wa.gov Viewed:6/5/2024 3:37:20 PM
Security Level: Email,Account Authentication Signed:6/5/2024 3:37:45 PM
(None), Login with SSO
Signature Adoption:Pre-selected Style
Using IP Address: 198.239.10.224
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Christopher McCord /� Sent:6/5/2024 3:37:46 PM
chris.mccord@commerce.wa.gov Viewed:6/6/2024 9:35:25 AM
Security Level: Email,Account Authentication Signed:6/6/2024 9:36:04 AM
(None)
Signature Adoption:Pre-selected Style
Using IP Address: 198.238.75.183
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Signer Events Signature Timestamp
Tony Hanson HDS
Sent:6/6/2024 9:36:05 AM
tony.hanson@commerce.wa.gov Viewed:6/6/2024 1:00:49 PM
Washington State Department of Commerce Signed:6/6/2024 1:01:00 PM
Security Level: Email,Account Authentication
(None) Signature Adoption:Pre-selected Style
Using IP Address: 147.55.149.139
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mark Barkley DocuSignedby: Sent:6/6/2024 1:01:01 PM
mark.barkley@commerce.wa.gov EAk8-03&12B0418565AC458tt,
Viewed:6/6/2024 1:28:53 PM
Assistant Director Signed:6/6/2024 1:28:56 PM
Washington State Department of Commerce
Signature Adoption:Pre-selected Style
Security Level: Email,Account Authentication
(None) Using IP Address: 198.239.157.71
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 6/5/2024 3:31:51 PM
Certified Delivered Security Checked 6/6/2024 1:28:53 PM
Signing Complete Security Checked 6/6/2024 1:28:56 PM
Completed Security Checked 6/6/2024 1:28:56 PM
Payment Events Status Timestamps