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State of Washington Departrnent of Ecology <br />Agreement No: TCPRA-1921-EverPW-00080 <br />Project Title; Everett Landfill Tire Fire <br />Recipient Name: CITY OF EVERETT <br />Funding Distribution Summary <br />Recipient /Ecology Share <br />Page I7 of 27 <br />Funding Distribution Name Recipient Match % <br />Recipient Share <br />Ecology Share <br />Total <br />Everett Landfill Tire Fire - <br />50.00 % <br />$ 290,000.00 <br />$ 2905000.00 <br />$ 5801000500 <br />Oversight <br />Total <br />$ 2905000.00 <br />$ 290,000.00 <br />$ 580,000.00 <br />AGREEMENT SPECIFIC TERMS AND CONDITIONS <br />N/A <br />SPECIAL TERMS AND CONDITIONS <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 />it RE 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 tiex covered transaction, participant, person, <br />primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the Ineaning 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 Isnowingly enter into any lower tier covered transaction with a <br />person who is proposed for debarment under the applicable Code of Federal Regulations, debarred, suspended, <br />declared ineligible, or voluntarily excluded from participation in this covered transaction. <br />5. The RECIPIENT/CONTRACTOR further agrees by signing this agreement, that it will include this clause titled <br />"CERTIFICATION REGARDING SUSPENSION, DEBARMENT, INELIGIBILITY OR VOLUNTARY <br />EXCLUSION" without modification in all lower tier covered transactions and in all solicitations for lower tier covered <br />transactions. <br />6. Pursuant to 2CFR180.330, the RECIPIENT/CONTRACTOR is responsible for ensuring that any lower tier covered <br />transaction complies with certification of suspension and debarment requirements. <br />Template Version I0/30/2015 <br />