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State of Washington Department of Ecology Page 11 of 21 <br /> Agreement No: SWMLSWFA-2019-EverPW-00090 <br /> Project Title: 2019-21 LSWFA City of Everett Public Works IMP <br /> Recipient Name: CITY OF EVERETT-PUBLIC WORKS DEPT. <br /> Funding Distribution Summary <br /> Recipient/Ecology Share <br /> Funding Distribution Name Recipient Match % Recipient Share Ecology Share Total <br /> City of Everett- Public Works 25.00 % $ 24,046.00 $ 72,138.00 $ 96,184.00 <br /> Dept. IMP <br /> Total $ 24,046.00 $ 72,138.00 $ 96,184.00 <br /> AGREEMENT SPECIFIC TERMS AND CONDITIONS <br /> N/A <br /> SPECIAL TERMS AND CONDITIONS <br /> RECIPIENT shall update the Spending Plan and Outcomes Data Collection form at least quarterly. The Spending Plan and <br /> Outcomes Data Collection form must be submitted along with a Payment Request/Progress Report.By checking the box <br /> provided in the Outcomes Data Collection section of the form, the RECIPIENT certifies that the outcomes reported for that <br /> quarter represent ONLY what was achieved with LSWFA(Ecology share plus local contribution). RECIPIENT shall not <br /> report outcomes achieved with funds that exceed the LSWFA Agreement's total budget. <br /> RECIPIENT must submit within thirty(30) days after the expiration date of this Agreement, all financial(including payment <br /> requests),performance,and other reports required by this Agreement. ECOLOGY shall have the right to deny reimbursement <br /> of payment requests received after this date. <br /> GENERAL FEDERAL CONDITIONS <br /> If a portion or all of the funds for this agreement are provided through federal funding sources or this agreement is <br /> used to match a federal grant award,the following terms and conditions apply to you. <br /> A. CERTIFICATION REGARDING SUSPENSION,DEBARMENT,INELIGIBILITY OR VOLUNTARY <br /> EXCLUSION: <br /> 1. The RECIPIENT/CONTRACTOR,by signing this agreement,certifies that it is not suspended,debarred,proposed for <br /> debarment,declared ineligible or otherwise excluded from contracting with the federal government,or from receiving <br /> contracts paid for with federal funds. If the RECIPIENT/CONTRACTOR is unable to certify to the statements <br /> contained in the certification,they must provide an explanation as to why they cannot. <br /> 2. The RECIPIENT/CONTRACTOR shall provide immediate written notice to ECOLOGY if at any time the <br /> RECIPIENT/CONTRACTOR learns that its certification was erroneous when submitted or had become erroneous by <br /> reason of changed circumstances. <br /> 3. The terms covered transaction,debarred, suspended, ineligible, lower tier covered transaction,participant,person, <br /> primary covered transaction,principal,proposal, and voluntarily excluded,as used in this clause,have the meaning set <br /> out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact <br /> ECOLOGY for assistance in obtaining a copy of those regulations. <br /> 4. The RECIPIENT/CONTRACTOR agrees it shall not knowingly enter into any lower tier covered transaction with a <br /> Template Version 10/30/2015 <br />