WA ST Military Department 10/9/2019

FFATA WORKSHEET Subrecipient Agency: City of Everett Grant and Year: Hazard Mitigaiton FFY15 Agreement Number: E19-216 Completed Andy Lee Accounting Manager 425-257-8604 by: Name Title Telephone Date Completed: 6/28/2019 YES STOP, no further NO Is your grant agreement less than $25,000? analysis needed, / GO to Step 2 GO to Step 6 Y STEP 2'", . ;, . In your preceding fiscal year, did your YES NO STOP, no further organization receive 80%or more of its annual GO to STEP 3 analysis needed, GO to gross revenues from federal funding? Step 6 � `�4:� Y 5 STEP 3. In your preceding fiscal year, did your YES NO STOP, no further organization receive$25,000,000 or more in GO to STEP 4 / analysis needed, GO to federal funding? �/ Step 6 Does the public have access to information about YES STOP, no further NO the total compensation*of senior executives in analysis needed, GO to STEP 5 your organization? GO to step 6 Executive#1 Name: Total Compensation amount: $ Executive#2 Name: Total Compensation amount: $ Name: Executive#3 Total Compensation amount: $ Name: Executive#4 Total Compensation amount: $ Executive#5 Name: Total Compensation amount:$ If your organization does not meet these criteria, specifically identify below each criteria that is not met for your organization: For Example: "Our organization received less than $25,000." We received less than 80% of our annual gross revenues from federal funding last year. Signature: C/(A -- Date: 10/7/2019 *Total compensation refers to: • Salary and bonuses • Awards of stock, stock options, and stock appreciation rights • Other compensation including, but not limited to, severance and termination payments • Life insurance value paid on behalf of the employee Additional Resources: http://www.whitehouse.gov/omb/open http://www.hrsa.bov/orants/ffata.html http://www.gpo.gov/fdsys/pkg/FR-2010-09-14/pdf/2010-22705.pdf http://www.grants.gov/ Page 1 of 3