2014/07/16 Council Agenda Packet

.-v• al avI IL.L.. l Subrecipient Agency: City of Everett Grant and Year: SHSP-12 I Agreement Number: E13-152 Completed by: Name Title Telephone Date Completed: STEP 1 Is your grant agreement less than $25,000? YES r ' STOP, no further analysis needed, GO to Step 6 NO r ' , GO to Step 2 STEP 2 In your preceding fiscal year, did your organization receive 80% or more of its annual gross revenues from federal funding? YES r, 1 GO to STEP 3 NO , , STOP, no further analysis needed, GO to Step 6 STEP 3 In your preceding fiscal year, did your organization receive $25,000,000 or more in federal funding? YES rf 1 GO to STEP 4 NO , , STOP, no further analysis needed, GO to Step 6 STEP 4 Does the public have access to information about the total compensation* of senior executives in your organization? YES r 1 STOP, no further analysis needed, GO to step 6 NO r- i GO to STEP 5 STEP 5 Executive #1 Name: T Total Compensation amount: $ Executive #2 Name: T Total Compensation amount: $ Executive #3 Name: T Total Compensation amount: $ Executive #4 Name: T Total Compensation amount: $ Executive #5 Name: T Total Compensation amount: $ STEP 6 If your organization does not meet these criteria, specifically identify below each criteria that is not met for your "Our organization: For Example: organization received less than $25,000." Signature: Date: * 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.hrsagov/grantsgfata.html http://www.gpo.gov/fdsys/pkg/FR-2010-09-14/pdf/2010-22705.pdf http://www.grants.gov/ SHSP-FFY 12 Page 25 of 25 64 E13-152 — Everett -DEM