HomeMy WebLinkAboutUnited States Department of Agriculture Forest Service Olympia National Forest - Interlocal AgreementFS-1500-19 (VER. 05/24)
OMB No. 0596-0217
EXP: 05/31/2027
MODIFICATION OF GRANT OR AGREEMENT
PAGE OF
PAGES
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1. U.S. FOREST SERVICE GRANT/AGREEMENT
NUMBER:
24-PA-11060900-042 (INVASIVE
PLANT INVENTORY PREVENTION
AND CONTROL IN MASON COUNTY)
2. RECIPIENT/COOPERATOR GRANT or
AGREEMENT NUMBER, IF ANY:
3. MODIFICATION NUMBER:
001
4. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING
GRANT/AGREEMENT (unit name, street, city, state, and zip + 4):
Olympic National Forest
1835 Black Lake Blvd SW
Olympia, WA 98512
5. NAME/ADDRESS OF U.S. FOREST SERVICE UNIT ADMINISTERING
PROJECT/ACTIVITY (unit name, street, city, state, and zip + 4):
Olympic National Forest
1835 Black Lake Blvd SW
Olympia, WA 98512
6. NAME/ADDRESS OF RECIPIENT/COOPERATOR (street, city, state, and zip
+ 4, county):
MASON COUNTY
411 N 5TH ST
Shelton, Washington 98584-3466
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:
CHANGE IN FUNDING: Add Funding $18,996.00, See box 9.
ADMINISTRATIVE CHANGES: Update Contacts, Update Provisions and Incorporate Provisions, See Box 9.
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):
This modification to the agreement with the County will add $18,996.00, for a new total of $53,996.00 as described in the Original
Financial Plan -Attachment A and the attached modification 001 Financial Plan, Attachement A.1. All previously available funds
not expended remain available.
UPDATE THE FOLLOWING PROVISIONS:
REMOVE COOPERATOR CONTACT
Kela Hall-Wieckert
ADD COOPERATOR CONTACT
Heidi Steinbach
hsteinbach@masoncountywa.gov
ADD U.S. FOREST SERVICE PROGRAM CONTACT
Partnership Coordinator
Jennifer Garcia Santiago
jennifer.garciasantiago@usda.gov
SYSTEM FOR AWARD MANAGEMENT REGISTRATION REQUIREMENT (SAM). The County shall maintain current
organizational information and the original Unique Entity Identifier (UEI) provided for this agreement in the System for Award
Management (SAM) until receipt of final payment. This requires annual review and updates, when needed, of organizational
information after the initial registration. More frequent review and updates may be required for changes in organizational
information or agreement term(s). Any change to the original UEI provided in this agreement will result in termination of this
agreement and de-obligation of any remaining funds. For purposes of this agreement, System for Award Management (SAM)
FS-1500-19 (VER. 05/24)
OMB No. 0596-0217
EXP: 05/31/2027
means the Federal repository into which an entity must provide information required for the conduct of business as a Cooperative.
Additional information about registration procedures may be found at the SAM Internet site at www.sam.gov.
INDIRECT COST RATES- PARTNERSHIP. Indirect costs are approved for reimbursement or as a cost-share requirement and
have an effective period applicable to the term of this agreement.
1. If the County has never received or does not currently have a negotiated indirect cost rate, they are eligible for a de minimis
indirect cost rate up to 15 percent of modified total direct costs (MTDC). MTDC is defined as all direct salaries and wages,
applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the
period of performance of the subawards under the award).
2. For rates greater than 15 percent and less than 25 percent, The County shall maintain documentation to support the rate.
Documentation may include, but is not limited to, accounting records, audit results, cost allocation plan, letter of indirect cost rate
approval from an independent accounting firm, or other Federal agency approved rate notice applicable to agreements.
3. For a rate greater than 25 percent, the U.S. Forest Service may require that the County request a federally approved rate from the
County’s cognizant audit agency no later than 3 months after the effective date of the agreement. The County will be reimbursed
for indirect costs or allowed to cost-share at the rate reflected in the agreement until the rate is formalized in the negotiated indirect
cost rate (NICRA) at which time, reimbursements for prior indirect costs or cost-sharing may be subject to adjustment.
4. Failure to provide adequate documentation supporting the indirect cost rate, if requested, could result in disallowed costs and
repayment to the U.S. Forest Service.
AGREEMENT CLOSE-OUT. Within 120 days after expiration or notice of termination shall close out the agreement.
Any unobligated balance of cash advanced to the County must be immediately refunded to the U.S. Forest Service, including any
interest earned in accordance with 7CFR3016.21/2CFR 215.22.
Within a maximum of 120 days following the date of expiration or termination of this agreement, all financial performance and
related reports required by the terms of the agreement must be submitted to the U.S. Forest Service by the County.
If this agreement is closed out without audit, the U.S. Forest Service reserves the right to disallow and recover an appropriate
amount after fully considering any recommended disallowances resulting from an audit which may be conducted later.
PAYMENT/REIMBURSEMENT. The U.S. Forest Service shall reimburse the County for the U.S. Forest Service's share of actual
expenses incurred, not to exceed $18,996.00, as shown in modification 001 Financial Plan Attachment A.1. In order to approve a
Request for Reimbursement, the U.S. Forest Service shall review such requests to ensure payments for reimbursement are in
compliance and otherwise consistent with the terms of the agreement. The U.S. Forest Service shall make payment upon receipt of
the the County's annual invoice. Each invoice from the County must display the total project costs for the billing period, separated
by U.S. Forest Service and the County's share. In-kind contributions must be displayed as a separate line item and must not be
included in the total project costs available for reimbursement. The final invoice must display the County's full match towards the
project, as shown in the financial plan, and be submitted no later than 120 days from the expiration date.
Each invoice must include, at a minimum:
1. The 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 & end).
5. Total invoice amount for the billing period, separated by U.S. Forest Service
and the County share with in-kind contributions displayed as a separate line item.
6. Display all costs, both cumulative and for the billing period, by separate cost
elements as shown on the financial plan.
7. Cumulative amount of U.S. Forest Service payments to date.
8. Statement that the invoice is a request for payment by “reimbursement”.
9. If using SF-270, a signature is required.
10. Invoice Number, if applicable.
The invoice must be forwarded to:
EMAIL: SM.FS.ASC_GA@USDA.GOV
FS-1500-19 (VER. 05/24)
OMB No. 0596-0217
EXP: 05/31/2027
FAX: 877-687-4894
POSTAL: USDA Forest Service
Albuquerque Service Center
Payments – Grants & Agreements
4000 Masthead Street NE
Albuquerque, NM 87109
Send a copy to: Cheryl Bartlett
Olympic National Forest
1835 Black Lake Blvd SW
Olympia, WA 98512
cheryl.bartlett@usda.gov
PROGRAM MONITORING AND PERFORMANCE REPORTS. The parties to this agreement shall monitor the work activities to
ensure that performance goals are being achieved.
The cooperator shall prepare a performance report for each reporting period that contains the following:
- A comparison of actual accomplishments to the goals established for the period. Wherever the output of the project can be readily
expressed in numbers, the report shall also include a computation of the cost per unit or output, asapplicable. Example: Goal-50
miles of trail maintenance; Actual-25 miles of trail work completed near mile marker 0.7. 25 miles x $422/mile = $10,500
- If established goals were not met, the report shall include (1) the reason for the delay, (2) a detailed explanation of why the goal
was not achieved and identify any factors that may have contributed to the delay, and (3) a plan of action for addressing the issue
and getting the project back on track. The plan should outline the specific steps that will be taken to address the issues and a
timeline for implementing these steps. This information will enable the Forest Service to understand the reasons for the delay to
determine if an agreement modification is warranted. Example: Due to severe weather conditions, the crew was unable to reach
certain areas impacted by landslides. The schedule has been modified to have a 5-person crew onsite starting in May, 2023 to
complete the remaining 25 miles of trails when optimal weather conditions are expected.
- The report shall also include any additional pertinent information relevant to the project.
For each ALN/CFDA, the performance report must include all relevant project work completed and/or invoiced for the reporting
period then submitted to the Forest Service Program Contact. The quarterly performance report for each respective ALN/CFDA is
due no later than 30 days after the reporting period ending March 31, June 30, September 30, December 31. The annual
performance report for each respective ALN/CFDA is due no later than 90 days after the reporting period ending March 31, June
30, September 30, December 31. The final performance report must be submitted either with the Cooperator’s final payment
request, or separately, no later than 120 days from the expiration date of the agreement, whichever is soonest.
For CFDA #10.717, a [QUARTERLY] progress report is required.
For CFDA # 10.699, an [ANNUAL] progress report is required.
For CFDA # 10.665, an [ANNUAL] progress report is required.
If financial and performance reports are not timely submitted according to the outlined terms and schedules, it is considered a
material breach of the agreement and will result in payment delays and could potentially lead to termination of the agreement.
NONDISCRIMINATION . The recipient/cooperator of this award must comply with all applicable Federal anti-discrimination
laws and regulations. For more information about USDA Civil Rights requirements, please visit https://www.usda.gov/about-
usda/general-information/staff-offices/office-assistant-secretary-civil-rights.
NONDISCRIMINATION STATEMENT – PRINTED, ELECTRONIC, OR AUDIOVISUAL MATERIAL . In accordance with
Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies,
offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based
on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public
assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or
funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA
FS-1500-19 (VER. 05/24)
OMB No. 0596-0217
EXP: 05/31/2027
Paperwork Reduction Act 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. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection
is 0596-0217. Response to this collection of information is mandatory. The authority to collect the information Section 7 of the Granger-Thye Act (16 U.S.C. 580d) and Title IV of the Federal Land
Policy and Management Act of 1976 (43 U.S.C. 1751-1753). 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. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Clearance Officer, OIRM, 1400
Independence Avenue, SW, Room 404-W, Washington, D.C. 20250; and to the Office of Management and Budget, Paperwork Reduction Project (OMB# 0596-0217), 725 17th Street NW,
Washington, D.C. 20503.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions
participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual
orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any
program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,audiotape, American Sign Language, etc.) should contact the responsible
agency or USDA’s TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made
available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any
USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your
completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.
The Privacy Act of 1974, 5 U.S.C. 552a and the Freedom of Information Act, 5 U.S.C. 552 govern the confidentiality to be provided for information received by the Forest Service.
U.S. Forest Service OMB 0596-0217
FS-1500-17B
Attachment: A.1 Title II Funds
USFS Agreement No.:Mod. No.:001
Cooperator Agreement No.:
Financial Plan Matrix:Note: All columns may not be used. Use depends on source and type of contribution(s).
(a) (b) (c) (d)
Cash
COST ELEMENTS Noncash to Noncash In-Kind
Direct Costs Cooperator
Salaries/Labor $1,849.53 $14,775.28 $3,675.68 $0.00 $20,300.49
Travel $0.00 $630.00 $280.00 $0.00 $910.00
Equipment $0.00 $0.00 $0.00 $0.00 $0.00
Supplies/Materials $0.00 $508.27 $490.00 $0.00 $998.27
Printing $0.00 $0.00 $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00 $0.00 $0.00
Other $0.00
Subtotal $1,849.53 $15,913.55 $4,445.68 $0.00 $22,208.76
Coop Indirect Costs $3,082.45 $861.13 $3,943.58
FS Overhead Costs $277.43 $277.43
Total $2,126.96 $18,996.00 $5,306.81 $0.00
$26,429.77
(a+b) ÷ (e) = (f)
Total Cooperator Share
(c+d) ÷ (e) = (g)
Total (f+g) = (h)
Total Project Value:
(e)
Total
20.08%
Agreements Financial Plan (Short Form)
24-PA-11060900-042
Note: This Financial Plan may be used when:
(1) No program income is expected and
(2) The Cooperator is not giving cash to the FS and
(3) There is no other Federal funding
FOREST SERVICE CONTRIBUTIONS COOPERATOR CONTRIBUTIONS
100.00%
(h)
(g)
Matching Costs Determination
Total Forest Service Share = (f)
79.92%
Page 1
Standard Calculation
Job Description Cost/Day # of Days Total
Invasive Plant Program Coordinator $348.88 4.00 $1,395.52
Forest Botanist $454.01 1.00 $454.01
Total Salaries/Labor $1,849.53
Standard Calculation
Travel Expense Employees Cost/Trip # of Trips Total
$0.00
Total Travel $0.00
Piece of Equipment # of Units Cost/Day # of Days Total
$0.00
Total Equipment $0.00
Supplies/Materials # of Items Cost/Item Total
$0.00
Total Supplies/Materials $0.00
Paper Material # of Units Cost/Unit Total
$0.00
Total Printing $0.00
Item # of Units Cost/Unit Total
$0.00
Total Other $0.00
Current Overhead Rate Total
15.00% $277.43
Total FS Overhead Costs $277.43
$1,849.53
Subtotal Direct Costs
Forest Service Overhead Costs
FS Non-Cash Contribution Cost Analysis, Column (a)
TOTAL COST $2,126.96
Printing
Other Expenses
Subtotal Direct Costs
Equipment
Travel
Salaries/Labor
Supplies/Materials
$1,849.53
WORKSHEET FOR
Standard Calculation
Standard Calculation
Standard Calculation
Standard Calculation
Job Description Cost/Day # of Days Total
$349.96 22.00 $7,699.12MCNWCB Coordinator
&rew 0ember $196.56 36.00 $7,076.16
Total Salaries/Labor $14,775.28
Travel Expense Employees Cost/Trip # of Trips Total
Travel to/from worksites 50 miles/trip @ $0.70/mi $35.00 18.00 $630.00
Total Travel $630.00
Piece of Equipment # of Units Cost/Day # of Days Total
$0.00
Total Equipment $0.00
Supplies/Materials # of Items Cost/Item Total
Misc M&S (herbicide, PPE, etc) 1.00 $508.27 $508.27
Total Supplies/Materials $508.27
Paper Material # of Units Cost/Unit Total
$0.00
Total Printing $0.00
Item # of Units Cost/Unit Total
$0.00
Total Other $0.00
Current Overhead Rate Total
19.37%$3,082.45
$3,082.45
Standard Calculation
Standard Calculation
Standard Calculation
Standard Calculation
TOTAL COST $18,996.00
$15,913.55
Total Coop. Indirect Costs
Other Expenses
Subtotal Direct Costs
Cooperator Indirect Costs
Subtotal Direct Costs
$15,913.55
WORKSHEET FOR
Standard Calculation
Standard Calculation
Printing
FS Cash to the Cooperator Cost Analysis, Column (b)
Salaries/Labor
Travel
Equipment
Supplies/Materials
Job Description Cost/Day # of Days Total
Mason CNWCB Coordinator $349.96 8.00 $2,799.68
Office Manager/Contract Admin 2.00 $876.00
Total Salaries/Labor $3,675.68
Travel Expense Employees Cost/Trip # of Trips Total
Travel to/from worksites 50 miles/trip @ $0.70/mi $35.00 8.00 $280.00
Total Travel $280.00
Piece of Equipment # of Units Cost/Day # of Days Total
$0.00
Total Equipment $0.00
Supplies/Materials # of Items Cost/Item Total
Misc M&S (herbicide, PPE, etc) 1.00 $450.00 $450.00
office supplies 1.00 $40.00 $40.00
Total Supplies/Materials $490.00
Paper Material # of Units Cost/Unit Total
$0.00
Total Printing $0.00
Item # of Units Cost/Unit Total
$0.00
Total Other $0.00
Current Overhead Rate Total
19.37%$861.13
$861.13
Standard Calculation
Printing
TOTAL COST $5,306.81
$4,445.68
Total Coop. Indirect Costs
Other Expenses
Subtotal Direct Costs
Cooperator Indirect Costs
Subtotal Direct Costs
$4,445.68
Standard Calculation
WORKSHEET FOR
Cooperator Non-Cash Contribution Cost Analysis, Column (c)
Salaries/Labor
Travel
Equipment
Supplies/Materials
Standard Calculation
Standard Calculation
Standard Calculation
Standard Calculation